Understanding Nerve Pain: Insights from MOVE Physiotherapists
- Jess Mcdonald
- Oct 6
- 4 min read
Updated: 6 days ago
At MOVE Sports Physiotherapy and Pilates, we understand that nerve pain can be one of the most complex and debilitating types of pain. Whether it’s from nerve compression, trauma, or a neurological condition, nerve injuries significantly affect how the body functions. By understanding the science behind nerve pain, we can help you manage and reduce discomfort, allowing you to regain control of your life.
What Happens When Nerves are Injured?
Nerve pain arises when damage occurs to the nerve tissues, which can significantly alter the way nerves transmit signals. This can lead to unique and often debilitating pain experiences.
Abnormal Impulse Generating Sites (AIGS)
In a healthy state, pain signals (nociceptive signals) originate from free nerve endings—normal impulse-generating sites. These sites specialise in detecting harmful stimuli and initiate pain signals. However, when nerves are damaged due to trauma, disease, or compression, parts of the axon (nerve fibres) may become sensitised, leading to the formation of Abnormal Impulse Generating Sites (AIGS). These ectopic sites generate spontaneous electrical signals, contributing to pain sensations such as: Burning, tingling, and electric shock-like sensations
A common example is in conditions like carpal tunnel syndrome, where nerve entrapment can lead to AIGS, causing persistent discomfort.
In severe cases like amputation, AIGS can form in severed nerve endings, leading to phantom limb pain.
The Nerve's Structure and Function
Understanding nerve pain requires appreciating the complex structure and function of nerves.
Length and Complexity - A single nerve, like the median nerve, can stretch nearly a meter from the spinal cord to the hand. Nerve function depends on the transport of essential proteins along the nerve fibres.
Mobility and Elasticity - Peripheral nerves are highly flexible and can stretch or slide within the body. This mobility is essential in rehabilitation, as nerve pain can be influenced by mechanical stress.
Insensitivity Under Normal Conditions - Healthy nerves typically do not generate spontaneous pain signals. They may briefly respond to stress (like when you hit your "funny bone"), but they generally do not generate ongoing pain unless there is damage.
Connective Sheaths and Deep Aches
Nerves are surrounded by connective tissues, including the epineurium, perineurium, and endoneurium. Damage to these sheaths often causes deep, aching pain, distinct from the sharp or electric sensations caused by AIGS. This pain typically arises from:
Chronic Compression: Long-term pressure on a nerve (for example, due to a herniated disc) can lead to inflammation of the nerve sheaths.
Trauma or Inflammation: Injury or disease affecting the connective layers can result in persistent, dull aches and reduced mobility.
Why Does Nerve Pain Persist?
Nerve pain can become chronic for several reasons. One key factor is the interaction between peripheral nerve damage and central nervous system changes. Neuropathic pain often persists long after the initial injury has healed and may become chronic. There is a complex relationship between biological and psychosocial factors that influences how pain is experienced:
Biological Risk Factors: Gender, age, and genetics can increase susceptibility to chronic pain.
Psychosocial Factors: Stress, trauma, negative emotions, and coping mechanisms can all amplify pain and contribute to its persistence.
Evidence suggests that changes in brain function occur in individuals with chronic pain. For example, the brain regions responsible for processing pain signals may become more sensitive, amplifying the perception of pain. This shift underscores the importance of addressing both physical and psychological factors when managing chronic nerve pain.
Implications for Neuropathic Pain Management
Managing neuropathic pain can be challenging because it involves complex interactions between the nervous system and emotional factors. However, there is hope. With the right strategies, nerve pain can be managed effectively, improving both function and quality of life.
1. Movement and Exercise
Movement is essential for managing nerve pain. A personalised exercise program can help restore
nerve mobility, reduce pain sensitivity, and improve overall function.
Aerobic Exercise: Regular activities like walking, swimming, or cycling can increase endorphins, improve cardiovascular health, and enhance neuroplasticity, potentially reducing pain sensitivity.
Resistance Training: Strength training can help restore function and reduce pain. Starting with low-intensity exercises and gradually increasing resistance is key.
Motor Retraining: Specific motor retraining exercises can help correct altered movement patterns and reduce strain on sensitive tissues.
2. Graded Activity for Pain Management
Graded activity involves gradually increasing the intensity and duration of exercise. This helps individuals build tolerance to activity and gain confidence in their physical abilities. The key principles of graded activity include:
Establish a baseline: Begin with manageable activities to ensure success.
Progress gradually: Increase intensity in small, consistent increments.
Monitor and adapt: Adjust the program based on pain levels and functional gains.
3. Psychological Strategies
Chronic pain is not just physical—psychological strategies can significantly improve your ability to manage pain. Techniques such as:
Cognitive Behavioural Therapy (CBT): Helps reframe negative thoughts related to pain.
Acceptance Commitment Therapy (ACT): Encourages acceptance of pain while focusing on meaningful activities.
Mindfulness and Relaxation Can reduce stress and enhance coping with pain. Even just understanding this can be helpful to dial down your pain response
4. Pharmacological Management
For some, medication may be necessary to manage nerve pain. Common options include:
Adjuvant Medications: Antidepressants and anticonvulsants are commonly prescribed for neuropathic pain.
Multi- and Interdisciplinary Care
Chronic pain management often requires a team-based approach. At MOVE Sports Physiotherapy and Pilates, we collaborate with other professionals—including GPs, osteopaths, psychologists, and exercise physiologists—to provide a holistic approach to pain management. This may involve structured programs combining physical, psychological, and educational strategies to empower you in managing your pain and improving your quality of life.
