Two Types of Chronic Pain: Neuropathic and Musculoskeletal Examined–October 2015

Two Types of Chronic Pain: Neuropathic and Musculoskeletal Examined–October 2015



Chronic Pain Series

This is the second in a three-part series on chronic pain. Click here to see the first part, Chronic Pain: An Overview. Click here for November’s focus on inflammatory pain and mechanical/compressive pain.

If you have chronic pain, you’ve probably scored it from 1 to 10 on the happy-sad face continuum. Is your pain mild, moderate or excruciating? Is it inconvenient or incapacitating? While not all pain can be cured, most pain can be managed so it interferes less with daily life. Read on to learn more about neuropathic and musculoskeletal pain.

Neuropathic Pain

About 8 percent of the population suffers from neuropathic pain, which is caused by a disease or injury to the nervous system—the intricate network of nerve cells and fibers that transmit messages between parts of the body. The disease or injury causes pain centers to receive the wrong signals from the damaged nerve fibers.

Neuropathy can result from many conditions, including alcoholism, unmanaged diabetes, cancer treatments, shingles, spinal nerve compression, stroke, and multiple sclerosis. The symptoms include burning, shooting, tingling, stabbing or electrical shock-like pain. It can include numbness, “pins and needles,” and other sensations that are difficult to describe. Pain can occur spontaneously or can be caused by cold, heat, gentle pressure on the skin or other stimuli that is not usually considered painful. People with neuropathic pain often have difficulty sleeping, which can lead to fatigue, and for some, depression.

To diagnose neuropathy, healthcare providers will take a medical history, ask about known or suspected nerve injuries and perform a neurologic exam. As with all types of pain, treatment for neuropathy often involves several approaches from medical to self-care. First, it is important to rule out any underlying disease that can be treated, for example, getting diabetes under control or treating a tumor that is pressing on a nerve.

Commonly prescribed medications include anti-seizure drugs and anti-depressants, even when seizures or depression aren’t present. These drugs act at different places in the body’s pain pathways, help promote sleep and may resolve some neuropathic pain. Topical patches, ointments, and transcutaneous nerve stimulation (TENS) may provide temporary relief. Narcotic or opioid pain medications can cause physical dependence and are generally tried only when all other treatment options have failed.

Self-care strategies can help decrease pain over time, for example:

  • A warm bath. Warm water increases blood flow and can slough off the day’s stress too.
  • Foot care. For those with foot neuropathy, the nerve pain may cause a lack of sensation so it’s important to check for injuries and infections.
  • Movement. Exercise triggers the release of endorphins—natural painkillers—and promotes blood flow to legs/feet.
  • Sleep. Develop good sleep habits by limiting caffeine after 12 pm, winding down with relaxing music or candles, and allowing for eight hours of sleep.

Chronic Pain - Part 2

Musculoskeletal Pain

As adults age, it is common to have periodic aches and pains. However, persistent pain is not a normal part of aging and is worth discussing with your provider. Persistent pain is common among older adults who also suffer from conditions such as arthritis or cancer.

Musculoskeletal pain affects the bones, spine, joints, muscles, bursae, tendons, ligaments or some combination. Sports injuries, falls, joint degeneration, back injuries, and overuse can cause musculoskeletal pain. It can be acute, such as with a direct blow to a muscle, or it can be long-lasting.

Bone pain occurs most commonly with injuries, and is deep, penetrating or dull. With bone pain, providers will seek to determine if the pain is due to a fracture or tumor. Generally less intense than bone pain, muscle pain can be caused by overuse, loss of blood flow, injury, infection, tumor or autoimmune reaction. It may include cramps and muscle spasms. Joint pain can be the result of diseases or due to injury. The stiff, achy feeling can worsen when the joints are moved. Bursae are the small sacs that provide cushion to the joints and they can be painful as the result of injury, overuse, gout or infection. Tendon and ligament pain is often caused by an injury and can worsen when the tender spot is moved.

Fibromyalgia may involve pain and tenderness in multiple locations such as muscles, tendons and ligaments. Another musculoskeletal disorder, Carpal Tunnel Syndrome, is caused by compressed nerves.

Treatment for musculoskeletal pain is best accomplished by treating its cause and will vary depending upon the location of pain. Sufferers report that a combination approach is key. Treatment options include:

  • Resting the affected area, such as immobilizing a joint with a splint to allow healing.
  • Applying heat or cold.
  • Physical or occupational therapy which may involve stretching, strengthening and conditioning exercises.
  • Prescription and over-the-counter pain relievers, including ibuprofen, muscle relaxers, steroid injections, and those mentioned on page 1.
  • Counseling, acupuncture, massage and chiropractic care.

Musculoskeletal pain can also disrupt sleep so the self-care measures mentioned above may help.

Testing for Musculoskeletal Pain

To diagnose musculoskeletal pain, providers will perform an exam and take a medical history to learn what factors affect the level of pain. Depending upon symptoms, these tests may be ordered:

  • Blood tests can confirm conditions like rheumatoid arthritis and Lyme disease.
  • Joint fluid tests can help diagnose conditions such as gout.
  • X-rays provide details about bones.
  • MRIs examine soft tissues (muscles, ligaments, tendons and cartilage).
  • CT scans offer detailed information about bones, soft tissues and blood vessels.


Need More Info?

If you or someone in your family struggles with any kind of chronic pain, your KnovaSolutions nurse is a source for additional information and support. Let us know how we can help — 800/355-0885.

The information contained in this newsletter is for general, educational purposes. It should not be considered a replacement for consultation with your healthcare provider.  If you have concerns about your health, please contact your healthcare provider.


Click here to view/download the full newsletter.

We encourage you to leave a comment or question below and a KnovaSolutions nurse or pharmacist will reply.


8 Responses to Two Types of Chronic Pain: Neuropathic and Musculoskeletal Examined–October 2015

  1. I have pain on both upper shoulder and both lower leg below knee. And doctor diagnosed with herniated disc and he operated on disc prolapsed part and he make fusion but surgery was good there is no any nerve damage and other complications.After surgery I got same both lower leg pain and upper shoulders pain continue. While I exposed my body with heat I feel better than medicine . Can you help me out what should I do on this condition thank you.

    • Hi Prashna,
      It’s good to read you are doing well after fusion surgery, but sorry to learn you continue to have lower leg and upper shoulder pain. It might be a good idea to follow up with your provider since you are still having pain. In some cases, he/she might order physical therapy if it is appropriate after surgery. Some people find that massage or gentle stretching activities, such as yoga or tai chi help with pain. Given the nature of your back surgery, you would need your provider’s approval before participating in those activities.

      As you know, using heat and/or ice packs helps to decrease pain. Usually ice or heat is applied for approximately 20 minutes and repeated every two hours. The two may be alternated. It is best to apply ice with a cloth or towel placed between the ice and skin to avoid an ice burn.

  2. I am 68 year old female. Had seen a compassionate surgeon for 4 years prior to having cervical issues since 1999. Started with him in 2012. In the beginning some mild to moderate stenosis, and nerve impingement showed at C5-6. Issues at C3-4 which caused Occipital migraine.. By 2013 more levels affected and C6-7 was determined to be impinging I the the nerve root bundle. MRI was showing fast progression and a discussion with my surgeon determined there was no guarentee surgery could relieve my pain. 2014 MRI brought severe stenosis or C6-7 . By the end of 2015 my surgeon determined me a surgical risk. All disk from C3 down were bad. It would be posterior surgery,long and painful recovery with possibilty of more damamge. I understand age. My disks heights are flattening or just loosing their heighth and I have osteophytes and narrowing in the formaminal space. Nerves run through the veritabrae and they get trapped.

    Since 1999 I have had CESI too many to count, PT, ,nerve blocks and two Nerve burns. One of the ablations worked for 7 months. The nerve blocks worked. One of my physical therapists did dry needling and that helped.

    My issue now is my new doctor has written a DX of Chronic Pain Syndrome. I have researched this and I feel hopeless. I have a therapist. I have also been through an intense six week 1 hour a week cognitive behavior session on managing my pain. I use the tools , I meditate, I eat healthy, I walk the hallway and long driveway ( we have no sidewalks).. Reaching, bending and lifting creat e pain. This is not imprinted on my brain . It is a medical issue. I don’t want strong opioids. I just weaned off of very strong opioids from a bad Doctor. I had no cravings. I just feel Chronic Pain Syndrome writes off my real honest pain.

    • Dear Linda,

      I am very sorry to hear about your experience with chronic pain. It seems like you have a good understanding of your condition and have tried many approaches to manage it. Because you are feeling pain when you do common actions like bending, reaching and lifting, it is easy to become discouraged and hopeless. Once pain becomes chronic (lasting longer than 6 months), it naturally affects your emotional health and can affect all other aspects of your life. Anything that affects your health in such a big way is a real medical condition. The diagnosis of chronic pain syndrome (CPS) is just a fancy name for what you are experiencing.

      I would encourage you to continue to experiment with the many coping mechanisms out there. People with CPS who have the best outcomes tend to be those who adopt a wide variety of strategies. Finding the right combination is the challenge. You are off to a great start by eating well, walking, seeing a therapist and meditating. Are you able to continue physical therapy and needling since that was helpful in the past? Do you know about Pilates and restorative yoga that focus on very small refinements in movement that help strengthen the core? Have you discussed with your therapist whether antidepressants would be appropriate for you? For some, antidepressants lift spirits and make it easier to see challenges in a different way. There’s massage, acupuncture, sleep hygiene improvements, maintaining social connections and many more methods that can offer small bits of relief. See our newsletter that describes complementary medicine Complementing Your Medical Care.

      Keep in mind too that if you feel your doctor isn’t offering the support you need with your medical conditions, it is worth considering looking for one who is better aligned with your needs and values. See our newsletter on the importance of having a primary care provider you trust Why It’s Important to Have a PCP..

      By the way, your decision to avoid opioids is a good one. Opioids are intended for short-term use with acute pain (for example, just after surgery) and the research show that they are not effective at treating long-term pain (and can even worsen it).

      I wish you luck with your experimentation, and hope you arrive at some combination of tactics that provide some relief.

  3. Hi I visited the doctor yesterday with severe lower back pain I am on medication for Breast cancer in 2015 and I also have 4 bulging discs and nerve pressure on my sacroilitic joints , The doctor said I have muscularskeleton pain, this is worse today and is covering a larger area also I have pins and needles in my hands and some numbness

    • Hi Angie, Thank you for your comment to our newsletter. Coping with low back pain and nerve pain (alone or together) can be especially debilitating and have a negative impact on a person’s well-being.

      Musculoskeletal pain affects the bones, muscles, ligaments, tendons, and nerves. Lower back pain is the most common type of musculoskeletal pain.

      The doctor will often perform tests to determine the underlying cause of the pain. These tests can include a physical examination, blood tests, x-ray, CT scan, or MRI.

      Your examination and the results of these tests will assist your doctor in diagnosing the cause and type of pain and creating a treatment plan for you. There are many non-surgical treatments for pain, including physical therapy; heat or cold compress; medications; relaxation; biofeedback; acupuncture or acupressure; injections with anesthetic or anti-inflammatory medications in or around the painful sites; strengthening, conditioning or stretching exercises; chiropractic care; or therapeutic massage.

      It is important that you and your doctor review your test results and develop a mutually agreed upon plan of care. In many cases, pain cannot be completely resolved; however, there are many treatments that are effective to at least decrease the pain to a tolerable level.

      I wish you the best as you work with your provider to find the source of your pain and explore ways to treat it.

      Linda Archer MSN, RN, CNS

    • Hello Stella,
      Thank you for your comment. We are pleased that you found the article informative and useful!

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