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Hot, Burning, Tingling and Shooting Pain: Neuropathic Pains and How We Treat Them

Neuropathic pain is one of the more difficult pain to treat. Unfortunately many of the conventional pain medications don't work particularly well for this, and many patients end up seeking out a pain management specialist for help for their ongoing suffering. A lot of times patients have tried over the counter and conventional prescription pain medications with his or her primary care doctor. One of the most important things to do is identify where the neuropathic pain is coming from. We start out by taking complete medical history. Where is the pain? When does the pain occur? What type of sensation is someone feeling? Is it burning? Is it numb? Is it weak? Are there any other medical conditions that we need to take into consideration? Once we've taken a full history and have gone over all relevant medical information, we spend time talking together and come up with a list of  what could be causing the pain.There are typically two goals to the different ways we treat. The first being: if we can identify the source of pain, can we eliminate the cause? The second being: can we reduce or eliminate the symptoms of suffering and weakness?


History and physical examination is very important however occasionally we need to order laboratory tests or obtain imaging tests like an MRI or x-ray, or possibly a nerve conduction test or EMG (electromyogram) under the care of a neurologist.


Neuropathic pain is described as a burning, tingling, numb, hot, shooting type of pain. Many people will experience neuropathic pain at some point in their life and many times it may go away but also sometimes it doesn't, and it causes unnecessary suffering.


A lot of patients have tried topical agents on their own, such as menthol, Bengay, or Icy Hot. This just doesn't seem to get to the source or the deep component of the pain. Neuropathic pain may come from diabetes, from chemotherapy related to cancer treatment, alcohol consumption, vitamin deficiency, or we may never know the source. Shingles can produce a condition known as postherpetic neuralgia.Sometimes this may be medicated by treating the shingles early and aggressively.Some patients just get unlucky and develop long term pain from their shingles. Carpal tunnel syndrome or cubital tunnel syndrome produce burning shooting pains into the hands however occasionally the pain is coming from something else. Trigeminal neuralgia procedures shooting or stabbing pain of the face or the jaw. Meralgia paresthetica produces a hot burning lateral thigh pain and numbness. We seek to try to find out what is causing the issue.  

Pain management specialists are in a unique position to reduce suffering from chronic pain related to neuropathic or nerve damage reasons. Typically the doctor and patient can start trying different things that will reduce the pain or even eliminate the pain and correct the source. Typically we start with topical agents and oral medications including local anesthetic and other numbing agents as well as low dose antidepressant medications which help disorder neuronal firing. Additionally some rather unconventional medications can be very effective for neuropathic pain, with low cost and minimal side effects. Traditional pain killer medications may also be needed in this scenario. Interventional procedures can be very helpful if oral medications are not. Local anesthetic injections can be tried. Spinal cord stimulators also known as neuromodulation can be trialed and also surgical treatment can be very helpful if no other option is abundantly clear.


Burning neuropathic pain is a challenging clinical entity that has multiple causes and reasons as to why it occurs.Understanding the pattern of pain, why it is occurring, and the possible course it may take is important to know to be able to come up with an effective plan to treat it. Also, avoidance of unpleasant side effects to the medications or treatment techniques as well as minimization of intervention and creating a simple therapeutic regimen is paramount to maintaining function and compliance for each individual patient.


About the writer: Robert Bowers, MD, is a dual board-certified, fellowship-trained anesthesiology and pain medicine specialist, founder of Bellevue Pain and Wellness PLLC, in Bellevue, Washington, which serves Bellevue, Seattle, Issaquah, Redmond, Renton, Everett, and all other surronding cities. Dr. Bowers is pleased to provide patient-focused treatment plans to help with back pain, sciatica pain, and debilitating and chronic pain conditions. He considers all aspects of a patient’s health and wellness before creating individualized treatment programs designed to address the underlying cause of pain instead of merely masking the symptoms. Visit our website: http://www.bellevuepainwellness.com


Dr Bowers strives to deliver high quality chronic pain management for chronic pain in the Seattle Bellevue area.


Check out some of Dr Bowers' prior blog posts:






Robert Bowers MD

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