Why can nerves cause pain?
Nerves are like electrical wires—they carry signals to and from your brain throughout your entire body. Nerves give you the ability to move, feel, touch and much more. When a nerve is cut or damaged, those signals are interrupted, which can cause pain, numbness, burning or loss of function in the affected area. Though nerves naturally regrow and regenerate, when they’re damaged, they won’t do so properly. As a result, a tangled mass of scar tissue called a neuroma can form, disrupting normal nerve function and potentially causing chronic pain. Think of it like a clogged hose or pipe, stopping water from flowing properly.
Could nerve damage be causing my chronic pain?
Think back to when your chronic pain first started—was it after a surgery, amputation, an accident or injury? Pain lasting more than three months after a surgery, amputation or traumatic injury may indicate that nerve damage is to blame. Take the quiz to find out.
How can a previous surgery result in nerve damage?
Nerves are often very small and sometimes challenging for a surgeon to see. Additionally, the anatomy and location of nerves can vary from person to person. During more complex surgeries and sometimes even routine surgeries, nerves may be unintentionally cut, compressed or stretched, causing damage to a nerve and leading to the development of chronic pain.
Pain persisting beyond normal recovery time for a given surgery may indicate that a nerve has been damaged. Any surgery can result in nerve damage; however, they are most commonly seen in the following procedures:
- Laparoscopic procedures
- Orthapedic procedures such as joint replacements or arthroscopic procedures
- Hernia repair
- Nerve biopsies
How can a traumatic injury result in nerve damage?
Peripheral nerves run throughout the body and are at risk of being damaged during an accident or traumatic injury—even accidents that don’t break the skin. Nerves can be crushed, stretched, bruised or cut, which can result in a loss of function and/or chronic pain. Often, chronic nerve pain can occur from either compression (or squeezing) of the nerve or by the formation of a neuroma—a tangled mass of scar tissue that can disrupt the normal function of the nerve, resulting in pain signals being sent to the brain.
Common types of injuries resulting in nerve damage are falls, sports injuries, fractures, glass or knife cuts, car accidents where limbs are stretched or badly bruised, and gunshots. Overuse injuries can also continually irritate the nerve and lead to chronic pain.
I’ve had an amputation and now have constant pain. How can surgical nerve repair potentially help?
During an amputation, nerves are cut and can potentially be left unrepaired, which can lead to a neuroma (scar tissue) forming at the end of the cut nerve. Not all neuromas are painful, but when they are, the pain can be debilitating. Pain may be felt be at the amputation site or experienced as phantom limb pain, a type of pain where nerves at the amputation site send pain signals to the brain, making it think the limb is still intact.
Surgical treatment of neuromas is focused on removing the neuroma and then microsurgically addressing the nerve to reduce the potential for a new neuroma to form. Your nerve repair surgeon can discuss the options with you to best address your specific symptoms.
What does pain caused by a damaged/injured nerve feel like?
Pain is different for everyone. Some complain of tingling, numbness or pain all over. Others describe it as “pins and needles,” sharp spasms, a burning sensation, or extreme sensitivity to touch or heat and cold. It may be constant or intermittent.
What is different about surgical nerve repair versus other treatments for chronic pain?
Often, the first course of action for patients with chronic pain is to manage the symptoms through pain medications and other complementary or noninvasive treatments such as massage, acupuncture and physical therapy. Many of these treatments offer temporary relief and do not fix the source of the pain.
Surgical nerve repair focuses on identifying and repairing the cause of the pain, potentially providing a much more permanent solution.
How is nerve pain diagnosed?
Doctors use a combination of tools to identify and diagnose nerve pain. This includes:
- Taking a comprehensive medical history—recording any previous surgeries, accidents or injuries you may have had
- Performing a physical examination at the location in which you have pain
- Performing diagnostic tests such as nerve block injections, nerve conduction tests, or imaging through ultrasound or MRI
When you visit the doctor, describe your pain in as much detail as possible. What does it feel like (tingling, hot, stabbing)? Where is the pain located? What triggers your pain? Are you having any weakness? This will help your doctor make the most accurate diagnosis possible.
What kind of surgeon repairs nerve damage?
Since nerves run throughout our entire bodies, there isn’t one specific type of surgeon who aligns precisely with the specialty of nerve surgery.
Instead, there are several different types of doctors who specialize in nerve repair. These doctors undergo extensive microsurgical training to become experts in their field.
The medical professionals who perform nerve surgery are often:
- Plastic reconstructive surgeons
- Orthopedic hand surgeons
- Oral maxillofacial surgeons
- A small number of doctors of podiatric medicine (DPMs)
Not all plastic surgeons, orthopedic surgeons or neurosurgeons work with peripheral nerves. Learn more.
How do I know if surgery will work? Can nerves really be repaired?
In the past, surgical options for repairing nerves were limited and had variable rates of success in alleviating nerve pain or restoring function. Surgical procedures that only cut the nerve but do not repair it, leave the nerve with the potential to form a future painful neuroma and don’t give you the chance to regain sensation or function.
Chronic pain caused by a symptomatic neuroma can be improved by removing the neuroma to get rid of the painful stimulus and then repairing the damaged nerve with a nerve graft to provide the opportunity to restore proper sensation and function. This technique has been used to help surgeons successfully repair damaged and injured peripheral nerves throughout the body. The use of the nerve graft in applications that include the repair of sensory and motor nerves in the hands, arms, face, torso, and lower extremities has been well documented in the clinical literature.
Is every type of nerve pain treatable with surgery?
Most types of peripheral nerve pain, especially nerve pain that can be linked to a previous surgery or injury, can likely be treated surgically. However, some types of neuropathic pain that are more generalized, like fibromyalgia or general neuropathy—meaning one specific pain location cannot be isolated or identified—are likely not treatable with surgery.
What type of procedure is used to treat nerve pain resulting from an injury or prior surgery?
The physical causes of nerve pain can be a neuroma, compression of the nerve or both. If a neuroma is identified as the cause of the pain, your surgeon will first locate and remove the neuroma. This gets rid of the painful stimulus and stops the pain signals to the brain. Then, depending on your specific nerve damage, your surgeon can repair the nerve by either reconnecting the nerve with a nerve graft (autograft or an allograft nerve to allow restoration of normal signals to the brain, isolating the nerve end with a nerve cap to reduce the potential for neuroma formation, or occasionally rerouting the nerves.
To repair nerve compression, your surgeon will need to release the traumatized tissue that’s pressing on or strangling the nerve. This is often done by cutting or removing the area of constriction. Releasing the tissue relieves the pressure placed on the nerve and allows it to regain mobility and appropriate blood supply. The surgeon may decide to protect the nerve by placing fat around it, wrapping the nerve with vein tissue or using an off-the-shelf nerve protector.
What are the risks of performing this procedure?
Surgeons have been successfully repairing nerve injuries and nerve damage all over the body for years, and there are numerous clinical studies on the technologies they use. Nerve repair is a common procedure, but should be done by a specialist trained in microsurgical nerve repair.
Is this procedure covered by insurance?
Nerve repair is generally a covered procedure. But always be sure to check your insurance policy since coverage may vary.
Will this type of surgical procedure require a hospital stay?
Your surgeon will work with you to determine your needs based on your specific case. However, many nerve repair procedures can be done on an outpatient basis. Speak to your surgeon to understand your options.
What can I expect after my nerve procedure?
Reduction or elimination of pain can be almost immediate. However, if your nerve is reconstructed, return of sensation or nerve function takes time and can feel a little strange. You may feel some small zings and zaps as your nerve starts to heal, but that may be good news and a sign that your nerve is starting to work again.
You might notice the following sensations during the first six months after surgery, but they typically go away within 12 months:
- Hot or cold sensations and sensitivity
- Little shocks or zaps
- Aching or tingling feelings
If your pain persists or there is no return of nerve function, you should consult your surgeon.
are you a candidate?
Answer these questions to see if surgical nerve repair is right for you.