Will Peripheral Nerve Pain Go Away Over Time?

Any time you feel pain in your body, it’s because nerves were disrupted or damaged. For example, you stub your toe and the pain is immediate, and then it goes away. But for people struggling with more serious and longer-lasting peripheral nerve pain, the issue is more complex.

To explain the science behind damaged peripheral nerves and whether they heal over time, we turn to leading neurosurgeon Dr. Ali H. Mesiwala. Dr. Mesiwala and our team have helped hundreds of patients find relief from damaged peripheral nerves, often through peripheral nerve surgery, and we want to share what we know here.

Leading drivers of peripheral nerve damage

Let’s look at the many ways you can develop peripheral nerve damage and the pain that’s often linked to the problem.

When we talk about peripheral nerves, we’re referring to the nerves that exist outside your central nervous system — which includes your brain and your spinal cord. This means that your peripheral nervous system covers almost every inch of your body outside these two areas, so it’s a vast network.

There are many ways you can damage this system, and we’re going to focus on more serious and longer-lasting peripheral nerve issues, such as:

• Trauma, where nerves are damaged or severed in an accident
• Autoimmune diseases that attack your peripheral nerves
• Infections
• Certain medications and treatments, such as chemotherapy and radiation
• Nerve entrapment issues, such as carpal tunnel syndrome
• Tumors on the nerves
• Alcoholism
• Diabetes

Diabetes, this last item on our incomplete list, is the biggest driver of chronic peripheral neuropathy. More than 38 million American adults have diabetes, and up to half of these people will develop diabetic neuropathy.

What we see on a routine basis in Neurosurgery/Spinal Surgery symptoms of nerve damage. The nerves that exit your spinal cord (spinal nerves) have components of: pain/temperature, deep sensation, and motor function. As such patients that have compression of those nerves leads to a myriad of symptoms ranging from pain, numbness/tingling, and, in certain instances, muscle weakness. 

When a patient undergoes treatment for their spine specifically interventional treatment like surgery, the goal of the surgery is to decompress the neural structures (spinal nerve(s)/spinal cord). The unfortunate part about this is that we are unable to repair the nerves themselves. Essentially the goal of the surgery is to eliminate that compression and to give the nerve the best chance of healing. 

The degree to which the nerve damage has occurred can only be assessed approximately 12-18 months after the surgery. It’s important to remember that the damage to the nerves (as it pertains to degenerative discs/mechanical compression) occurs over a long period of time so the relief may not be immediate. 

Often times patients find themselves feeling frustrated when this has not been explained to them. And there are instances where the patient’s pain and/or other neuropathic symptoms and the relief from the surgery start to plateau. That is when we start looking a peripheral nerve damage or chronic pain syndrome. 

Again there are a multitude of treatment options available, but it falls under the discretion of the physician, and a comprehensive assessment if there is a viable treatment for the symptoms a patient is experiencing. 

Do nerves heal themselves?

Now let’s get to our main topic as to whether nerves can heal, allowing your nerve pain to go away. The short answer is it depends on the extent of the damage.

For example, for people with diabetic neuropathy, the damage is largely irreversible, because the blood vessels that serve the nerves are also compromised.

As well, there are some disorders, such as rheumatoid arthritis, in which the body is constantly launching an attack on joints and nerves.

If your nerve pain stems from damage due to trauma, nerves can regrow, but slowly. On average, it takes about a month for a nerve to grow 1 inch. So, your road to pain relief after an injury depends upon how much of your nerve needs to regrow.

For nerve entrapment issues, the reversal of pain is usually much simpler. The nerve isn’t necessarily damaged, just compressed, and all we need to do is to give your nerve(s) more space. This would be more like carpal tunnel syndrome or cubical tunnel syndrome. 

With regards to nerves healing after spinal surgery the simple answer is that we are allowing them the best chance to heal,but unable to actually repair them. 

How we can relieve nerve pain due to damage

As a neurosurgeon, Dr. Mesiwala is well-versed in the many ways to relieve your nerve pain due to peripheral neuropathy, such as:

Repairing the nerve 

If you have severed nerves, Dr. Mesiwala can reconnect the ends surgically. If there’s a larger gap, he can also bridge it with a nerve graft. This kind of treatment is limited to reconstructive plastic surgery/microsurgery with peripheral nerves (not the spinal nerves, spinal cord). 

Removing the tumor

If your nerve pain is due to a tumor that’s pressing up against the fibers, Dr. Mesiwala can remove the tumor. Really anything that causes compression of a nerve(s) should be approached in a specific manner. Sometimes its not just a tumor causing compressing a nerve(s), but just muscle, scar tissue, etc. A good example of this is decompression of the brachial plexus (the nerves that make up the neural structures in our arms and hands). 

Releasing the nerve

If it’s an entrapment issue that’s causing your nerve pain, Dr. Mesiwala can free your nerve, giving it much-needed space for optimal function.

 

Neuromodulation

If the nerve is damaged beyond the point of repair or healing, Dr. Mesiwala might suggest neuromodulation, a technique in which he implants a device that emits signals that disrupts the pain signaling.

Neuromodulation includes treatment like spinal cord stimulators and peripheral nerve stimulators. Spinal cord stimulators place an electrode on/around the spinal cord versus a peripheral nerve stimulator in which the electrode is placed adjacent to the nerves in the periphery.  The evaluation for these modalities is quiet extensive including a physical and neurological exam, evaluation of radiological scans, a psychiatric profile and then ultimately undergoing a trial procedure to determine if it provides meaningful relief. This is typically done in conjunction with a pain management physician who performs then trial, and then Dr Mesiwala would implant the electrode and internalize the generator. 

A simple way of thinking about how these systems work is by imagining that there is a sound that you hear (pain) and the stimulator generates a sounds thats louder, thus drowning out the sound you heard previously (drowning out the pain signals as they travel up to the brain). That is a very rudimentary explanation but hopefully that provides a better understanding. 

While nerves can be tricky, the good news is that you have an expert in your corner who can help figure out your best path forward to relief. 

Dr. Mesiwala is on the forefront of neuromodulation treatment options. Not only does he perform these operations on a regular basis but is part of the faculty to train other surgeons on the operative techniques and is also involved with future research and development on this technology. 

In addition to stimulators, we regularly employ other treatment modalities like pain pumps, and even a new technology which helps with muscle regeneration through an electrode and generator implant. 

Ultimately, Dr Mesiwala not only has the expertise to evaluate spinal disorders and chronic pain disorders but also has a vast array of treatment options to offer patients to optimally treat them. 

To schedule an appointment with Dr. Mesiwala and our team, we invite you to contact one of our offices in Newport Beach, Marina del Rey, or Rancho Cucamonga, California.