Classification And Types Of Pinched Nerve Pain
Each and every body part is surrounded by nerves and tissues. Most of the times, nerves are related to that particular body part, but the nerves are of two types.
- Efferent or Motor Nerves: Nerves that transfer information or transmit impulses from the CNS (brain) out to the effector organs such as glands and muscles. This way the brain sends different commands to the different organs and parts of the body.1 For instance, commands sent through brain help muscle contracture and relaxation. More importantly these commands tend to influence heartbeat.
- Afferent or Sensory Nerves: Afferent nerves carry information/impulses from different organs of the body back to CNS (brain) for processing information related to sensation, taste, touch, or pain.2
This information is transmitted along the nerves through signals such as electrochemical and the information passes through electrical cord. These signals are interrupted when any nerve is pinched along the path. In such case, the information has started from the body part, but did not reach the CNS. Somatic nerves which transmit impulses from joints and skeletal muscles to the brain. Visceral nerves carry impulses from visceral organs to the brain.
Etiology And Risk Factors of Pinched Nerve Pain
The nerves are compressed when excessive pressure is applied to them by the tissues surrounding the nerve. The pain emanating from this pinch nerve is called pinched nerve pain. Sometimes, tissues may be cartilage or bone. Herniated disc compresses the nerves and there generates low back pain. In some cases, tendons or muscles may be the root cause of compressing the nerves. When it comes to CTS (carpal tunnel syndrome), different number of tissues might be responsible in compressing the median nerve that include enlarged bone which constricts the tunnel, degenerated and thickened ligament, or tendon sheaths that are swollen within the tunnel.
Different other conditions may be responsible for the tissue to compress the nerves or nerve roots. Some of the conditions that may compress the nerve or cause damage to the nerve are osteoarthritis, stress from prolonged working hours, constant sitting or standing job duties, poor posture, aggressive sports activities, obesity or injury to the ligaments.
This constant or sudden pressure leads to inflammation (swelling) of the nerve and alters the function of the nerves. In some cases where the nerve is stressed or pinched for a short period, then the damage to the nerves or nerve fibers is not significant. Patient can take little rest and get along with normal and usual daily activities. Without proper and sufficient rest, the nerves are under continuous pressure leading to development of severe pain which may lead to entrapment of the nerve or damage the nerves or surrounding tissues.
Some Common Risk Factors Which May Increase Pinched Nerve Pain Are
- Swelling/inflammation caused due to rheumatoid arthritis in which the nerves may be compressed, specifically in joints.
- A condition which can cause thickening of bone or trauma which may lead to bone spurs. This is a condition in which bone spurs tighten the spine and constricts the space the path in which nerves travel. Pinching of the nerves occurs in this region.
- Aggressive work related activities, overuse of the body parts in jobs or sports, etc., require chronic and repetitive use of extremities. People with such activities are often prone to have pinched nerves.
- Unequal distribution of weight to the lower extremities occurs in cases people with poor posture. In such cases, pressure will be more on the nerves and spine. In some cases, obesity can lead to uneven distribution of weight to the lower extremities or excessive stress on some parts of the body leading to pinching of the nerves.
- Women are prone to get CTS because they have carpal tunnels that are smaller.
Signs And Symptoms of Pinched Nerve Pain
Pins and needles, tingling sensations (in case of paresthesia), decreased sensation or numbness, burning, sharp, shooting pain, twitching or muscle weakness, feet or hands falling asleep.3 Pain radiates from the affected part to the adjacent structures and shoots down to lower extremities. In severe cases, pain is aggravated with sneezing or mild cough. In chronic conditions, patient may have sleeping difficulties. If the signs and symptoms of pain persists for more than a week and the pain is not alleviated with measures taken at home, then should seek doctor’s advice and take proper treatment.
Treatment for Pinched Nerve Pain
Common treatment that is recommended or suggested by the doctor initially is taking proper rest and giving adequate time for the pinched nerve to heal on its own. In this process, doctor may suggest to stop doing activities that are the root cause for the pain. If the pain persists even after initial treatment, then bracing or splinting may be required so as to immobilize the area for a period of time. These splints are braces are advisable to wear only during work related activities or day time. During night-time, patient can come off brace or splint to sleep. In case of carpal tunnel syndrome, if the pain become chronic and is not alleviated with conservative treatment or medication, then carpal tunnel release will be recommended.
- Conservative Treatment may include physical rehab. Physiotherapy is recommended in most of the cases to help alleviate pain symptoms and to work on strengthening of the muscles. Physical therapy would include activity modification, exercises, and strengthening exercises. Expertise of the physical therapist plays a vital role in alleviating the pain. The duration of the treatment is also important in terms of treating the pain, so should follow physiotherapist’s recommendations.
- Medications: Self-treatment with medication is always dangerous. People should take medicines that are prescribed by the doctor only. Common drugs prescribed for pinched nerve would include NSAIDs (nonsteroidal anti-inflammatory drugs) and analgesics. Different other drugs are prescribed depending on the severity of the pain. To minimize swelling and pain, corticosteroid injections are given to the affected part.
- Surgery: In cases where nerve entrapment or pinched nerve pain is not alleviated with medication or conservative methods of treatment, then surgery is recommended to remove the pressure from the affected body part. Necessary precautions to be taken before and after surgery will be explained to the patients whom are to be followed carefully. Surgical treatment may also be necessary to treat bone spurs or removing herniated discs in the spine. Carpal tunnel release is surgical treatment done to treat CTS caused by compression of the median nerve.
Prevention of Pinched Nerve Pain
Monitored flexibility and strengthening exercises, maintaining good posture, regular exercise program, reduce repetitive activities, restrict frequent usage of affected body part, taking breaks as often as possible from work, work on weight loss program in case of obesity.
Investigations for Pinched Nerve Pain
Patient should give adequate information about the signs and symptoms of pain such as exact affected body part, activities of daily living, job related activities, injury details, etc., based on which doctor will get an idea about the type of pain and its cause. Initially doctor will recommend conservative treatment and if the pain persists even after several days of conservative treatment, the doctor will go ahead and conduct different tests to confirm the severity of compression. Based on this, treatment will be decided. Tests may include nerve conduction velocity study, electromyography, and MRI (magnetic resonance imaging).