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Most people assume that the worst part of living with a spinal cord injury is using a wheelchair. While a wheelchair may be more physically obvious, nerve pain is a seemingly invisible menace. While everyone has a different experience and there is a varying degree of secondary complications from person to person. The worst part for me is living with constant nerve pain or neuropathy due to nerve damage from my level of injury and below.
The pain becomes background noise at a point, and ranges from a dull pins and needles sensation, to a moderate burning or electric tingling sensation. Although when it flares up it can become a sharp pinching sensation, or like full electric shocks travelling down my legs. At its worst… it feels like I am being stabbed and sliced by hot knifes. There is also a high degree of hypersensitivity at my level of injury so at times even light touch can result in pain (similar to sunburnt or irritated skin). I have several tattoos, I used to participate in full contact martial arts, and I once took a glass to the side of the head in a bar fight, needless to say I would consider myself to have a high pain tolerance, and nerve pain trumps them all.
For the most part it is something I live with, and can ignore and endure. Although, sometimes the pain is so intense it is hard to think straight, and there are some nights where it is so bad it prevents me from being able to fall asleep.
It is a daily battle.
Unfortunately nothing ever makes it go away completely, but there are several different methods I use to lessen the severity of the pain. These are a combination of personal experience and suggestions from others about what has worked for them. Spinal cord injuries are highly variable and everyone has a unique experience, especially when it comes to nerve pain. A solution for one person may cause worse pain for another person. So it is important to do your own research and decide what is best for you and your body.
A lot of these methods work by means of distraction. Giving the brain something else to focus on, or alternate input to be able to ignore the pain. For some people nerve pain is purely neurological; while for others it has a muscular/skeletal component as well. It can be frustrating trying to get control of pain, and it can be a lot of trial and error. Here are some different things to try:
Nerve Pain Remedies
Here is a list of various tools you can try to get your nerve pain under control and bring yourself some relief. Some options are more feasible as ‘”quick fixes” while others are more related to long term management and preventative measures. I am not a medical professional and this is not intended to replace professional medical advice, I just wanted to compile an arsenal of things to try in the fight against neuropathy.
Stretching/Exercise
This can be as simple as shifting positions, doing a quick pressure relief lift, elevating your feet, or laying down for a bit if you have been sitting in your chair for awhile. For some people stretching will cause nerve pain to worsen, so start small and see how it feels for you. If you are planning on doing a more substantial stretching session, it can be done in bed, or on the floor on a thick exercise mat. Although, if you don’t wish to transfer from your chair, stretches can be done there as well. Accessories such as a yoga strap (or two) can be a very useful tool to help stretch in a more passive manner, allowing you to relax further. Another helpful accessory is a foam muscle roller, which can be used to massage the area, release sore muscles, and increase circulation.
A good habit is to lay on your front side/stomach at least once a day. This is important to facilitate stretching of the hip flexors which get very tight over time. It is also important to take pressure off your butt after sitting for prolonged periods. Pillows or bolsters can help with comfort and positioning if need be.
For others doing light to moderate exercise is a better relief from nerve pain than stretching. It helps to occupy the mind, and increases blood flow throughout the body. Increased circulation and body temperature can help to alleviate nerve pain. In addition the endorphins produced during exercise are said to have an analgesic effect.
Keeping the Mind Occupied
As mentioned in the previous section, it can be helpful to keep the mind occupied to relieve nerve pain. It helps to give the mind something else to focus on other than the pain. While simply ignoring the pain isn’t always the most optimal solution, sometimes it is the only practical solution available in a situation. It can be helpful to stay calm and relaxed, even as you feel a pain spike coming on. Anxiety about the pain can cause the experience of pain to worsen or last longer. Remind yourself that the pain will subside, take a deep breath and prepare to ride it out.
Any recreational activity you find engaging and soothing can be helpful. This will be different for everyone, but it could be relaxing activities such as: painting, reading, meditating, cooking, knitting, playing video games, playing with pets, the list goes on. Personally nerve pain is the worst for me when I am trying to fall asleep. There is less to focus on to keep the mind off of pain. In this case, I find it helpful to watch a movie or tv show until I fall asleep. Reading a book is another option if you are trying to reduce screen time before bed. White noise machines as a distractive measure are also helpful for some people.
Electrostimulation
Neurological pain is due to a dysfunction of the nervous system. The nervous system of the body is an electrical system. Therefore certain methods of electrostimulation may be beneficial for reducing nerve pain severity in the body.
TENS Unit
TENS stands for Transcutaneous Electrical Nerve Stimulation. Colloquially known as “Dr. Ho” machines by many. They consist of a battery operated power source, and electrodes that are placed on the skin through which electric pulses are sent. They inhibit pain by providing the brain another sensation to focus on. These units are are readily available to buy online and are relatively inexpensive. They are also fairly compact for portability, but is more of an at home option rather than a portable solution.
FES
Functional Electric Stimulation or FES combines electrostimulation with functional movement. It can be used to rebuild muscle mass in atrophied limbs. Which may be a cause of pain for some. It is also beneficial for range of motion and long-term joint health. While it is possible to purchase a FES bike for at home use, the high cost may be prohibitive to some people. Thankfully some fitness centers (such as the YMCA), and some rehabilitation/physio centers (Steadward Centre) have FES bikes available for use by appointment. Usually a consultation appointment is necessary to determine if FES is a good fit for your specific injury.
Acupen
This is a similar idea to the TENS unit, but provides electrostimulation in a portable form. There are several different acupen models available online, but are usually battery powered and come with a conducting gel. This is a great option if you are looking for a portable solution that you can use on the go.
Acupuncture
As previously mentioned the nervous system is an electrical energy system. The body has many different energy lines that are connected in a network and influence many body processes. A spinal cord injury or other neurological injury can negatively affect these delicate energy lines, causing imbalances and blockages that the body that arise as pain.
By using very thin needles inserted into the surface of skin, acupuncture seeks to rebalance the energy lines of the body. Acupuncture sessions can be used as a long form preventative measure against nerve pain. It also may be combined with electrical stimulation by hooking a TENS machine up to the thin acupuncture needles. A few sessions may be needed to notice a substantial difference in pain relief. After a few sessions once a week or once every other week, the sessions can be spaced further apart and act as more of a proactive and preventative measure.
Massage/Pressure
Gentle massage of the affected area, or sustained deep pressure can be useful in alleviating pain. Especially if the pain has a neuro-muscular component to it. Professional massages can also be a useful preventative measure for long-term pain reduction by helping relieve hypersensitivity to touch. Compression socks or compressive leggings can also be a useful wearable option to provide gentle pressure to the legs and pain relief. To provide targeted relief to a specific pressure point a tennis ball or a squash ball can be useful low cost tools.
Weighted Blanket/Lap Pad
For those with nerve pain through the leg and hip area, a weighted blanket or lap pad can be very beneficial. The pressure can help diminish the pain response, and it is a hands-free option while on the go or doing other activities.
Grounding/Earthing Mats
Grounding or earthing is the process of realigning your bodies electrical energy by connecting to the earth. The surface of the Earth is rich in negative ions. If disconnected from the earth the body builds up a static charge. Once connection is established the charge is neutralized. It can be more difficult to perform this practice as a wheelchair user since our bare feet rarely come in contact with the earth. Grounding mats solve this problem. These come in all shapes and sizes, from small desktop mats to full body size to be used when laying in bed. The mat is connected to the grounding wire of an electrical socket and is said to help balance the body’s electric charge by providing this vital connection. Its anti-inflammatory effects can also be beneficial in reducing nerve pain.
Vibration Therapy
In line with other therapies I have mentioned vibration therapy is similar in that it “over-rides” the pain response by activating alternate sensation pathways. The nervous system has several different somatosensation (sensory) receptors: temperature, light-touch, deep touch, vibration and pain to name a few. When the nerves are damaged it can result in an abnormal signal, which is interpreted by the body as pain. Therefore therapy using a vibration plate can help over-ride the pain response by giving the body another signal to “focus on.”
Vibration therapy can be done by using a massage chair, or placing the feet on a vibration plate. There are also portable “massage chair pads‘ that often have built in heating pads as well. These can work as a good semi-portable option.
Heat Therapy
Heat therapy works to help relax muscles and provide an alternative neurological input other than a pain response. Be mindful if the area of your body below your injury displays atypical neurologic response to temperature, it can trigger autonomic dysreflexia in some people and can be potentially dangerous. I would recommend starting with something more localized like a heating pad before subjecting your body to the more extreme conditions of a hot tub, sauna, or steam room.
Heating Pads
There are many different options available. From the traditional rice filled pillows you heat in the microwave, to the longer lasting electric variety. For those on the go, there are also options marketed as glove or boot warmers. There are also “Icy/Hot” muscle pain stick on pads that may provide sustained pain relief option.
Hot Shower/Hot Bath
These are simple options, accessible, at home options that can be highly effective. You can make the experience as luxurious as you like and give yourself a little spa like aromatherapy with a shower bomb or bath bomb to jazz it up. Epsom salts are also a great addition to a bath and provide relief to sore muscles. There is also research showing that the magnesium component of Epsom salts can help relieve nerve pain by inhibiting calcium ion entry into cells and reducing pain thresholds.
Hot Tub
Hot tubs are similar to baths, but are generally hotter and the jets may provide extra relief for muscles. Many recreational facilities have hot tubs accessible either with a lift and accompanying water wheelchair. Some older facilities may have a less accessible set-up with a few steps to bump down with the help of a grab bar for support. Either way it can be a nice social outing and activity to do with friends.
Sauna/Steam Room
Many recreational facilities have accessible saunas or steam rooms. They may be a little intense to begin with. So I would suggest small increments to start with and building your tolerance up from there. Be sure to drink lots of water and stay hydrated if you are planning on an extended session.
Cold Therapy/Cryotherapy
Much like heat therapy, cold therapy, or cryotherapy works to provide an alternative neurological input other than a pain response. Similarly, be mindful if the area of your body below your injury displays atypical neurologic response to temperature, it can trigger autonomic dysreflexia in some people and can be potentially dangerous. It may also cause nerve pain to become worse. So be mindful of your body and your experience. I would recommend starting with something more localized like a cooling pad/ice pad before subjecting your body to the more extreme conditions such as an ice bath. Cold therapy is definitely less “pleasant” than heat therapy, but it can be a powerful tool.
Cold Packs/Ice Packs
These gel packs can be placed in the freezer so they are frozen and ready when you need it. Avoid putting the ice pack directly on your skin if you have diminished sensation. Instead, wrap in a cloth to give the skin a barrier against irritation and damage.
Cold Shower
This is a great method to ease into cold therapy. At the beginning of your shower turn the water setting to as cold as you can handle and either do a full body cold shower, or focus on the area of nerve pain. After a few minutes warm up the water and continue with your normal shower routine. This can be an invigorating practice and can help boost energy levels and circulation as well.
Ice Baths
Also known as Cold Water Immersion or CWI. This is a more extreme form of cold therapy, and is a technique often used by professional athletes. Generally, a bathtub is filled with ice water and immersion lasts 2-10 minutes. Localized ice baths rather than full immersion can also be beneficial if your nerve pain is in a location that permits localized soaking. It can be combined with the Wim Hof Method. Which combines deep breathing, meditation and cold water immersion to unlock the full potential of the body.
Water Therapy
Water can be very healing. As previously mentioned as a heat or cold therapy option. It is also beneficial to be able to feel “weightless” in the water and relieve the compression in the body from spending long periods of time sitting.
Swimming
Most recreation centers are wheelchair friendly and either have zero entry ramps into the pool, or a lift system and accompanying water wheelchair. Allowing the body to relax and float in the water can be very therapeutic. A float belt or other floatation device can allow you to relax fully without fear of submerging. Swimming can also be a great form of exercise that allows you to be free of a wheelchair. Water shoes are a great investment to ensure your feet don’t get scraped or scratched on the bottom of the pool or the pool deck.
Float Tank Therapy
This is a more specialized form of water therapy. Float tanks involve hyper-salinized water so your body becomes buoyant and feels weightless. Float tanks primarily use Epsom salts, so they also beneficial for the absorption of magnesium as previously touched on. They have been proven to help reduce stress, anxiety and depression. Studies show it may also be effective against nerve pain as well. Local availability may vary, I have not personally found any local float tank establishments that are wheelchair accessible. But they may be available in your area.
Meditation/ Breathing Exercises
There are many different types and methods of meditation. Common meditations for pain relief include: body scans, and deep breathing exercises. Body scans can help you feel more in-tune with your body and the pain rather than dismissing it or avoiding it. Deep breathing exercises have a direct effect on the central nervous system and can help decrease tension, stress and anxiety. All things that can feed the pain response if left unchecked.
The breath is a powerful tool to regulate our emotional response to pain. It also provides increased oxygenation of the body for healing and health. A simple breathing exercise to try is called 4-7-8 breathing. It is a breathing technique focused around breath retention, with a quick inhale and a prolonged exhale. Simply inhale for a count of 4, hold the breath for a count of 7, and exhale the breath for a count of 8. Repeat this cycle a minimum of 3 times before returning to your regular breath. This breathing pattern helps activate the parasympathetic nervous system (which is our bodies “rest and digest” mode rather than our “fight or flight” mode) and helps to reduce stress in the body.
Changing Relationship to Pain
This contradicts my previous statement suggesting to keep busy and ignore the pain. Sometimes it can be helpful to come fully into the pain. Rather than having a reactionary response to an onset or anticipation of nerve pain, which can often make the pain worse, it can be helpful to hold space for the pain. Noting the pain as an experience, something that is happening, rather than identifying with the pain. Changing the narrative from “I am in pain” to “This is pain” and allowing yourself to become an observer of the pain rather than a victim.
Another helpful tip is to reframe the nerve pain as something positive, such as nerves re-growing and rewiring. Or reframing the pain as something funny by giving it a silly name like flamey-o attack or the shockies (sorry these are lame examples haha). It can be helpful to remind yourself of pain outbursts in the past and remind yourself that it will not last forever, and that you have gotten through similar situations in the past. It can also be helpful to remember you are not alone, and reach out to friends who understand what you are going through first-hand.
Listening to Your Body
Changing your relationship to pain by seeing it as your body trying to send a message. Even if the message has been scrambled and is being falsely interpreted as a pain response. Although it can be difficult, trying to reframe your bodies pain response as a friend rather than a foe. Sometimes nerve pain may be your body’s way of telling you your clothing is too tight, a waistband is cutting in, it is time for a pressure relief or position change. It could also be a signal for other issues such as dehydration, edema of lower limbs, your body is too hot/cold, or your bladder is full. All issues that can be easily remedied.
Keep in mind that it may also be a signal of more serious problems such as a pressure ulcer, a muscle contracture, broken bone, a kidney stone or a UTI/bladder infection. So it is important to monitor potential underlying causes of nerve pain, especially if it can potentially (and quickly) lead to a life threatening predicament.
This next part will not apply to everyone. But as a menstruating female, I also notice that as my hormone levels change in response to my cycle. During certain points in my cycle I have a higher sensitivity to pain. This may be something to keep in mind if this applicable.
Topical Muscle Rubs/Sprays
Topical solutions for nerve pain can be advantageous for their portability and relatively quick relief. Rubs and sprays can be combined with massage to help alleviate pain. They may be sprays, balms, or rollerball style. There are many different brands available, in addition to the ones I have listed here. I will break down some of the commonly included ingredients and some specific brand names. Never use undiluted essential oils on your skin. Never use essential oils straight up! Always combine them with a carrier oil such as coconut oil or grapeseed oil so the skin does not become irritated. Avoid using topicals or sprays on broken or inflamed skin.
Menthol Based
Menthol based rubs and sprays result in a invigorating, cooling sensation. These can be effective if you experience a burning or hot component to your nerve pain. Menthol based topicals are often combined with isopropyl alcohol which acts to reduce the temperature threshold for the receptors, but can also be drying for skin.
Eucalyptus Based
Eucalyptus is another common ingredient in pain relief topicals. Similar to the cooling effect provided by menthol, eucalyptus oil can also provide a mild warming or cooling sensation to the skin to off-set the pain response.
CBD Based
High dose CBD topicals provide pain relief and have anti-inflammatory properties. Note while these products do not contain THC, they have variable legality in certain countries, so do your research before buying.
Lidocaine Based
Lidocaine works as a surface numbing agent and can provide relief for some forms of nerve pain. It is the same sort of creams people use before getting tattoos, and can provide fairly long lasting relief.
Arnica Based
Arnica is a natural herb with known pain relief properties. It is often a component of pain relief topicals and rubs.
Tiger Balm
Tiger balm is a favourite of many, and contains camphor, menthol, cajuput, eucalyptus, capsicum, and clove oils. It provides a soothing warming sensation; but it is worth to note that the smell may be quite strong if you aren’t used to it! There are several varieties of tiger balm. The white version is less intense and doesn’t stain the skin orange like the original variety. But the small container is highly portable and it has many other uses besides pain relief. It is also good for bug bites, minor burns, and headaches.
Icy/Hot Stick on Patches
As previously mentioned in the heat/cold therapy sections, these stick on patches, creams or spray provide the best of both worlds. They are great for prolonged pain relief in a specific area.
Magnesium Spray
Epsom salts/magnesium was mentioned previously in the heat therapy section as an additive to a hot bath to provide pain relief, especially if it is due to sore muscles. There are also magnesium sprays available which are quick absorbing and can be applied locally. Magnesium is important for nerve support and relaxing muscles.
Diet
Due to the level of my spinal cord injury, my nerve pain in somewhat tied to my digestive system. It materializes as hypersensitivity after I eat a meal as my food digests. This may not hold true for everyone, but there is definitely a relationship between my diet and my nerve pain.
Noting Your Trigger Foods/Beverages
I love spicy food. Always have, always will. Unfortunately, after my injury spicy food now causes my nerve pain to flare up. For the most part its not super noticeable, but when I decide to indulge in something cooked with excessive red chilis, or ghost peppers, I notice an uptick in nerve pain for a few hours. It hasn’t diminished my love for spicy food, but I am more mindful of this now.
Highly processed or fried foods are also triggers for my nerve pain. I usually try to eat pretty healthy-ish, but sometimes you just got to have some nacho cheese sauce from a jar, or fast food on the go. For the most part I try to stick to a diet of whole foods with plenty of vegetables. Fruit is great too, but sometimes the acidity can trigger nerve pain for some. This is especially true of citrus fruits.
Another common trigger is caffeine. So it can be worth trying to cut down or cut out these kinds of beverages. Choosing a herbal variety or infusion instead. High sugar diets can also trigger an inflammatory response resulting in increased pain levels. In addition, some people may experience a sensitivity to gluten products, resulting in an inflammatory response. It may be worth keeping a food and nerve pain journal to note correlations that occur over time, and adjust your diet accordingly. Another important aspect that has helped me is not overeating, and implementing periods of intermittent fasting to allow the body time to digest.
Anti-Inflammatory Foods/Beverages
Nerve pain may be due in part to inflammation in the body. There are many foods that have proven anti-inflammatory properties. These are often high in anti-oxidants and other nutrients. Here is a list of foods with anti-inflammatory properties that may be beneficial to add to your diet:
- turmeric
- berries
- fish
- avocados
- broccoli
- mushrooms
- grapes
- tomatoes
- cherries
- green tea
- cocoa/dark chocolate
- olive oil
In addition to these, it is also important to remember to stay hydrated with water or clear fluids, and eat a varied, balanced diet.
Sunshine
A combination of light therapy and heat therapy. As well as enjoying the outdoors, and getting some fresh air. Simply sitting in the sunshine can be very therapeutic and great for nerve pain relief; especially after a long Canadian winter. Make sure to be safe about sun exposure. Either limiting time spent, applying necessary UV protection, or enjoying a shaded area. Vitamin D has also been shown to reduce pain levels in addition to the phototherapy benefits. So all the more reason to soak up some sun. There are also studies showing the benefits of lamp therapy if it is hard to come by sunshine year round where you live.
Supplements
Supplements can be taken orally and provide support for different aspects of pain management. They may take longer to work than a topical solution, but can provide a proactive or preventative long-term pain relief solution.
Turmeric/Curcumin
Turmeric‘s active ingredient is curcumin. Turmeric was previously listed in the diet section, but can be taken as a supplement as well. It has been proven to be a powerful anti-inflammatory. Combining with black pepper can help aid absorption. Note it may interact with certain blood thinners, so be mindful if you are combining these.
Lions Mane Mushroom Powder
Lions mane mushroom extracts help promote nerve re-growth and regeneration. This may help reduce never pain severity in some people.
Arnica
Arnica was previously mentioned in the topicals section, but is also available in oral form for a preventative pain remedy.
CBD Extract
CBD or Cannabidiol was previously mentioned in the topicals section, but is also available in oral form. As noted before, make sure to check legality in your area and act accordingly. It may also be available in vaporizer form for more immediate pain relief.
Medications
There are several types of medications often prescribed for nerve pain although these may have negative long-term side effects. So it is worth to research these before deciding this as your primary way to deal with nerve pain.
Gabapentin/Lyrica
Gabapentin or Lyrica are often prescribed for nerve pain. For some people they work great, for other people they provide no relief. Side effects can include a fogginess, dizziness, or swelling if the hands and feet. It is designed to be taken at regular intervals so it stays at a constant level in the body. If you do decide to quit taking gabapentin, it is best to consult a doctor and slowly wean yourself off, rather than quitting cold turkey.
Acetaminophen /Ibuprofen
Commonly known as Tylenol and Advil respectively. These are not prescription medications, but I find that when my nerve pain gets really bad, they work to take the edge off and allow me to function normally. They can be useful when nerve pain flares up when you are out and about.
There are many other prescription and non-prescription medications available to help with nerve pain. It is best to consult with your doctor or a pain specialist to find out which options are best for you.
Time
While nothing works consistently or completely to get rid of nerve pain completely in my experience. The old adage rings true “time heals all.” In time your body will get more used to having pain as background noise, but it can be overwhelming during the adjustment period after a spinal cord injury. For some people this adjustment period is months, for other people this adjustment can take years. So be kind to yourself and gentle to your body. Try various relief combinations and find which work best for you.
I hope this has helped give some new ideas for alleviating nerve pain after spinal cord injury. Thanks for reading.
