Nerve pain, medically termed neuropathic pain, occurs when the nervous system itself is damaged or malfunctioning, sending incorrect pain signals to the brain. This discomfort is often described as a burning, shooting, or stabbing sensation, frequently accompanied by tingling or numbness in the affected area. Because the underlying cause can range from systemic disease to physical compression, finding the appropriate medical professional depends entirely on the source and severity of the nerve damage.
Starting the Journey: Primary Care and Initial Diagnosis
The initial step in addressing nerve discomfort is consulting a primary care physician (PCP), such as a Family Medicine or Internal Medicine doctor. This provider performs a detailed medical history and a focused physical and neurological examination. The PCP determines if the pain is truly neuropathic, stemming from nerve damage, or if it is nociceptive, originating from an injury to tissue, muscle, or bone.
They often order blood work to check for systemic conditions that commonly lead to neuropathy, such as diabetes or vitamin deficiencies. By ruling out these metabolic causes, the PCP narrows the diagnostic focus. If the cause remains unclear or the pain does not respond to initial management, the PCP provides a referral to the appropriate specialist for advanced diagnosis and treatment.
Specialists Focused on Nerve Function and Rehabilitation
When nerve pain is complex, two specialists primarily focus on non-surgical management: the neurologist and the physiatrist. A neurologist is an expert in the central and peripheral nervous systems, focusing on the disease process affecting the nerves themselves. They use diagnostic tools like Nerve Conduction Studies (NCS) and Electromyography (EMG) to measure the electrical activity of nerves and muscles, pinpointing the location and extent of damage. Neurologists manage conditions such as peripheral neuropathy, multiple sclerosis, and nerve entrapments primarily through medication and lifestyle adjustments.
A physiatrist, or a doctor of Physical Medicine and Rehabilitation (PM&R), focuses on restoring function and improving quality of life. Their approach centers on the musculoskeletal system and the functional disability caused by the nerve issue, often treating spinal cord injuries or pinched nerves related to the spine. Physiatrists frequently prescribe physical therapy and may perform image-guided injections, which both diagnose the source of pain and provide therapeutic relief.
Surgical and Procedural Intervention
If conservative therapies are unsuccessful, or the pain is severe and chronic, patients may be referred to specialists focused on advanced procedures. Pain management specialists, often anesthesiologists by training, concentrate on interrupting pain signals through minimally invasive techniques. They utilize interventional procedures such as epidural injections, nerve blocks, and radiofrequency ablation to target the nerves responsible for the pain. These specialists aim for pain relief and functional improvement when medication alone is insufficient to manage persistent discomfort.
For cases involving structural problems causing nerve compression, a surgical consultation becomes necessary. Both orthopedic surgeons and neurosurgeons perform spine operations, but their training emphasizes different areas. Neurosurgeons focus on the nervous system itself, including the spinal cord and nerve roots, and are often consulted when symptoms involve significant neurological deficits. Orthopedic surgeons specializing in the spine focus more on the bony and musculoskeletal elements, such as spinal alignment or stabilization. Surgery is typically reserved as a last resort when non-surgical treatments have failed to resolve severe nerve compression or damage.
Warning Signs: When Nerve Pain Requires Immediate Care
Nerve pain can signal a medical emergency requiring immediate attention at an emergency room. The sudden onset of bilateral leg weakness or paralysis is a severe sign that nerve function is rapidly deteriorating. An urgent warning sign is “saddle anesthesia,” defined as a sudden loss of sensation or numbness in the groin, buttocks, and inner thigh area.
Difficulty controlling bladder or bowel function, such as urinary retention or incontinence, can indicate Cauda Equina Syndrome. This syndrome occurs when the bundle of nerves at the base of the spinal cord is compressed, and delayed treatment can lead to permanent damage. If nerve pain is accompanied by a high fever, stiff neck, or sudden, severe headache, it could signal an infection in the spine or central nervous system, demanding immediate evaluation.