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Why it happens

Nerves carry pain signals; when they are damaged by high blood sugar, a virus, compression, injury or chemotherapy they generate pain on their own. Because the fault is in the nerve rather than in a joint or muscle, anti-inflammatories do little; medication that calms nerve signalling, and treatment directed at the nerve itself, work better.

How Dr. Kiruthika assesses it

History and examination of sensation, strength and skin changes; ultrasound of accessible nerves to look for compression or swelling; nerve conduction studies and blood tests where the cause is unclear. Diabetes control and foot checks are reviewed with your diabetologist.

Conditions treated

Diabetic neuropathy

Nerve damage from long-standing diabetes, usually in both feet first. Treatment: blood sugar control with your diabetologist, medication for nerve pain, foot care to prevent ulcers, and in selected cases ultrasound-guided perineural PRP injection around the affected nerves, which is offered with clear expectations as an emerging treatment.

Post-herpetic neuralgia

Pain persisting after shingles along the same skin band, often severe to light touch. Early antiviral treatment of shingles reduces the risk. Established pain: medication, topical agents, and image-guided injections around the affected nerves — at the trunk or the scalp — to calm them.

Nerve entrapments — median, radial and ulnar

A nerve compressed at a tunnel or under a ligament: the median nerve in the carpal tunnel, the ulnar nerve at the elbow, the radial nerve in the forearm, the common peroneal nerve at the knee, the tibial nerve in the tarsal tunnel. Ultrasound identifies the site; hydrodissection frees the nerve with fluid under direct view. Surgery when there is muscle wasting.

Chemotherapy-induced neuropathy

Numbness, tingling and pain in the hands and feet during or after chemotherapy. Managed with medication and supportive measures in coordination with the oncologist; image-guided perineural injections for localised pain.

Complex regional pain syndrome (CRPS)

Severe, disproportionate pain in a limb after injury or surgery, with swelling, colour and temperature change and extreme sensitivity. Early diagnosis is critical. Treatment combines medication, active physiotherapy and image-guided injections near the sympathetic nerves — at the neck for the arm, the lumbar spine for the leg — to allow rehabilitation.

Treatment options, least to most invasive

  1. Treating the cause — blood sugar, vitamin deficiency, compression — and medication for nerve pain
  2. Topical agents and desensitisation physiotherapy
  3. Ultrasound-guided perineural injection or hydrodissection
  4. Perineural PRP in selected cases
  5. Image-guided sympathetic injections for CRPS
  6. Surgical decompression for entrapment with muscle wasting

On the day

Perineural injections and hydrodissection take fifteen to thirty minutes under ultrasound guidance. Sympathetic injections take twenty to thirty minutes with monitoring and a short observation period.

Red flags

Seek urgent medical attention today if you have loss of bladder or bowel control, numbness in the area you sit on, weakness that is getting worse, fever with the pain, a recent fall or major injury, or unexplained weight loss. These are not conditions for an outpatient injection.

Questions patients ask

Why don’t my painkillers work?

Nerve pain uses different pathways from joint or muscle pain. It responds to medication that calms nerve signalling, not to anti-inflammatories.

Can nerve damage be reversed?

Compression can be relieved and the nerve often recovers. Damage from diabetes is slowed by good control and its pain treated; full reversal is uncommon.

Is an injection around a nerve permanent?

No. It reduces pain for weeks to months and allows rehabilitation; it can be repeated.

What is a sympathetic injection?

An injection near the nerves that control blood flow and sweating in a limb, used in CRPS to reduce pain and swelling so the limb can be moved.

Should I see a neurologist?

For neuropathy of unknown cause, yes. Dr. Kiruthika will refer where the diagnosis needs it.