Physical therapies for neuropathic (nerve) pain

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Neuropathic (nerve) pain means that pain is caused by nerves sending abnormal pain messages to the brain. Some types of physical therapies are more commonly used with people with neuropathic pain. These include desensitization therapy, contrast baths and graded motor imagery. Read below to find out more about each of these types of therapies.

Here, we provide an overview of three physical therapies that are commonly used for neuropathic pain.

Desensitization therapy

hand holding feather

Sometimes, people with neuropathic pain become extra sensitive to stimuli such as touch, pressure or temperature. Even being lightly touched with a feather might feel painful.

Desensitization therapy is designed to help adjust your body’s response to these different types of stimuli so that they are less painful. Desensitization therapy may work for some types of specific localized peripheral neuropathies (nerve injuries), but it does not work for all types of neuropathic pain.

When discussing desensitization therapy (or any other therapy) with your healthcare provider, they should be able to give an idea of the types of improvements you can expect to see within a given timeframe and the overall number of visits you should anticipate.

During desensitization therapy, a therapist will apply different types of stimuli to the part of your body that is extra sensitive. These stimuli may include different textures (for example sand, rice, foam chips), fabrics, light or deep pressure, vibration and heat or cold. Desensitization therapy can feel unpleasant, but none of the stimuli are dangerous. The therapist will also help you learn how to make your own desensitization kit for home use. This type of therapy needs to be done several times a day for best results.

Your pain should return to baseline levels within one hour of treatment. If it takes longer than this, the desensitization therapy might be too much for your body. If so, it is recommended that you discontinue this form of treatment, or talk to your healthcare team about how to adjust the treatment so it provides benefits without a long-lasting flare of your pain.

What is the evidence?

There is limited evidence that desensitization therapy can be helpful for some people with neuropathic pain. Talk to your healthcare provider to see if this treatment might be an option for you.

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Contrast baths (also called hot/cold immersion therapy)

bathroom faucet

A contrast bath is a form of passive hydrotherapy as well as a desensitization technique. It involves switching between hot and cold baths. Depending on where you have pain, the contrast bath is used with just a part of your body (usually your hand or foot).

Switching between hot and cold temperatures is not appropriate for some people, and may cause rapid changes in your blood pressure, so always talk to your healthcare provider to decide if this treatment is right for you. Also keep in mind that if contrast baths do prove to be effective for you, they are easy to do at home without the need for a healthcare provider.

What is the evidence?

There is limited evidence that contrast baths can be helpful for people with neuropathic pain. Talk to your healthcare provider to see if this treatment might be an option for you.

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Graded motor imagery

Graded motor imagery is a therapy for pain in one or more limbs where you use your mind to imagine yourself doing different activities or movements.

One type of motor imagery is called mirror therapy. This uses a mirror box, which contains two compartments, one for each limb, both painful and non-painful. The compartment with your painful limb has a covering so that you do not look at it. Instead, you look into the mirror on the side with your non-painful limb and make a simple movement. For example, if your hand is affected by chronic pain, you could wave your non-painful hand. Because you see the reflected image of your non-painful hand moving, your brain interprets this as seeing two non-painful limbs. Sometimes, this activity can reduce the pain in your limb.

Check out this video about mirror box thera​py from McVay Physical Therapy​ to see how it works.​

 

What is the evidence?

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There is moderate evidence that graded motor imagery can be helpful for some people with neuropathic pain. Talk to your healthcare provider to see if this treatment might be an option for you.

Last updated: May 2nd 2016