Physical therapies for neuropathic (nerve) pain

Neuropathic (or 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.

Desensitization therapy

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. It is important to note that while desensitization therapy may work for some types of specific localized peripheral neuropathies (nerve injuries), it does not work for all types of neuropathic pain. As with any other therapy, when discussing desensitization therapy with your healthcare provider, they should be able to give you an idea of the types of improvements you can expect to see within a given timeframe, as well as the overall number of visits that you should anticipate for this course of treatment.

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 (e.g. 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 per day for best results.

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

What's 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.

Contrast baths (also called hot/cold immersion therapy)

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 (e.g. 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.

What's 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.

Graded motor imagery

Graded motor imagery is a therapy where you use your mind to imagine yourself doing different activities or movements. One example of motor imagery is called Mirror Therapy. It uses a Mirror Box, which contains two compartments. You place your non-painful limb into one compartment, and your painful limb into the other. There is a covering over the compartment containing your painful limb. You look into the mirror on the side with your non-painful limb and make a simple movement. For example, if your hand was affected, you could wave your non-painful hand. Because you are seeing the reflected image of your non-painful hand moving, your brain will interpret this as seeing two non-painful limbs. Sometimes, this activity can reduce the pain in your limb.

What's the evidence?

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.