What is the treatment for a pinched nerve?

From the Guidelines

Treatment for a pinched nerve should start with assessing the pain and establishing a diagnosis, followed by initiating therapy with a secondary-amine tricyclic antidepressant (TCA) or a selective serotonin norepinephrine reuptake inhibitor (SSNRI), such as duloxetine or venlafaxine, as first-line treatment. The goal of treatment is to reduce pain and improve quality of life. According to the study by 1, the pharmacological management of neuropathic pain, which includes pinched nerve pain, involves a step-wise approach.

Initial Treatment

• Assess pain and establish the diagnosis of neuropathic pain
• Initiate therapy with a TCA, such as nortriptyline or desipramine, or an SSNRI, such as duloxetine or venlafaxine
• Consider topical lidocaine for localized peripheral neuropathic pain
• Evaluate the patient for non-pharmacological treatments, such as physical therapy, and initiate if appropriate

Medication Options

• Duloxetine has shown consistent efficacy in painful diabetic peripheral neuropathy and is a simple dosing regimen, with 60 mg once daily being as effective as 60 mg twice daily 1
• Venlafaxine has shown efficacy in painful diabetic peripheral neuropathy and painful polyneuropathies, but requires careful titration to an efficacious dosage 1
• Gabapentin and pregabalin are also effective options, but require careful titration and dosage reduction in patients with renal insufficiency 1

Ongoing Management

• Reassess pain and health-related quality of life frequently
• If substantial pain relief is achieved, continue treatment
• If partial pain relief is achieved, consider adding another first-line medication
• If no or inadequate pain relief is achieved, switch to an alternative first-line medication or consider referral to a pain specialist or multidisciplinary pain center 1

A more recent study by 1 also supports the use of a tailored and stepwise pharmacological strategy for the treatment of diabetic peripheral neuropathy, which can be applied to the treatment of pinched nerve pain. However, the study by 1 provides a more comprehensive and detailed approach to the pharmacological management of neuropathic pain.

From the Research

Treatment Options for Pinched Nerve

• Conservative management is often the first line of treatment, which may include electrotherapy, positioning on splints, and active as well as passive physiotherapy 2.
• The goal of conservative treatment is to prevent overstretching of paralyzed muscles, stimulate the regeneration of motor nerve fibers, and reintegrate the paralyzed muscles with the mobile muscles 2.
• In some cases, surgical intervention may be necessary, such as in cases of sharp and complete transection of a nerve, or if there is no reversal of the proximal portion of the neurologic deficit after 2 to 5 months 3.
• Surgical techniques, such as peripheral nerve stimulation, may be used to treat posttraumatic trigeminal neuropathic pain, and can be performed using a minimally invasive approach 4.
• Diagnosis and treatment of nerve injury and compression can be challenging, and may involve the use of advanced imaging techniques, such as ultrasound and MRI, as well as electrodiagnostic testing and surgical exploration 5.

Special Considerations

• Management of brachial plexus injuries requires a separate approach, with analysis of each element of the plexus and consideration of clinical, electrical, and radiologic findings 3.
• Obstetric brachial plexus palsy is a controversial condition, and initial conservative management is often recommended, with observation for 9 to 12 months before considering surgical repair 3.
• Postural brachial plexus compression neuropathy can be treated with exercises, patient education, and behavior modification, and may require operative treatment in severe cases 6.