If you’re wondering how to distinguish between nerve pain and muscle pain, you’re not alone - nerve pain and muscle pain share some similarities and can often be difficult to tell apart. It’s especially difficult if you haven’t been diagnosed with a specific condition yet.
When we think we’ve pulled a muscle, or if we experience muscle pain after exertion or exercise, we’re usually not too worried about it - we can generally recover quite easily. Nerve pain on the other hand feels a bit more scary and serious. The problem is that some muscle pain can feel like nerve pain, and understanding what type of pain you have determines what the next steps might be to get relief.
What Is Nerve Pain?
Also known as neuralgia or neuropathic pain, nerve pain isn’t a response to an injury or inflammation of a muscle, but rather a pain caused by injury or disease of the nervous system. When nerves get damaged, become diseased or malfunction for some reason, they set off the “alarm system” in our bodies – pain.
Common causes of nerve pain
The common causes of nerve pain include:
· Autoimmune diseases: when the immune system attacks the nerves in autoimmune conditions, nerves are damaged and can create pain. This is commonly seen in multiple sclerosis, rheumatoid arthritis, Sjögren's syndrome, Lupus, Guillain-Barré syndrome, and vasculitis.
· Inherited (genetic) conditions: hereditary disorders such as Charcot-Marie-Tooth disease and Hypermobile Ehlers Danlos Syndrome can cause nerve pain.
· Diabetes: roughly 30% of neuropathy cases are a symptom of diabetes, as extended periods of high blood sugar levels can damage the nerves over time.
· Trauma to the nerves or physical injury: nerves can be damaged from severe accidents, surgery, fractures, or compression to the nerves (as happens in carpel tunnel, for example).
· Repetitive strain injuries: exerting the same area of your body over and over for extended periods can result in irritation of the nerves in that area, and then nerve pain. Carpel tunnel syndrome may be one example of this.
· Infections: Nerve pain is often experienced by those with HIV, AIDs, Lyme disease, shingles (herpes zoster), leprosy, hepatitis B and C, or diphtheria.
· Vitamin deficiencies: Particularly deficiencies in vitamin B12, B1 (thiamine), niacin, and vitamin E can lead to nerve damage.
· Alcohol use disorder: Chronic excessive alcohol intake can damage nerves directly and cause nutritional deficiencies that further contribute to neuropathy.
· Cancer and its treatments: Some cancers can compress or invade nerves, and treatments like chemotherapy and radiation can also cause neuropathic pain.
· Exposure to toxins: Heavy metals (lead, arsenic, mercury), industrial chemicals, and some medications (notably certain chemotherapy drugs, antibiotics, and antiepileptic drugs) can damage nerves.
· Metabolic and endocrine disorders: kidney disease, liver disease, and hypothyroidism can all contribute to nerve damage.
· Other causes: Poor blood supply to nerves, chronic inflammation, tumors pressing on nerves, and rare protein disorders (such as amyloidosis or monoclonal gammopathies) can also be responsible.
· Less common causes include phantom limb pain after amputation, facial nerve conditions (like trigeminal neuralgia), and critical illness neuropathy after severe illness or prolonged intensive care.
· In some cases, no specific cause is found—this is called idiopathic neuropathy.
Symptoms of Nerve Pain
Signs you have nerve pain, not muscle pain, include:
· Tingling, shooting, burning, or stabbing pain
· A burning sensation
· A buzzing similar to a mild electrical shock
· Numbness of reduced sensitivity (especially in hands and feet)
· Heightened sensitivity to touch, temperature or stimuli
· Difficulty with controlled movement or to plan movement (motor nerves may be affected)
· Muscle weakness
· Pain may be worse at night (depending on nerves affected)
· Pain does not go away with the use of simple analgesics or anti-inflammatories
· Problems with autonomic functions (digestion, sweating, or blood pressure for example).
Nerve pain needs a professional medical evaluation and diagnosis, to identify the root cause and treat it correctly.
What Is Muscle Pain?
Medically referred to as myalgia, muscle pain can affect a specific area or be felt throughout the body and can range from mild to severe. When it’s the result of a mild injury or illness (muscle pain experienced during flu, for example) it can resolve on its own, but if it’s persistent (lasting a month or longer), it may be a a symptom of an underlying condition – worth a visit to your healthcare practitioner.
Common causes of muscle pain include:
· Injury or trauma (sprains, strains)
· Overuse of muscles (when you’ve over-exerted physical activities or exercise)
· Muscle tension, stress
· Viral infections (like flu)
· Chronic conditions (such as metabolic disorders, autoimmune conditions, and fibromyalgia)
· Side effects of certain medications like statins and ACE inhibitors
· Electrolyte imbalances (low calcium or potassium)
Symptoms often include:
· Soreness or aching
· Cramps or spasms in the muscles
· Sensitivity to touch
· Stiffness
Muscle pain may be temporary and resolve on its own, especially if related to minor injury, overuse, or mild illness. However, if it is severe, persistent (lasting a few weeks) or associated with other symptoms like fever, muscle weakness, or numbness, it may indicate a more serious underlying condition and should be evaluated by a healthcare provider.
Key Differences Between Nerve and Muscle Pain
Remember that muscle pain and nerve pain can feel very similar, and repetitive muscle pain which continues over an extended period (around a month) can develop into nerve pain if left untreated, or if you repeatedly overextend yourself. The nerves learn “pathways” for pain which, when triggered repeatedly, think that they should keep firing. Nerve pain is one of the most common types of chronic pain - read more about chronic pain here.
However, the key differences between nerve and muscle pain include:
· A difference in sensation: nerve pain can be sharp or stinging, while muscle pain is usually duller, achy, throbbing pain. Sometimes, muscle pain can trigger nerve pain and then both occur at the same time, and this can be very confusing. This is especially common in lower back pain, when stiff, inflamed or strained lower back muscles which connect to the nerves in the lower back, irritate these nerves. You may then experience both types of pain at the same time in your lower back, in the nerves themselves and the surrounding and connected muscles.
· Location and pattern: nerve pain can be felt anywhere in the body that has a nerve supply. Nerve pain will be felt in the area of the body that is supplied by a particular nerve.
Muscle pain is usually felt as a more diffuse pain, which can be referred from other parts of the body, and is typically felt in the soft (muscular) parts of the body rather than the joints.
· Duration and triggers: nerve pain may be triggered by an unusual movement such as bending or lifting something heavy, as well as unexpected triggers like stress, or nothing at all. This may be felt immediately in relation to a task, or unexpectedly when doing absolutely nothing! Muscle pain usually occurs after exercise that your body isn’t quite used to, or more than you’re used to. You may experience muscle pain a few hours later, or only days later. If a muscle is strained due to cold muscles and an exaggerated movement, you will probably experience immediate pain which may be quite sharp, followed by a second, dull, achy kind of pain.
· Associated symptoms: nerve pain is often accompanied by numbness, which may be a serious cause for concern – see your pain specialist as soon as possible. This numbness may also be referred – for example, you may have irritated a nerve in the neck, but feel numbness in your arm, or irritated a nerve at the bottom of the spine but feel numbness in one or both legs.
Diagnostic Tips: How to Self-Assess Your Pain
There are several important questions to ask yourself, and signs to look out for in both nerve and muscle pain. Rest and movement affect each type of pain differently, so make sure that you know what’s happening - preferably get a diagnosis in the next few days from a pain practitioner - before taking any action.
There are a few ways to see if you have muscle injury or muscle pain:
· You can test mobility and strength with a gentle movement or slight resistance, such as moving your foot if you feel pain in your ankle and comparing it to the other side. Pain or weakness indicates that you have muscle pain, rather than nerve pain.
· If basic or “normal” movements such as getting up from a chair create a dull or throbbing ache or pain, this is also a good indicator of muscle pain.
· If your pain responds to simple analgesia, heat or massage, it is most likely muscle pain.
If you think you may have a nerve issue:
· For neck or shoulder pain: tilt your head towards the painful side, and if this causes increased pain, radiating pain, tingling or numbness, you may have a pinched nerve.
· Rotate your wrist outwards and stretch to the side. If you experience a burning or tingling pain down your arm, this could be nerve pain.
· Touch your skin in the affected area. If it’s extremely sensitive to your touch or to changes in temperature, it might be a nerve issue.
· If your pain gets worse with movement, this may be a sign of nerve pain, or if it does not respond to simple analgesia in the way you would expect.
When to See a Doctor Immediately
Signs that you should see a Doctor urgently include persistent numbness, weakness, or sharp, shooting, immediate pain after a specific movement or injury. It is vital to get a professional diagnosis as quickly as possible to avoid incurring longer term or recurring pain or mobility problems.
· If pain lasts longer than a week and doesn’t improve with rest and over-the-counter medications
· Swelling, warmth, or inflammation around the sore muscle, which might indicate infection
· Rash, especially a “bull’s eye” looking rash
· Fever
When to go to an emergency room
· Difficulty breathing or swallowing
· Dizziness
· Extreme muscle weakness, paralysis, or inability to move a limb.
· Severe, sudden pain after an injury
· Strange shape in or around the muscle
· Reduced urination or any bowel disfunction
· Vomiting and fever along with muscle pain
Treatment Options Overview
Whether you have muscle pain or nerve pain, it’s important to first get a clear diagnosis from a professional healthcare provider.
They may prescribe rest, medication, or physical therapy, or a combination of these. In certain cases of nerve pain, a minimally invasive nerve block procedure might be suggested.
For very minor muscle pain resulting from overuse, usually rest, ice, elevation and compression should help the pain ease off. However, if pain continues after a few days, you should seek professional medical care, preferably from a pain practitioner.
Preventing Nerve and Muscle Pain
Identifying types of pain can be difficult, especially when you’re in pain – so rather prevent both types as much as you can! There are many great small “hacks” you can incorporate into your daily life that may help fend off both types of pain quite effectively.
Avoid Tobacco and Limit Alcohol Strictly
Nerves and muscles may be damaged with excessive drinking and smoking.
Get a Good Night’s Sleep
Our cells regenerate during sleep – so make sure you’re getting enough quality sleep every night (6 – 9 hours; anything below 6 hours has the potential to interfere with the healing process).
Exercise Regularly
Nerve function, blood flow, and reduced inflammation are just some of the benefits of exercise – helping to prevent muscle and nerve pain. If you’re already in pain, try low-impact exercise such as walking, cycling, and swimming. Balancing, weight and resistance training are essential parts of your workout routine.
Warm Up, Cool Down, and Progress Exercise Gradually
The extra 5 – 10 minutes of warmups and cool downs are truly worth it – as you’ll prevent nerve irritation and muscle strains. Increase your exercise amount and intensity gradually and with awareness of your body.
Move Your Body throughout the Day
Sitting is the new smoking! Move your body in bits throughout the day. Humans were designed to move, not sit still for hours on end. So, here’s your newest excuse to take regular breaks! Add some stretching and small bouts of exercise. Recent studies indicate that getting up and doing 10 squats every 45 minutes levels out blood sugar levels very well (better than going to the gym at the end of a long day of sitting).
Make Good Posture and Ergonomics a Habit
Did you know that maintaining good posture can help prevent nerve irritation and muscle pain? Try to check in with yourself about your posture regularly and incorporate ergonomic devices as much as possible.
Prioritise an Anti-Inflammatory Diet
Following an anti-inflammatory diet, which is similar to the Mediterranean diet (whole grains, fruit, leafy vegetables, lean proteins and some natural fats) has shown positive results for both nerve and muscle pain.
Stay Hydrated
Nerve and muscle health are optimised by good hydration.
Get Enough Vitamin B
B vitamins are helpful in maintaining nerve health.
Manage Weight and Diabetes
Avoid additional pressure on the nerves and muscles by maintaining a healthy weight. Those with diabetes need to keep strict control of their blood sugar levels to prevent neuropathy.
Keep Stress at Bay
Stress can contribute significantly to inflammation and muscle tension. Try mindfulness meditation, breathing exercises, and incorporate relaxing activities you enjoy into your schedule.
Monitor for Early Symptoms and Seek Prompt Care
Muscle weakness, tingling, numbness or persistant pain mean it’s time to visit your healthcare practitioner. Timely diagnosis and treatment can go a long way in avoiding future pain. Foot checks are essential for those with diabetes or neuropathy.
Prevent Infections and Injuries
The shingles vaccine can reduce the risk of post-herpetic neuralgia. If you experience reduced sensation in your feet, make sure to wear good footwear when walking, running or working out.
FAQs
Q: Can nerve pain go away on its own?
A: Sometimes, but it depends on the injury or cause. Nerve injuries heal very slowly, and chronic nerve pain (pain lasting longer than 4 - 6 weeks) may seem to go away and then come back.
Q: How long does muscle pain last?
A: Delayed onset muscle soreness (DOMS) which is the muscle pain you might have after exercise, usually starts 12 to 24 hours afterwards, peaking between 24 and 72 hours, and subsiding within 5 days at longest. This is usually a normal response to exercise that was a bit different or more intense than your usual activity. Muscle strains can take weeks to months to heal, depending on severity.
Q: Is numbness always a sign of nerve damage?
A: While it isn’t always a sign of nerve damage (it could also be circulatory problems, vitamin deficiencies, or certain systemic illnesses). However, it is the most common. Severe or persistent numbness is definitely a reason to check in with your pain management team.
It can be stressful and confusing to try and figure out our chronic pain. The Pain Collective is here to help.
Call 087 550 0644 or email info@healthcollectiveheal.com for an appointment at any clinic – we have numerous locations all over the Western Cape, as well as clinics in Johannesburg, Gqeberha, and Mbombela.