What are the treatment options for a pinched nerve

Assume the nerve is not pinched at the spine but is pinched in the muscles, bones, ligaments, tendons, etc outside of the spine.

What treatment options are there? Can things be divided into two treatment camps:

  1. Untrap/unpinch the nerve
  2. Symptom management of a nerve that will remain trapped

Or are there other factors?

My impression is conservative treatment involves things like various forms of physical therapy, stretching regimens, exercises, various massage therapies, etc. to help loosen up the tissue around the nerve to untrap it. Also avoiding putting pressure on it (bad ergonomics, tight clothes, carrying items improperly, etc). Last resort is usually surgery to remove the compression, move the nerve and/or create a channel.

For symptom management you may have prescription meds (neurontin, elavil, etc), topical treatments (capsacian, lidoderm, etc), supplements (B vitamins, lipoic acid, etc), TENS units, etc.

What does cortisone injection do? Does that reduce inflammation enough to take pressure off the nerve? Does cortisone ever untrap a nerve, or is that a temporary fix?

I’m sure there are a lot of other therapies to deal with a pinched nerve. I’ve read botox is used in some cases (I’m sure in a next to last resort case), and radio ablation to kill the nerve, or actually cutting it in severe cases (where permanent numbness is better than chronic severe pain).

There is a therapy I heard of recently, Ultrasound hydrodissection. they use ultrasound to find where the nerve is pinched, and then they stick a needle to the entrapped point and inject a few ml of saline water which untraps the nerve and allows it to glide.

What if the nerve is scarred? Does anything break up the scar tissue? Are there any treatments where they free a trapped nerve, then wrap it (where it is scarred and entrapped) in some kind of biofilm to help with conductivity and prevent entrapment in the future?

What other options are there, and is there a standard ‘do A first, if that fails do B, if that fails do C’ methodology? Also does it matter which nerve is entrapped and where or is the treatment methodology pretty much the same?

If there is scarring on a nerve, can the scars be broken up and the nerve rebuilt?

Has anyone ever excised the part of a nerve that is trapped and scarred, then replaced it with a new piece of nerve tissue?

I’m sure there are many other treatment options, what else is there?

It seems you’ve already googled this.

I have two herniated disks and sciatica and so far have kept chronic pain to between zero and a dull roar with exercising, staying active and thin, and very infrequent as-needed steroids and/or narcotic pain meds. About every 2-3 years I get a nuclear episode where I cannot dress myself or potty without help :eek: but so far, that’s only lasted a few days each time and steroids plus narcotics have helped a great deal.

I also have frequent numbness, pain and peripheral neuropathy in my hands and arms due to my trade as a painting contractor/decorative painter and plasterer. Again, there are some very simple exercises that I’ve found effective. As in, I start getting the burning-shooting pain and numbness so I do these exercises for a few days and it goes away. Before I figured out exercises could do the trick, the symptoms drove me to braces, doctors and chiropractors (none of which really did much for me.)

Also deep-tissue massage from a properly-qualified practitioner as needed; I swear by that and have done so for over 20 years. WAY cheaper than medical/chiropratic intervention, plus it feels so good.

I’m 56 and have been dealing with these issues for about 20 years and so far have avoided surgery or long-term medical treatments while at the same time remaining quite physically fit and generally pain-free. I have no experience or knowledge of anything more invasive than what I’ve outlined. YMMV and IANOD.

That link isn’t very thorough though. I know its Mayo Clinic and all, but they barely cover 1/4 of the treatment options I’ve come across in researching this issue. The treatments they do promote like NSAIDs generally don’t work that well on nerve pain. No mention of gabapentin, TENS units, topical analgesics, hydrodissection, radio ablation, etc.

It seems like the treatment options are all divided over the internet. I probably need to join a forum like neurotalkdevoted to this stuff.