I’ve written a few times now about nerve pain and how it confuses treatment. The problems with nerve pain are:

1. Identifying it
2. Finding the root cause

And this is why you can be having the best tennis/golfers elbow treatment, the best carpal tunnel treatment, the best knee and leg pain treatment with no effect. Because it’s actually a problem with the nerve supplying that area not that area itself. The pain comes from somewhere else.

So how do we find that critical “somewhere else”?

Finding the root cause of pain

So, if the pain isn’t coming from where you feel it how do we find it?

1. A thorough clinical, physical assessment – checking not just the painful area but also the areas that can refer pain. This takes a while!
2. Talking to you! I’ve listed before various symptoms which give critical clues that the pain is related to nerves not the location – it jumps/moves, tingling, pins and needles, sharp or searing

Now a key tool in all of this is a system called Dermatomes.

So what’s a Dermatome?

A dermatome is an area of skin that is mainly supplied by a single spinal nerve. There are 30 in total, one for each squishy disc between the bony discs of the spine.

And they follow a general pattern. So if all your pain keeps jumping about in a specific area, or you get tingling or pins and needles across a certain part, breathing difficulties, loss of sensation or a feeling of cold in a particular body part, even a rash, we check to see if these correspond to a dermatome. Then we can use that to identify the nerve affected and check the spine.

So they are an amazingly useful diagnostic tool to identify the root cause of those difficult to treat nerve pain issues. Because if we treat the root cause the symptoms go away.

Dermatomes and Thermal Imaging

One of the biggest tools in my arsenal when it comes to diagnosing and explaining nerve pain is my Thermal Imaging camera. This is because of how the body passes the information to the skin for the camera to “see”.

For a large part the thermal imaging camera reads/sees nerve activity passed to the skin. So, broadly speaking, we see heat in areas of inflammation and cold in areas where there is a lack of nerve function.

You can see a great example here of how we can see whether the pain in the elbow is actually tennis elbow or in fact referred neck pain.

In classic sciatica we would expect to see a lot of heat at the lumbar spine with a corresponding cold patch in the lower legs which mimics the dermatome.

This makes diagnosing and identifying the correct spinal disc to treat easy and painless (traditional nerve function tests are pretty darn uncomfortable!). It also helps you, the patient, understand what’s going on. It can be very difficult to understand, and frustrating when I want to treat your neck but it’s your elbow that hurts, by showing you an image and explaining what’s going on this can often make it easier to understand.