Nerve Pain vs. Muscle Pain

Core differences

• Source

  • Nerve pain: Damage/irritation of peripheral or central nerves (radiculopathy, neuropathy, post‑herpetic, etc.).​

  • Muscle pain: Injury, overuse, strain, or trigger points in muscle or tendon; primarily nociceptive/myofascial.​

• Pain quality

  • Nerve: Burning, electric, shooting, stabbing, “shock‑like,” or with allodynia/hyperalgesia.​

  • Muscle: Dull, aching, sore, crampy, or tight; may be throbbing with overuse or strain.​

Pattern and distribution

• Location and spread

  • Nerve: Often follows a dermatome or nerve distribution; classically radiating (e.g., down leg in radiculopathy).​

  • Muscle: Usually localized to the involved muscle or muscle group; referred pain arises from trigger points but still maps to myofascial patterns, not dermatomes.​

• Temporal pattern and triggers

  • Nerve: Can be spontaneous, disproportionate to visible tissue injury, often persistent and worse at night; may be provoked by spinal motion that tensions/compresses the nerve.​

  • Muscle: Often clearly linked to exertion, acute strain, or posture; typically improves over days with rest and gentle stretching unless there is significant structural damage.​

Associated symptoms and exam

• Sensory phenomena

  • Nerve: Paresthesias (tingling, pins‑and‑needles), numbness, dysesthesias; possible sensory loss or altered temperature/pain perception.​

  • Muscle: Stiffness, tightness, and local tenderness; paresthesias are uncommon unless there is secondary nerve involvement.​

• Motor findings

  • Nerve: True weakness in the myotomal distribution, possible reflex changes, sometimes atrophy in chronic lesions.​

  • Muscle: Pain‑limited strength but normal neuro exam; focal tenderness or taut bands/trigger points that reproduce local and referred pain with palpation in myofascial pain.​

Response to maneuvers and treatment

• Provocative/relieving factors

  • Nerve: Neural tension tests (e.g., SLR, Spurling) may reproduce radiating symptoms; stretching the limb often worsens nerve pain.​

  • Muscle: Stretching and gentle movement often relieve minor muscle pain; direct pressure on a strained area is painful but does not cause dermatomal radiations or neuro symptoms.​

• Medication responsiveness

  • Nerve: Often only partially responsive to simple NSAIDs/acetaminophen; may need agents like gabapentinoids, SNRIs, TCAs, or topical lidocaine/capsaicin.​

  • Muscle: Typically improves with NSAIDs, Ibuprofen, Acetaminophen, rest, ice/heat, and physical therapy/manual techniques; trigger point therapies for myofascial pain.​