Neuropathic pain is a type of pain that is caused by an injury of the nervous system. It can also be caused by infections such as herpes or disease conditions such as diabetes, or it may result from a nervous system dysfunction. Moreover, the pain may be accompanied by oedema and sweating, changes in the local blood flow or changes in the tissue such as atrophy or osteoporosis.
This specific type of pain is caused when a ”short circuit” alters the nerve signals that will be abnormally interpreted in the brain. This can cause a burning sensation and other extremely painful sensations accompanied by neuropathic pain, which is classified as on eof tje main types of chronic pain.
The disease does not respond well to the usually treatment of pain relief and it is therefore necessary to resort to centrally action analgesics, anticonvulsants and antidepressants.
What are the symptoms?
Neuropathic pain is an intense pain that is felt in the nerves of the body and it can be accompanied by a burning sensation, shocks and hypersensitivity to touch. It, may also be accompanied by tingling and numbness of the region that has its nervous path compromised. However, it may involve more than one nerve and this can lead to widespread pain which can further affect the trunk, legs and arms.
The pain can also be accompanied by an exaggerated sensitivity to stimuli that does not usually cause any pain; such as contact with clothing or other objects. The pain may persist even after removal of the painful stimulus.
Pain can be intermittent or continuous and its intensity can vary from mild to very intense, depending on the cause and the nerves that are involved.
Causes of neuropathic pain
Neuropathic pain can be caused by several factors such as:
- Alcoholism or nutritional deficiency, which affect nerve function significantly
- Diabetes mellitus, which mainly affects the limbs, causing peripheral diabetic neuropathy
- Problems in facial nerves
- Thyroid problems
- Infections by bacteria or viruses, such as syphilis, herpes or AIDS which can affect the nerves by releasing toxins
- Spinal cord trauma caused by accidents, fractures or surgeries
- Amputation of a limb, in which the pain arises due to the missing limb, known as phantom limb pain
Moreover, chemotherapy and diseases such as multiple myeloma and multiple sclerosis can also result in neuropathic pain.
How the diagnosis is made
There are various symptoms that help to distinguish between neuropathic pain but they are not sufficient in confirming the diagnosis. Therefore, it is very important to consult with the doctor, who will make inquiries so as to know the level of the pain, when it occurs and the intensity at which it is felt. With that, he will be able to perform a physical evaluation or neuromuscular tests so as to determine which neurological regions have been affected.
What is the treatment?
Neuropathic pain usually heals by itself but in case it des not heal, there are treatments that can be prescribed to relieve one of the pain that comes with it. Treatment depends on the underlying disease that causes the neuropathic pain and it consists of treating the disease or the nerve, hence relieving the pain.
Drugs that can be used include Carbamazepine, Gabapentin or Pregabalin, which act by decreasing the electrical activity of the nerves or inhibiting the passage of pain through certain nerve pathways. Also, centrally acting analgesics such as Tramadol and Tapentadol, can be used as they act by calming the pain and decreasing the electrical activity of the nerves. Anti depressants such as Amitriptyline and Nortriptyline, work by not only relieving pain but also reducing depression, as this is common in people who experience pain in the chronic phase.
Physiotherapy, occupational therapy and the use of electrical and thermal stimuli can also be used to improve physical function and to help the patient gain functionality. In more severe cases of neuropathic pain, surgery may be an option.