Neuropathic Pain

27th November 2006 at 11:26 GMT by Dr.C.A.Jenner MB BS, FRCA. Permalink.

Article on the clinical features and treatment of Neuropathic Pain

Introduction

Neuropathic pain is a complex, chronic pain state, most often accompanied by a tissue injury. According to various studies, neuropathic low back pain affects an estimated 5.6 million people in the US. The condition is typically characterized by a burning and shooting pain, along with a feeling of tingling and numbness.

The term gets its origin from ‘neuro’ which means nerves in Greek, and ‘pathy’, which means abnormality. In general, pain experts classify the physical causes of pain into two types, the nociceptive and the neuropathic pain.

The nociceptive pain is time limited and results from sprains, bone fractures, burns, bumps, bruises and inflammation. On the other hand, the neuropathic pain is chronic and occurs in reference with the abnormal functioning of the central nervous system.

Forms of Neuropathic Pain

The most common forms in which neuropathic pain manifests itself include:

• Postherpetic neuralgia
• Reflex sympathetic dystrophy/nerve trauma
• Components of cancer pain
• Phantom limb pain
• Entrapment neuropathy (.e.g. carpal tunnel syndrome)
• Peripheral neuropathy (vast nerve damage)

Shooting or lancinating pain, burning pain, paraesthesia, dysaesthesia, numbness and allodynia (pain produced by a non-painful stimulus) are the most prominent characteristics of neuropathic pain.

Causes of Neuropathic Pain

Neuropathic pain is the result of an injury or malfunction of or pathological changes in the peripheral or central nervous system. Dysfunction of the nervous system is the chief cause of occurrence of neuropathic pain.

On an average, neuropathic pain occurs because of one of the below:

• Alcoholism
• Amputation
• Back, leg and hip problems
• Chemotherapy
• Diabetes / Diabetic neuropathy
• Facial nerve problems
• HIV infection or AIDS
• Multiple sclerosis
• Shingles
• Spine surgery

Neuropathic Pain – Therapeutic Options

Most of the time, neuropathic pain presents itself as a chronic condition and tends to respond poorly to conventional forms of treatment. On the contrary, it may respond quite well to the anti-seizure and antidepressant medications.

Though experts stress that neuropathic problems are not fully reversible, yet partial improvement is often possible. In addition, the patient group of the neuropathic lower back pain is often difficult to define in clinical practice.

Once diagnosed, physicians prescribe the drugs commonly prescribed by for neuropathic pain, for the treatment of neuropathic lower back pain as well. However, research also indicates that for the next five years gabapentin, NSAIDs, opioids and antidepressants will remain the mainstay of management of neuropathic lower back pain.

Here, we briefly outline the main treatment forms prescribed for the neuropathic pain, in general:

• Anti-convulsant medication, such as carbamazipine, gabapentin, pregabalin
• Tri-cyclic anti-depressants, such as amitriptyline, dothiepin, clomipramine
• Anti-spasmodics, such as baclofen, diazepam
• NSAIDs, such as non-steroidal anti-inflammatory drugs
• Trans Electrical Nerve Stimulation (TENS)
• Opioids, capsicum cream
• Acupuncture, reflexology, aromatherapy, homeotherapy
• Bio-feedback/relaxation