CHRONIC NEUROPATHIC PAIN
Neuropathic pain is described as a shooting or burning pain caused by damage or injury to the nerves. The nerves help in transferring information between the brain and spinal cord through the skin, muscles and other parts of the body.
This could happen if the nervous system is damaged or not working efficiently. People could feel pain from any of the multiple levels of the nervous system through the peripheral nerves, the spinal cord and the brain.
Peripheral nerves are spread throughout the body to organs like organs, arms, legs, fingers and toes. The pain does not start abruptly or goes away quickly. It is majorly a chronic condition that leads to constant pain symptoms.
Neuropathic pain is usually contrasted to nociceptive pain that is defined as the type of pain occurring due to an acute injury like smashing a finger with a hammer or stubbing a toe when walking barefoot.
Neuropathic pain is associated with abnormal sensations known as dysesthesia or pain caused by normally non-painful stimuli (allodynia) which may be continuous and/or episodic (paroxysmal) in nature.
CAUSES OF CHRONIC NEUROPATHIC PAIN
Neuropathic pain could be caused due to any disease, an injury, an infection or loss of limb. Chronic neuropathic pain is mainly related to some underlying health condition like cancer or diabetic neuropathy, or due to treatments such as chemotherapy.
- Disease –
Neuropathic pain could be a result of a symptom or complication of several diseases and conditions. The disease would include diabetes, facial nerve problems, HIV infection or AIDS, central nervous system disorders like stroke, Parkinson’s disease, multiple sclerosis, etc., complex regional pain syndrome, shingles and postherpetic neuralgia. Long-term alcohol intake or alcohol abuse leads to many complications, including chronic neuropathic pain. Nerve damage caused from chronic alcohol use or alcohol abuse can have long-lasting and painful effects. Trigeminal neuralgia causes severe neuropathic pain on one side of the face. Cancer treatment like chemotherapy and radiation could also cause neuropathic pain impacting the nervous system and causing unusual pain signals.
- Injuries –
Injuries or problems to back, leg, and hip can cause lasting damage to nerves. While the damage or injuries may heal but the nervous system damage lasts for a long-term. Herniated discs and spinal cord compression could damage the nerve fibers around the spine.
- Infection –
Usually infection does not cause neuropathic pain. However, infections like shingles, syphilis, HIV infection or AIDS might lead to persistent neuropathic pain. Shingles could trigger a neuropathic pain leading to postherpetic neuralgia.
- Limb Loss –
Due to amputation, phantom limb pain syndrome can cause nerve pain. Even after amputation, the brain still receives pain signals from the amputated body part. The nerves at the junction of amputation are misfiring as well as sending corrupted signals to your brain.
Other reasons which could lead to neuropathic pain are vitamin B deficiency, carpal tunnel syndrome, thyroid problems, facial nerve problems and arthritis in the spine. Nerve compression or infiltration due to a tumor could also lead to nerve pain.
SYMPTOMS OF CHRONIC NEUROPATHIC PAIN
Symptoms of neuropathic pain can vary from person to person. Some common symptoms of neuropathic pain are:
- Spontaneous pain – The pain comes without stimulation and is experienced as shooting, burning, stabbing, or electric shock-like pain accompanied with tingling, numbness, or a “pins and needles” feeling.
- Evoked pain – The pain is normally induced as non-painful stimuli like cold, gentle brushing against the skin, pressure, etc. referred to as allodynia. Sometimes the pain may be evoked due to stimuli like pinpricks and heat which is known as hyperalgesia.
- Any chronic unpleasant or abnormal sensation could be spontaneous or evoked (dysesthesia).
- Trouble falling asleep and emotional problems caused due to disturbed sleep and pain.
- Pain decreased in response to a painful stimulus known as hypoalgesia.
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DIAGNOSIS OF CHRONIC NEUROPATHIC PAIN
The diagnosis of neuropathic pain is based on assessment of a patient’s medical history. If underlying nerve damage is suspected, it is confirmed with testing and evaluation through electromyography (NCS/EMG) of the nerves.
In case the neuropathy is suspected it is confirmed with various tests that include blood work for vitamin deficiencies or thyroid abnormalities, as well as imaging studies to exclude a structural lesion impacting the spinal cord.
TREATMENT OF CHRONIC NEUROPATHIC PAIN
The goal of neuropathic pain treatment is to diagnose the underlying disease or condition which is responsible for the pain, and to treat it at the earliest. The doctor would aim to provide relief from pain, maintain capabilities despite the pain, and improve the quality of life.
Most common treatment regime followed for treating neuropathic pain includes:
- Medication – Over-the-counter medications like non-steroidal anti-inflammatory drugs (NSAIDs) like Aleve and Motrin are used to ease off the pain. In severe cases opioids are prescribed with mild doses. Antidepressants like tricyclic antidepressants or serotonin-norepinephrine reuptake inhibitors and anticonvulsants like gabapentinoids are useful in treating pain as well as anxiety by interfering with pain signals and stopping faulty transmissions.
- Cream and ointment – Capsaicin cream is effective in providing relief by absorbing it through the skin helping in reducing the levels of Substance P that is the neuro-transmitter associated with inflammation and pain.
- Lidocaine Patch – It is a local anesthetic patch used to relieve pain associated with postherpetic neuralgia (PHN).
- Implantable Device – This is an invasive procedure that requires a surgeon to implant a device in the patient’s body. The device may be implanted in the brain or in the spine. The device sends electrical impulses into the brain, spinal cord, or nerves that stop the irregular nerve signals and reduce the symptoms.
- Transcutaneous electrical nerve stimulation (TENS) – A TENS machine sends a mild electrical impulse in the body. Electrodes, which are the sticky pads, from the machine are placed on the skin over the area of pain. The stimulation of certain nerve fibres help in blocking signals carrying pain impulses to the brain and spinal cord causing the muscles to relax and ease off the pain.
- Percutaneous electrical nerve stimulation (PENS) – This is helpful in treating severe neuropathic pain (refractory). The procedure involves insertion of an electrode under the skin with the help of a needle instead of a sticky pad (electrode) on the skin. The needles inserted are connected to an electrical stimulator machine that helps in relaxing the nerves and easing the pain.
- Acupuncture – This therapy involves insertion of fine needles at the affected area (specific points/energy channels). This helps in stimulating the nervous system and triggers the body’s own healing response that in turn helps with pain management.
Apart from the above treatments physical therapies, relaxation, and massage therapies are also used to reduce symptoms of neuropathic pain which help in easing the muscles and nerves thus reducing the pain.
Pain is a very complex situation and each person who is affected responds to pain differently. Pain has numerous physical and psychological impacts on the body and individuals could experience fatigue, anxiety, mood changes and depression.
Neuropathic pain could negatively impact the patient’s life. If steps are not taken to treat it on time the symptoms can worsen. A combination of medications, physical therapy, psychological treatment, and even surgery or implants are used to provide the best results.
Neuropathic pain which does not respond to the therapies could be treated with spinal cord stimulation, peripheral nerve stimulation and brain stimulation.
If you or anyone you know is suffering from chronic neuropathic pain, our expert providers at Specialty Care Clinics will take care of your health and help you recover.