The ever-elusive Neuropathic Pain

Often, we hear this term neuropathic pain. But what is it exactly? 

Neuropathic pain is pain caused by damage to nerves or problems with the nervous system. People with neuropathic pain typically describes the pain to be: 

  • Sharp 
  • Burning 
  • Tingling 
  • Stabbing 

The pain may be present all the time, it also can come and go. It usually is worse at night and at rest. For certain patients, the pain can be excruciating when gently touched. 

 The pain brought about by the condition can be so severe, it affects the daily lives of patients. It may affect their sleep, appetite, restrict movement, etc. While for some patients the condition may just “disappear”, in others, it can last for months or even years. With severe pain over long period of time, it’s not surprising that some of these patients eventually develop anxiety and depression. 

 

The root cause 

There are many causes of neuropathic pain. Here are some examples: 

  • Post-herpetic neuralgia: After recovering from shingles, which is a viral infection on nerve roots, patients may develop neuropathic pain as a consequence of damage to the nerves. 
  • Diabetic Neuropathy: As diabetics develops and continues to be uncontrolled, high concentrations of blood sugar can cause damage to nerve cells resulting in neuropathic pain. 
  • Stroke: During a stroke, part of the brain is damaged and blood flow is blocked causing neuropathic pain 
  • Direct damage to nerves: Severe burns or any physical damage to nerves may leave the victim with neuropathic pain. This includes damage which occurs from surgery. A condition known as Phantom Limb Syndrome can occur after surgical amputation of a limb. Even though the limb has been amputated, the body does not recognize that, and feels as though the amputated limb is in pain. 

 Even though there are many known causes of neuropathic pain, sometimes doctors are also at a loss to what is the cause of the pain in certain patients.  

 

Hit-andMiss 

There are treatments available for neuropathic pain which includes medications and adjuvant (or “add on”) therapies. However, treatments can be a hit-and-miss as different patients respond very differently to different types of treatment. Therefore, treating the pain can be tricky. That is why it may take your doctor several attempts before getting the right medication and treatment strategy that work for you. 

 

Types of medications 

Although there are several types, or classes of medications used to treat neuropathic pain, most of them are used to treat other conditions as well. Please don’t be surprised when you find out what other conditions these medications are for. For example: 

  • Medications for depression: These medications work on the areas of the brain that process pain. Being prescribe this does not mean you are depressed.  
  • Medications for seizures: Seizure is caused by overactivity of the brain; hence these medications reduce the activity, thereby reducing neuropathic pain. 
  • Opioids: The is a group of very strong pain medications which includes morphine. This is not routinely used but may be used in cases of severe pain. 
  • Anaesthetics: Anaesthetics are medicines that numb the body and may come in the form of a spray or cream. 

 

Adjuvant Therapies 

Adjuvant (or “add on”) therapies may also help in reducing neuropathic pain. They work hand-in-hand with medications and may be synergistic in effect.  

 Examples of such therapies include: 

  • Physical Therapy: Pain rehabilitation techniques are proven clinically to be useful in addition to medications. 
  • Counselling: Psychosocial support and cognitive behavioural therapy with a clinical psychologist is also useful in coping with neuropathic pain. 
  • Acupuncture: There is positive evidence, even though not very strong, to indicate that acupuncture relieves neuropathic pain 
  • Devices affecting nerve signals: Devices that provide Transcutaneous Electrical Nerve Stimulation (TENS) have been shown to reduce neuropathic pain in several small-scaled studies. 

 

Self-help 

There are also several things that a patient my do to relieve some of the pain 

  • Relaxation exercise such as listening to classical music and deep breathing exercises help alter how the mind perceives pain 
  • Staying active can help in coping with pain 
  • Hot or cold pack might be useful, but always check with your doctor to make sure it is safe for you before trying 

 

Lastly, if you do feel depressed (read about the signs and symptoms here), make sure you seek help from your doctor or healthcare provider. Many patients who have long-term neuropathic pain succumb to depression. Furthermore, treating depression can also assist in coping with pain. 

 

 

References:  

  1. Kasper D, Harrison T. Harrison’s Principles of internal medicine. New York: McGraw-Hill Education; 2015. 
  2. Cheing GL, Luk ML. Transcutaneous electrical nerve stimulation for neuropathic pain. J Hand Surg Br. 2005;30(1):50-5. 
  3. Akyuz G, Kenis O. Physical therapy modalities and rehabilitation techniques in the management of neuropathic pain. Am J Phys Med Rehabil. 2014;93(3):253-9. 
  4. Korhan EA, Uyar M, Eyigör C, Hakverdioğlu yönt G, Çelik S, Khorshıd L. The effects of music therapy on pain in patients with neuropathic pain. Pain Manag Nurs. 2014;15(1):306-14 
  5. Effects of Acupuncture on Neuropathic Pain: A Systematic Review and Meta-analysis. Available at: http://www.neurology.org/content/84/14_Supplement/P3.306. Accessed September 18, 2017. 
  6. Patient education: Neuropathic pain (The Basics) [Internet]. uptodate.com. 2017 [cited 18 September 2017]. Available from: https://www.uptodate.com/contents/neuropathic-pain-the-basics 
Pou Wee Gan
Pou Wee Gan

M.Pharm, MBBS, BCPS, R.Ph

A pharmacist first, then a medical doctor. An avid tea drinker and an occasional poet.

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