Neuropathic pain


Neuropathic pain

Description, Causes and Risk Factors:

Alternative Name: Neuralgia.

Abbreviation: NP.

Pain initiated or caused by a primary lesion or dysfunction in the nervous system.

Types of pain may include:

Nociceptive pain: This is the type of pain that all people have had at some point. It is caused by actual, or potential damage to tissues. For example, a cut, a burn, an injury, pressure or force from outside the body, or pressure from inside the body (for example, from a tumour) can all cause nociceptive pain. The reason we feel pain in these situations is because tiny nerve endings become activated or damaged by the injury, and this sends pain messages to the brain via nerves. Nociceptive pain tends to be sharp or aching. It also tends to be eased well by 'traditional' painkillers such as paracetamol, anti-inflammatory painkillers, codeine and morphine.

Neuropathic pain: This type of pain is caused by a problem with one or more nerves themselves. There is often no 'injury' or tissue damage that triggers the pain. However, the function of the nerve is affected in a way that it sends pain messages to the brain. Neuropathic pain is often described as burning, stabbing, shooting, aching, or like an 'electric-shock'.

The types of nerve damage that cause neuropathic pain have diverse etiologies. These include infections, trauma, metabolic abnormalities, chemotherapy, surgery, radiation, neurotoxins, nerve compression, inflammation, and tumor infiltration. Theoretically, neuropathic pain is principally, if no exclusively, dependent on dysfunction of the unmyelinated (C-type) and thinly-myelinated axons.

Causes and risk factors may include:

    Peripheral neuropathic pain syndromes.

  • Chemotherapy-induced neuropathy.

  • Complex regional pain syndrome.

  • HIV sensory neuropathy.

  • Neuropathy secondary to tumor infiltration.

  • Painful diabetic neuropathy.

  • Phantom limb pain.

  • Postherpetic neuralgia.

  • Postmastectomy pain.

  • Trigeminal neuralgia.

  • Central neuropathic pain syndromes.

  • Central poststroke pain.

  • Multiple sclerosis pain.

  • Parkinson disease pain.

  • Spinal cord injury pain.

  • Alcoholism.

  • Drug and chemical induced.

Neuropathic pain can occur at any age, but affects older people more frequently than younger people. Damage to the nerves can change a person's sense of touch and can limit arm and leg movement.

Symptoms:

Common symptoms may include:

    Shooting and burning pain.

  • Tingling and numbness.

Specific symptoms may include:

    Allodynia: Pain produced by a usually non-painful stimulus.

  • Hyperalgesia: Extreme sensitivity to painful stimuli.

  • Paresthesia: Abnormal skin sensations (as tingling, tickling, itching or burning) usually associated with peripheral nerve damage.

  • Dysesthesias: Spontaneous or evoked unpleasant sensations,such as an annoying sensationelicited by cold stimuli or pinprick testing.

  • Hyperpathia: A delayed and explosive pain responseto a noxious stimulus applied to thesymptomatic area.

Diagnosis:

A doctor will conduct an interview and physical exam. He or she may ask questions about how you would describe your pain, when the pain occurs, or whether anything specific triggers the pain.

A thorough physical examination and neurological examination can help determine where the lesion is and asses nonneuropathic contribution to the patient's pain most commonly musculoskeletal, inflammatory, myofascial, and psychological processes.

Laboratory tests may include:CBC with differential, sed rate (sedimentation rate), chem profile, thyroid, B12, folate, fasting blood sugar, glycohemoglobin, protein electrophoresis, Lyme titers, Hepatitis B/C, HIV, Anti-nuclear, Sjogren's titers, Anti-neutrophil cytoplasmic antibodies (ANCAs), Rheumatoid factor, cryoglobulins, Anti-sulfide antibody titers, Anti-Hu titers, heavy metal - serum/urine screens, CSF for demylinating diseases & meningeal carcinomatosis, biopsies Dx for vasculitis, amyloidosis, sarcoidosis.

Treatment:

The treatment of neuropathic pain is challenging, in part because of its multiple etiologies, symptoms, and underlying mechanisms. The treatment specifically tailored for you can help you better manage your pain. You want to discuss all of your options with your medical team to determine what sort of treatment program is right for you. Depending on your specific needs, physicians, psychologists, or physical therapists may be involved in your treatment program.

Pharmacological treatment options may include:

Medications are given to decrease pain and discomfort. You may discuss with your medical team which medications you need. Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) decrease mild-to-moderate pain and inflammation for a short period of time. Medications such as tricyclic antidepressants (TCAs) like amitriptyline, nortriptyline, and desipramine help decrease pain and also help with sleep and mood. Capsaicin and Lidocaine cream may be prescribed to soothe skin sensitivity and relieve pain. Take medications only after consulting with your doctor. Other treatments such as transcutaneous electrical nerve stimulation (TENS) may be used in selected circumstances.

Other treatment options may include:

    Increasing physical activity.

  • Using cognitive-behavioral strategies and stress management techniques to help with mood and functioning.

  • Managing stress.

  • Improving your blood pressure.

  • Quitting smoking, alcohol, and tobacco.

  • Lowering your blood sugar levels.

Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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