What is Neuropathic Pain?
When damage or dysfunction is caused to the nervous system, the nerves are unable to function properly and may cause pain. This is called neuropathic pain. The pain stems from the nerves inability to transmit sensations to the brain, resulting in a sense of numbness or lack of sensation altogether. Sometimes, a person experiences pain in the affected area.
Pain can arise from any level of the nervous system – peripheral nerves, the spinal cord, or the brain. The wrong signals are sent from damaged nerve fibers and the nerve functions may change once damaged. Neuropathy is defined as a disturbance of function or a change in nerves. While the source of neuropathic pain is not always determined, approximately 30% of cases are caused by diabetes.
Causes of Neuropathic Pain
There are multiple reasons why patients develop neuropathic pain. When certain neurotransmitters are released at an increased rate, along with the inability of the nerves to regulate the signal, these changes may lead to a painful sensation in the affected area.
When the spinal cord interprets these changes in neurotransmitters and experiences a loss of normally-functioning cells, there is a perception of pain. This happens even when there is a lack of external stimulant. The brain can lose its ability to block pain following an injury or trauma like a stroke.
Over time, further cell damage occurs in all these areas and the sense of pain continues.
There are a myriad of sources that can trigger neuropathic pain, including:
- Chemotherapy medications
- Complex Regional Pain Syndrome
- HIV or AIDS
- Facial Nerve Problems
- Nerve Compression
- Central Nervous System Disorders (Multiple sclerosis, Parkinson’s disease, etc.)
Signs and Symptoms
Identifying neuropathic pain is difficult because few, if any, signs are commonly present. Patients may describe their symptoms as dull, sharp, hot, cold, sensitive, itchy, burning, or any other descriptor of pain. There may be pain when pressure is applied or even a light touch. Many people experience pain in their feet, legs, or upper extremities. Because the hands and feet are typically affected, symptoms are frequently described as being in a “stocking-glove distribution.” The symptoms may vary.To help identify how much pain a patient is experiencing, physicians may use a visual scale or a numeric scale. The Wong-Baker FACES pain scale rating assists patients who may have a difficult time orally describing their pain.
Experiencing chronic pain is the most common complaint in patients with neuropathic pain. Due to the intricacies of diagnosing this pain, it is possible to continue for weeks or even months before a patient seeks medical attention.
The goals of treatments is to ultimately treat any underlying condition or disease and provide pain relief. This will result in a higher quality of life and maintaining functionality that may have been lost due to pain.
Treatment options may include:
- Multimodal Therapy: medicines, physical therapy, psychological treatments and sometimes surgery are used to treat neuropathic pain.
- Nerve Blocks: Injections are administered by pain specialists. These include steroids, local anesthetics, or other medicines
Spinal cord stimulation is a possible option for pain that has not responded to the therapy.