Neuropathic pain, also referred to as neuralgia, occurs when the nerves in the body begin to send faulty pain signals. This is what you should know if you’re suffering from this type of pain, as well as treatments that can help.
What Is Neuropathic Pain?
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In the U.S., nearly 10% of adults over the age of 30 suffer from neuropathic pain. Neuropathic pain can originate from any nerve in the body. Common symptoms include:
- Tingling (“pins and needles”) sensations
- Difficulty sensing temperatures
Even things like your clothes brushing against the affected area can spark pain signals. It’s as if your nerves have lost the ability to tell what hurts and what doesn’t.
What Are Common Neuropathic Pain Causes?
The root cause of neuropathic pain is damage to the nerve itself. This can occur due to trauma or injury to the nerve. There are also other medical conditions that can cause nerve damage.
There are four main types of neuropathic pain.
- Central neuropathy: Neuropathic pain that originates from the central nervous system (the brain and the spinal cord)
- Peripheral neuropathy: Affecting nerves in the limbs, hands, and feet (which are controlled by the peripheral nervous system)
- Focal neuropathy: This type affects only a single nerve in the head, hand, torso, or leg
- Mixed neuropathy: Mixed neuropathy also has elements of pain from a specific type of injury (not just nerve damage)
These different types of pain have roots in a variety of causes. Some of these causes include the following:
- Chronic alcoholism
- Amputation of a limb
- Herpes zoster infection (shingles)
- Spinal surgery
- Problems in the back, hips, or legs
- Chemotherapy drugs
- Certain infections (such as HIV or AIDS)
- Multiple sclerosis
- Problems with the facial nerve
- Various other nerve conditions
Do I Have Neuropathic Pain?
The first step in treating neuropathic pain is getting a proper diagnosis. In many cases, this can be challenging. Symptoms are sometimes vague and fleeting. There may be no clear beginning of pain or known cause. The first diagnostic tool is always collecting a medical history. This helps your doctor gather as much information as possible.
Your doctor might also use a pain scale to assess your pain. They might also ask you to keep a pain journal to identify triggers and to track pain.
After the medical history, a physical examination is important. This helps determine if you are struggling to differentiate between sensations (e.g., hot/cold and sharp/dull).
If after these examinations a nerve injury is suspected, your doctor may order a nerve conduction study. This tracks electrical activity in the nerves to see if they are responding (and how well).
Additional testing may be ordered, including blood work to look for nutritional deficiencies. This also helps rule out other chronic medical conditions. Your doctor may also order imaging studies to check for lesions in the spinal cord or other possible causes of your pain.
Neuropathic Pain Treatments That Can Help
Finding neuropathic pain treatments can be challenging. Traditional over-the-counter pain and anti-inflammatory medications may not work for neuropathic pain.
Proper neuropathic pain treatment starts with identifying the underlying cause, if possible. Once this occurs, your doctor can evaluate what damage can be reversed. Nerves are remarkably resilient, and can, in some cases, heal and regenerate. This process can take months or even years, but it is possible for some people.
If your nerve damage cannot be reversed or effectively managed, you have many treatment options available. You may a combination of these approaches to manage your pain. Always talk to your doctor before starting any treatment regimen.
Tricyclic antidepressants have shown positive results treating pain related to the following conditions:
- Diabetic neuropathy
- Post-mastectomy pain
How antidepressants work for pain is not well understood, but for patients with these forms of neuropathic pain they can provide profound relief.
It’s important to note that antidepressants are not generally effective for neuropathic pain associated with phantom limb pain, pain related to cancer, chronic lumbar root neuropathic pain, pain related to chemotherapy treatment, or pain related to HIV infection.
Another type of antidepressant, serotonin-norepinephrine reuptake inhibitors (SNRIs), have been studied for treating neuropathic pain. These medications are considered first-line treatment options for pain related to diabetic neuropathy and fibromyalgia.
In most cases, opioids are not used as treatment for neuropathic pain. The potential for serious side effects outweighs any benefits for most patients. However, studies have shown that they can be effective in the short-term for the treatment of diabetic peripheral neuropathy, post-herpetic neuropathy, painful polyneuropathy, and phantom limb pain.
Another medication, tramadol, is similar to opioids and has shown positive results for the treatment of diabetic neuropathy, post-herpetic neuropathy, painful polyneuropathy, and phantom limb pain. Tramadol has a lower risk of dependence than typical opioids and is also less sedating.
For localized pain relief, topical agents (e.g., topical lidocaine and capsaicin) are used in gel or patch form.
The use of Botox (botulinum toxin type A) is another option in the treatment of neuropathic pain. A study in 2017 found good results in the treatment of intractable pain related to diabetic neuropathy, trigeminal neuralgia, and spinal cord injury.
Chronic pain conditions are frustrating for both patients and their doctors. Neuropathic pain can be particularly challenging because getting a diagnosis can take a while, and the road to healing is long and uncertain.
At Pain Doctor, we are committed to helping you find the cause of your neuropathic pain and walking on that road with you.
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