What is Neuropathic Pain? How Is It Treated?

Neuropathic pain is one of the types of chronic pain. Neuropathic pain may develop due to disease, injury or infection, but it is not a direct result of these causes.

Pain typically occurs due to an illness or injury. For example, if we hit our foot against a hard surface, we will feel pain right after. In neuropathic pain, the pain is not due to such an event, the body produces pain signals on its own. Burning, stinging pain may be felt. Pain can be continuous or random. Decreased sense of touch or numbness are other symptoms that often accompany it. Complaints may worsen or decrease over time.

It is estimated that 10% of the population has neuropathic pain complaints.

What Causes Neuropathic Pain?

Diseases

Neuropathic pain can occur in various diseases. Multiple sclerosis, multiple myeloma, cancer are some of them. Diabetes is responsible for 30% of all neuropathic pain cases. People with diabetes may complain of complaints such as loss of feeling, numbness, pain, burning, and tingling in their hands and feet. Long-term excessive alcohol consumption can also cause neuropathic pain by causing damage to nerve tissues. Some cancer treatments (chemotherapy, radiotherapy) may cause similar complaints by affecting the nerves.

injuries

Injuries to muscles, joints, nerves or soft tissues can cause neuropathic pain. Injuries to the lower back, neck, arm or leg can lead to nerve damage. Lumbar-neck hernias can compress the spinal cord or nerve roots. Although soft tissues heal, the healing capacity of nerve structures is lower. As a result, pain persists even years after the injury.

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Infection

HIV-AIDS, syphilis, shingles are infections that can cause pain in the form of burning, tingling.

Amputation

A rare cause of neuropathic pain is phantom limb syndrome, which can be seen in amputees who have lost an arm or leg. Although the brain no longer exists, it thinks it receives pain signals from the part of the lost limb. This may be because the nerve fibers close to the amputated part send an incorrect signal to the brain or changes in the brain. In addition to the arm and leg, phantom pain may also be felt for a finger, ear or another lost body part.

Other Causes

  • Vitamin B deficiency
  • Nerve compressions
  • Thyroid diseases
  • problems with facial nerves
  • Spinal diseases

Symptoms

  • Burning, throbbing or tingling pain
  • tingling or numbness, pins and needles
  • Self-starting pain unrelated to any cause
  • Pain caused by things that should not normally cause pain, such as friction of clothing, light touch, cold air.
  • Persistent feeling of discomfort or abnormality
  • Difficulty sleeping and resting
  • Psychological problems related to chronic pain

Diagnosis

The diagnosis of neuropathic pain is made by questioning the complaints and physical examination. There are some standardized questionnaires and screening tests for this purpose. The person is questioned in terms of risk factors. To investigate the cause, further investigations such as blood examination, imaging methods (X-ray, MRI, USG, etc.), electromyography (EMG) may be required.

Treatment

The first step in treatment is to identify and, if possible, treat the underlying disease. Apart from this, various drug treatments, physical therapy and alternative methods are available to relieve pain.

  • Simple pain relievers (paracetamol, non-steroidal anti-inflammatory drugs)
  • Pain relief creams and plasters (lidocaine, capsaicin, etc.)
  • opioid pain relievers
  • Antidepressant drugs (tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors)
  • Antiepileptic drugs (gabapentin, pregabalin)
  • Nerve blocks (injections containing local anesthetic and steroids can be done around the nerve fiber thought to be responsible for the pain)
  • Implants (spinal cord stimulators)
  • Lifestyle changes (adjustments in work and home environment)
  • Physical therapy (massage, electrical stimulation, exercise)
  • Other methods (acupuncture)
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