What clinical features suggest that a pain is neuropathic? The following clinical features are most helpful in supporting a suspicion that a given pain state is neuropathic: • Perhaps most notably, neuropathic pain is usually associated with signs and symptoms of sensory loss, although that sensory loss may be modest or restricted to small fiber (thermal …
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What are the postulated mechanisms for pathology in the pathways that lead to neuropathic pain? Experimental evidence exists for multiple mechanisms of neuropathic pain, and different mechanisms may be relevant in different neuropathic pain conditions. These mechanisms can include peripheral sensitization, central sensitization, deafferentation pain, and alterations in descending pain modulation. • Peripheral nerve disease may …
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What are the neuroanatomic pathways involved in pain? Physiologic pain transmission begins with nociceptors, which are peripheral axons whose terminals transduce real or potential tissue injury. Cutaneous nociceptors, for example, are small myelinated or unmyelinated axons equipped with surface receptors that transduce real or potential skin injury into neuronal discharges, thus initiating a cascade of …
Are there any new treatment options in the pipeline for neuropathic pain Transcranial magnetic stimulation (TMS) is an intriguing option that utilizes a magnetic field to alter brain activity, as a noninvasive alternative to surgical DBS. TMS was approved by the FDA in 2008 for treatment of major depression and is now being explored for …
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Dorsal root entry zone lesioning and deep brain stimulation for neuropathic pain Dorsal root entry zone (DREZ) lesioning involves a neurosurgeon exposing the spinal canal via a laminectomy and inserting a small probe under a microscope to destroy dorsal horn cells of the spinal cord via radiofrequency ablation. The procedure has had promising results in …
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Invasive techniques for spinal cord stimulation Spinal cord stimulation (SCS) includes percutaneous placement of electric leads or surgical placement of a “paddle” lead in the posterior epidural space. The leads are secured in place and tunneled under the skin to a pulse generator implanted subcutaneously. The device sends electric impulses to the spinal cord with …
specific exercise techniques that may be useful. Yoga and Tai Chi, an Eastern art that involves slow and deliberate relaxation and balance techniques, are becoming increasingly popular in the treatment of neuropathic pain. Yoga has been studied specifically in multiple sclerosis and has shown benefit in fatigue level and other MS symptoms. Studies on Tai …
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