Neuropathic Pain

What is Neuropathic Pain

Neuropathic pain is pain caused by damage to the nerves that are responsible for certain sensations in your body (sensory nerves). The pain can be caused by:

  • Damage to the sensory nerves that send signals to your spinal cord and brain (peripheral nervous system).
  • Damage to the sensory nerves in your brain or spinal cord (central nervous system).

Neuropathic pain can make you more sensitive to pain. Even a minor sensation can feel very painful. This is usually a long-term condition that can be difficult to treat. The type of pain differs from person to person. It may:

  • Start suddenly (acute), or it may develop slowly and last for a long time (chronic).
  • Come and go as damaged nerves heal, or it may stay at the same level for years.
  • Cause emotional distress, loss of sleep, and a lower quality of life.

What are the causes?

The most common cause of this condition is diabetes. Many other diseases and conditions can also cause neuropathic pain. Causes of neuropathic pain can be classified as:

  • Toxic. This is caused by medicines and chemicals. The most common cause of toxic neuropathic pain is damage from cancer treatments (chemotherapy).
  • Metabolic. This can be caused by:
    • Diabetes. This is the most common disease that damages the nerves.
    • Lack of vitamin B from long-term alcohol abuse.
  • Traumatic. Any injury that cuts, crushes, or stretches a nerve can cause damage and pain. A common example is feeling pain after losing an arm or leg (phantom limb pain).
  • Compression-related. If a sensory nerve gets trapped or compressed for a long period of time, the blood supply to the nerve can be cut off.
  • Vascular. Many blood vessel diseases can cause neuropathic pain by decreasing blood supply and oxygen to nerves.
  • Autoimmune. This type of pain results from diseases in which the body’s defense system (immune system) mistakenly attacks sensory nerves. Examples of autoimmune diseases that can cause neuropathic pain include lupus and multiple sclerosis.
  • Infectious. Many types of viral infections can damage sensory nerves and cause pain. Shingles infection is a common cause of this type of pain.
  • Inherited. Neuropathic pain can be a symptom of many diseases that are passed down through families (genetic).

What increases the risk?

You are more likely to develop this condition if:

  • You have diabetes.
  • You smoke.
  • You drink too much alcohol.
  • You are taking certain medicines, including medicines that kill cancer cells (chemotherapy) or that treat immune system disorders.

What are the signs or symptoms?

The main symptom is pain. Neuropathic pain is often described as:

  • Burning.
  • Shock-like.
  • Stinging.
  • Hot or cold.
  • Itching.

How is this diagnosed?

No single test can diagnose neuropathic pain. It is diagnosed based on:

  • Physical exam and your symptoms. Your health care provider will ask you about your pain. You may be asked to use a pain scale to describe how bad your pain is.
  • Tests. These may be done to see if you have a high sensitivity to pain and to help find the cause and location of any sensory nerve damage. They include:
    • Nerve conduction studies to test how well nerve signals travel through your sensory nerves (electrodiagnostic testing).
    • Stimulating your sensory nerves through electrodes on your skin and measuring the response in your spinal cord and brain (somatosensory evoked potential).
  • Imaging studies, such as:
    • X-rays.
    • CT scan.
    • MRI.

How is this treated?

Treatment for neuropathic pain may change over time. You may need to try different treatment options or a combination of treatments. Some options include:

  • Treating the underlying cause of the neuropathy, such as diabetes, kidney disease, or vitamin deficiencies.
  • Stopping medicines that can cause neuropathy, such as chemotherapy.
  • Medicine to relieve pain. Medicines may include:
    • Prescription or over-the-counter pain medicine.
    • Anti-seizure medicine.
    • Antidepressant medicines.
    • Pain-relieving patches that are applied to painful areas of skin.
    • A medicine to numb the area (local anesthetic), which can be injected as a nerve block.
  • Transcutaneous nerve stimulation. This uses electrical currents to block painful nerve signals. The treatment is painless.
  • Alternative treatments, such as:
    • Acupuncture.
    • Meditation.
    • Massage.
    • Physical therapy.
    • Pain management programs.
    • Counseling.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do not drive or use heavy machinery while taking prescription pain medicine.
  • If you are taking prescription pain medicine, take actions to prevent or treat constipation. Your health care provider may recommend that you:
    • Drink enough fluid to keep your urine pale yellow.
    • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
    • Limit foods that are high in fat and processed sugars, such as fried or sweet foods.
    • Take an over-the-counter or prescription medicine for constipation.

Lifestyle

  • Have a good support system at home.
  • Consider joining a chronic pain support group.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
  • Do not drink alcohol.

General instructions

  • Learn as much as you can about your condition.
  • Work closely with all your health care providers to find the treatment plan that works best for you.
  • Ask your health care provider what activities are safe for you.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • Your pain treatments are not working.
  • You are having side effects from your medicines.
  • You are struggling with tiredness (fatigue), mood changes, depression, or anxiety.

Summary

  • Neuropathic pain is pain caused by damage to the nerves that are responsible for certain sensations in your body (sensory nerves).
  • Neuropathic pain may come and go as damaged nerves heal, or it may stay at the same level for years.
  • Neuropathic pain is usually a long-term condition that can be difficult to treat. Consider joining a chronic pain support group.
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