Neuropathic Pain : Causes, Treatment, and Medication

Overview

A shooting or burning pain that is often chronic, unrelenting, and sometimes severe may indicate neuropathic pain. It is often the result of nerve damage or miscommunication between nerves. Neuropathic pain is typically caused due to trauma or the body sending unprompted pain signs to the brain.Damage to the nerve can affect the site of the injury and the areas around it. The pain progressively worsens. The symptoms may be mild to severe. 

The blog explains neuropathic pain, its types, symptoms, causes, diagnosis, and various treatment options. 

What is neuropathic pain?

As mentioned earlier, neuropathic pain is an onset of shooting or burning pain that is constant and chronic. It occurs due to trauma to the nerve or malfunctioning of the nervous system that sends unprompted pain signals to the brain. Neuropathic pain progressively worsens. The severity of the pain differs among patients.

The patient may experience a flare-up without notice and at any time. A feeling of numbness or sensation loss is also a neuropathic pain symptom. Nerve damage in the central or peripheral nervous system causes neuropathic pain. 

What are the types of neuropathic pain?

.When there is damage in one nerve is called mononeuropathy, and when several nerves are damaged is called polyneuropathy. There are several types of neuropathy, and they are as follows:

1. Peripheral neuropathy: It affects the body’s extremities, including feet, legs, arms, and hands.
2. Autonomic neuropathy: this type of neuropathic pain affects the nerves that monitor the internal organs and regulates essential functions, including breathing and digestion. 
3. Focal neuropathy: A single nerve in the head, hand, torso, and leg is affected. It is known as focal neuropathy. Bell’s palsy is a classic example of this disorder, which causes sudden pain and paralysis on one side of the face. 
4. Diabetic neuropathy: As the name suggests, it is caused due to diabetes. It damages the blood vessels supplying oxygen and nutrients to the nerve, thus decreasing the functionality of the nerve. 
5. Compression mononeuropathy refers to an injury to a single nerve due to compression on the nerve or a blood vessel disease. When the blood vessel is narrow, it restricts blood flow to the nerves resulting in improper functioning of the nerve. Constant strain and injury cause compression in the nerves as they pass through the joint or tight passage in the body. Carpal tunnel syndrome is one example of compression mononeuropathy. 
6. Phantom limb syndrome is a type of neuropathic pain in which the person experiences sensation or pain in the missing limb. The patient experiences burning, prickling, or shooting pain. Nearly 80% of patients who have undergone amputation experience phantom limb syndrome, as the brain and spinal cord send mixed signals to the limb. The patient may experience symptoms for close to six months, which may reduce after a year.
7. Trigeminal neuralgia: when there is compression or damage to the trigeminal nerve, it causes trigeminal neuralgia. It results in severe pain while performing daily tasks, such as brushing the teeth and washing the face. 
8. Postherpetic neuralgia: It is a complication of shingles and typically affects the areas in the body that are affected by shingle rashes. Nearly 18% of shingles patients develop postherpetic neuralgia, and older adults with shingles experience it.
9. Thoracic or lumbar radiculopathy is a type of mononeuropathy affecting one or both sides of the chest or abdominal wall. Diabetic patients often develop thoracic or lumbar radiculopathy .

What are the symptoms of neuropathic pain?

Each patient experiences the symptoms differently. Some patients experience mild pain, whereas others experience severe pain. The following are some of the common symptoms of neuropathic pain:

1. Sudden onset of pain caused without any stimulation. This pain can be shooting, burning, stabbing, or electric shock-like pain. Sometimes, patients experience a sense of tingling, numbness, or a feeling of pins and needles.
2. Pain that occurs with non-painful stimuli. These stimuli include gentle touch on the skin, pressure, and many others. Such pain is known as allodynia. However, evoked pain may also mean increased pain for painful stimuli, such as pinpricks and heat. These are known as hyperalgesia. 
3. Dysesthesia means an unpleasant and abnormal sensation due to spontaneous or evoked pain stimuli
4. Emotional issues due to troubled sleep and pain
5. Mottled or red skin
6. Severe itchiness
7. Changes in pain that are linked to the weather
8. Depression
9. Anxiety

When to seek medical help?

Patients should seek immediate medical help if they notice any neuropathic pain symptoms.

Request an appointment at Apollo Hospitals        

What are the causes of neuropathic pain?

Neuropathic pain can be caused by diseases, including:

• Alcoholism.
• Diabetes.
• Facial nerve problems.
• HIV infection or AIDS.
• Central nervous system disorders (stroke, Parkinson’s disease, multiple sclerosis, etc.)
• Complex regional pain syndrome.
• Shingles. (Pain that continues after your bout with shingles ends is called postherpetic neuralgia.)

Other causes include:

• Chemotherapy drugs (cisplatin, paclitaxel, vincristine, etc.).
• Radiation therapy.
• Amputation, which can cause phantom pain.
• Spinal nerve compression or inflammation.
• Trauma or surgeries with resulting nerve damage.
• Nerve compression or infiltration by tumors.

What are the risk factors of neuropathic pain?

The following are the risk factors of peripheral neuropathy:

1. Poorly controlled diabetic levels
2. Alcohol abuse
3. Vitamin B deficiency
4. Infections, including Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, and HIV
5. Autoimmune diseases, such as lupus and rheumatoid arthritis
6. Disorders of the kidneys, liver, or thyroid
7. Exposure to toxins
8. Family history of neuropathic pain
9. A constant and repetitive motion

How is neuropathic pain diagnosed?

Your healthcare provider will take a medical history and do a physical exam. If your provider knows or suspects you have nerve injury, they will recognize typical neuropathic pain symptoms. Your provider will then try to find the underlying cause of the neuropathy and trace the symptoms. 

What are the treatment options for neuropathic pain?

Treating the underlying disease, providing pain relief, maintaining nerve functionality, and improving the quality of life are some treatment goals. Doctors generally recommend multimodal therapy to treat neuropathic pain. The following are the treatment options:

1. Medications:  Several medications help relieve the signs and symptoms of neuropathic pain. The following are the medications prescribed by the doctor: 

• Pain relievers: Mild symptoms need over-the-counter medicines, such as nonsteroidal anti-inflammatory medication. However, severe symptoms need stronger painkillers. Sometimes, when other treatment options fail, the doctor prescribes medicines containing opioids, including tramadol or oxycodone. However, knowing that such medication results in addiction and dependency are vital. 
• Anti-seizure medications: medications that treat epilepsy, sometimes may help relieve pain. The medicines include gabapentin, pregabalin, topiramate, carbamazepine, and lamotrigine. Drowsiness and dizziness are a few side effects of anti-seizure medicines. 
• Antidepressants: Medicines used to treat depression can also alleviate nerve pain. These medications include tricyclic antidepressants, amitriptyline, nortriptyline, duloxetine, venlafaxine, venlafaxine, and desvenlafaxine. Antidepressant medications cause side effects, such as dry mouth, nausea, drowsiness, lightheadedness, changes in appetite, weight gain, and constipation.
• Topical treatments: Applying topical creams that contain substances present in hot peppers may relieve symptoms. However, it causes a burning sensation and irritation at the site – some people tolerate it, while others do not. Lidocaine patches also help in pain relief. Drowsiness, dizziness, and numbness at the patch side are the side effects of lidocaine patches. 
• Nerve blocks: Sometimes, doctors prescribe nerve block injections, local anaesthetics, and other medication that temporarily blocks nerve pain. These injections need to be administered regularly.

2. Therapies: Numerous procedures and therapies help relieve symptoms of neuropathic pain. The following are the therapies:

• Transcutaneous electrical nerve stimulation (TENS): Several electrodes are placed on the skin that sends tiny electric current at different intervals and frequencies. 
• Plasma exchange and intravenous immune globulin: Such procedures help suppress the immune system in patients with inflammatory conditions. 
• Physical therapy: Doctors may recommend physical therapy for patients with muscle weakness. Physical therapy improves movement. Patients may require hand and foot braces, a cane, a walker, or a wheelchair.

3. Surgery: If the neuropathic pain is due to pressure on the nerve, including pressure from a tumour,  surgery may relieve the pressure. 
4. Implantable devices: If a patient hasn’t responded to any treatment options, the doctor recommends implanting devices. These are embedded into the body through surgery. The procedure is invasive, and the device is inserted in the brain or the spinal cord. These devices send tiny electric shocks to stop irregular nerve signals and prevent the symptoms from worsening. 
5. Lifestyle treatment: The doctor may recommend several physical, relaxation, and massage therapies to relieve neuropathic pain symptoms. These treatment options help relax muscles. For instance, if a neuropathic pain patient experiences increased symptoms after sitting for several hours, it becomes challenging to perform a desk job. A therapist may help patients by teaching them techniques to comfortably sit, stretch, stand, and move, preventing pain.

However, it is vital to note that neuropathic pain often doesn’t respond well to standard pain treatments and may occasionally worsen over time. For some patients, the pain may cause severe disability. A multidisciplinary approach with therapies may help relieve neuropathic pain in such cases.

What are the complications of neuropathic pain?

Sometimes, peripheral neuropathy pain can cause severe medical issues, including foot ulcers, changes in heart rhythm, gangrene, and blood circulation problems. Complications vary based on the underlying cause of peripheral neuropathic pain. 

Conclusion: 

Neuropathic pain is debilitating and can be constant. A few lifestyle changes, medication, therapies, and a healthy diet can help keep the pain under control and prevent the disorder from worsening. 

Frequently Asked Questions (FAQs)

What are the lifestyle changes that help manage peripheral neuropathic pain?

The following are lifestyle remedies that help in managing peripheral neuropathic pain:

• Diabetic patients should take care of their feet to prevent getting injured
• Stay fit and continue regular exercise
• Quit smoking
• Include healthy meals
• Say no to excessive alcohol consumption
• Regularly monitor blood sugar levels