Neuropathic Pain and Neuralgias
Neuropathic Pain and Neuralgias
Neuropathic pain and neuralgias are pains that arise due to various nerve damages in the body. This damage can be caused by trauma, systemic diseases like diabetes, microbial diseases, and sometimes pains of unknown cause can occur in the form of neuralgia. The main causes of neuropathic pain include:
- Inflammation
- Infections like shingles
- Cancer chemotherapy
- Radiation therapy
- Surgery
- Nerve compression due to tumors
- Pressure on nerves emerging from the spinal cord (like disc herniation)
- Diabetes, thyroid diseases, anemia
- Spontaneous age-related or genetic nerve disorders
- Brain damages like strokes.
Neuropathic pain often feels different from many other types of pain. It is frequently described with words like sharp, throbbing, burning, or feeling like an electric shock. It can intensify at night and can be continuous, like after a stroke or in diabetes. In conditions like trigeminal neuralgia and sciatic pain, it can come and go.
Types of neuropathic pain include:
Allodynia: Pain arising from stimuli which normally do not provoke pain, like a breeze on the arm or sheets rubbing against the leg.
Hyperalgesia: Increased pain from stimuli that should only produce mild pain. For instance, tapping an arm can feel like touching a hot iron.
Dysesthesia: Uncomfortable sensations that can't be strictly described as pain, like feeling as if the foot is swollen or having a sensation of bugs crawling on the skin.
To determine the cause of pain, X-rays, blood tests, and nerve conduction tests can be conducted. Additionally, a physician may refer you to a neurologist, brain surgeon, or a physical therapy specialist.
Treatment
Most over-the-counter or prescription painkillers do not work for neuropathic pain. Antidepressants and antiepilepsy drugs that stop pain signals to the brain can be used. These can be used alone or in combination with other medications. Their effect starts within days or weeks, so they should be taken regularly to decrease the pain. Even if they can't completely eliminate the pain, they will reduce it to a tolerable level.
Other treatment methods for neuropathic pain include:
- Massage
- Applying heat to the painful area
- Applying cold to the painful area
- Biofeedback (a method that allows controlling body responses through the brain)
- Electronic nerve stimulation devices
- Topical anesthetics like menthol or lidocaine
- Injections of local anesthetics, cortisone, or other drugs to block pain.
Injections into or around the nerve can provide temporary or permanent pain relief, but might also cause numbness in the area. Cortisone injections can also be beneficial by reducing inflammation.
Patients who don't respond to medication may consider interventional methods like nerve blocks at pain clinics.
