NEUROPATHIC PAIN CAUSES AND TREATMENT OPTIONS

According to the International Association for the Study of Pain, neuropathy is defined as a “pain initiated or caused by a primary lesion or dysfunction of the nervous system”. Neuropathy can be caused by any disease or injury to the nervous system. Neuropathy pain is a broad category including many types of causes, characteristics, symptoms, and treatment options. Of course, regardless of how it happened, the common symptoms of neuropathy include numbness, tingling, itching, burning, subjective change in temperature, and sensitivity to pain. Many times this pain occurs with only a touch. The symptoms can happen continuously, intermittently, or any combination. Other symptoms include stiffness, tightness or swelling, sleep disorders, and fatigue. There also may be signs of neurologic damage, like tremors or muscle atrophy.

The type of neuropathy depends on the mechanism behind it. Sometimes it is an underlying disease like diabetes. It could be the site of the lesion, like the peripheral nerve or spinal cord. Other times it is another mechanism. Classifying neuropathy is a complicated process based on expert opinion, anatomy, duration, presumed cause, body system, severity, and presumed mechanism. No one of these can be the all in all only standard. Diagnosis results from trying to understand the underlying disease or dysfunction.

In the United States, it is estimated that 1.5% of the general population suffers from neuropathy. That is not including those who are cancer or diabetic patients. More than 3 million people suffer from painful diabetic neuropathy and 1 million have postherpetic neuralgia.

CAUSES AND RISK FACTORS

Some underlying causes of neuropathy include trauma, endocrine, neurologic dysfunction, autoimmune, or infectious disease. Along with these are associated risks for getting the condition. Here are some:

  • Smoking, an age greater than 40 years, longstanding diabetes mellitus, and uncontrolled glucose levels are rick factors for getting diabetic neuropathy.
  • Age greater than 50, acute severe pain, rash, sensory impairment, psychological distress, or prodrome are risk factors to getting postherpetic neuralgia.
  • Female sex, older age, multiple sclerosis, and females with hypertension are risk factors for trigeminal neuralgia.

NATURAL COURSE OF NEUROPATHY

Chronic neuropathy pain follows its own course when it comes to presentation, duration, and pain characteristics. It also depends on the mechanism or underlying cause. The usual course of neuropathy is a slow and steady progression of pain and other manifestations of the condition. Sometimes symptoms level off over the course of months or years. Other times it may worsen. Patients with neuropathy have to be reevaluated consistently to determine if the increased pain is due to the progression of the underlying disease or if there is a new set of conditions bringing on the increased pain symptoms. Pain seems to worsen if the underlying disease worsens.

DIAGNOSIS

When diagnosing neuropathy, doctors perform a thorough examination and review a comprehensive medical history of the individual.  The patient’s systems are reviewed and appropriate diagnostic laboratory studies completed. Great attention must be placed on any neurologic abnormalities. Any diagnostic tests are justified during the initial examination and completed. While most of this is focused on the physical state of the patient, the total well-being of the person must be taken into consideration. The roles of mind, body, and person have to be accounted for and treatments depend on identifying certain psychosocial factors.

TREATMENTS FOR NEUROPATHY SYMPTOMS

Treatment for neuropathic pain includes pharmaceutical and non-pharmaceutical agents. There is not just one solution to the problem. If analgesics are chosen, they come with their own set of side-effects and may prove ineffective for many individuals. Non-pharmaceutical treatments include exercise, transcutaneous electrical nerve stimulation (TENS), massage, and acupuncture.

There are other over-the-counter, alternative, and complementary medications for treating neuropathic pain but most of these have not been extensively studied. Prescription drugs seem to be the treatment of choice, with a variety that uses different mechanisms of action. Some are antidepressants, antiepileptics, and local and topical anesthetics.

The general goal of these treatments is to decrease pain symptoms by 50%. This would be considered a “very much improved” score. Even a 30% pain reduction would be considered as clinically important.

Personally, I like the non-pharmaceutical treatments. They are non-invasive and have no side-effects. However, they have not been extensively studied in their relation to helping neuropathic pain so they have to be approached with caution. On the other hand, exercise is beneficial for most anyone who wants to maintain a healthy lifestyle. Massage is bound to help anyone who suffers from muscle pain or other pains. Acupuncture has been exalted in the Eastern cultures for medicinal properties. It would be a good treatment to try but do give it a few times before reaching conclusions about the procedure. TENS seems to help in coping with pain.

Neuropathy is a condition that is very complicated with no easy solutions to the condition. However, once diagnosed, you and your doctor can team up together to implement a combination of treatments that can greatly improve neuropathic symptoms and help give you a quality lifestyle.

 

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