If your nervous system is not functioning properly or is damaged, neuropathic pain may occur. You can feel pain from any of the various levels of the nervous system—the peripheral nerves, the spinal cord, and the brain. The central nervous system consists of the spinal cord and brain. The peripheral nerves are those that run throughout your body, reaching places such as organs, arms, and legs.
Damaged nerve fibers send wrong signals to pain centers. As a result, the nerve function and central sensitization may be affected by nerve damage.
Neuropathy refers to a disorder of function or a change in the nerves. Diabetes is the cause of about 30% of cases of neuropathy. It is difficult to determine the cause of neuropathic pain. However, this type of pain is associated with many diseases.
Symptoms & Causes
What are some possible causes of neuropathic pains?
Many conditions can cause neuropathic pain, including:
- Nerve problems in the facial area.
- HIV infection or AIDS.
- Multiple sclerosis and other disorders of the central nervous system (stroke, Parkinson’s, etc.
- Complex regional pain syndrome.
- Shingles. Postherpetic neuralgia is a form of shingles pain that persists after you have had your bout.
There are also other causes:
- Drugs used in chemotherapy (cisplatin and paclitaxel; vincristine
- Radiation therapy.
- Amputation can cause phantom pain.
- Inflammation or compression of the spinal nerve
- Traumas or surgeries that result in nerve damage.
- Nerve compression and tumor infiltration
What Are The Symptoms Of Neuropathic Pains?
Neuropathic pain can present with many symptoms. These symptoms may include:
Spontaneous pain occurs without stimulation.): Stabbing, shooting, burning, or electric shock-like pain; numbness, tingling, or a “pins and needles” feeling.
Evoked pain: Pain brought on by typically non-painful stimuli s like pressure, cold, gentle brushing against skin, or gentle friction. Allodynia is the name for this condition. Evoked pain can also refer to the induction of pain by normal painful stimuli like heat and pinpricks. This type of pain is called Hyperalgesia.
Dysesthesia is a painful, unusual sensation that can be evoked or spontaneously (dysesthesia).
Problems sleeping and emotional issues due to sleep disturbances and pain.
Pain that may be lessened in response to a normally painful stimulus (hypoalgesia).
DIAGNOSIS and TESTS
What Is The Diagnosis Of Neuropathic Pain?
Your healthcare provider will conduct a complete medical history and perform a physical exam. Next, your provider will identify typical symptoms of neuropathic pain if they suspect you have a nerve injury. Then, the provider will investigate the cause and track down the symptoms.
There are many possible causes of peripheral neuropathy. Therefore, a physical exam may also include blood tests. Usually, the diagnosis requires:
Your complete medical history. Your doctor will examine your medical history. This includes your symptoms, lifestyle, exposures to toxic substances, and family history of neurological (neurological).
Neurological examination. Your doctor may examine your tendon reflexes and muscle strength, tone, and ability to feel certain sensations.
Your doctor may ask you to perform the following tests:
- Blood tests. These tests can detect vitamin deficiencies, diabetes, abnormal immunity function, and other signs of conditions that could cause peripheral neuropathy.
- Imaging tests. CT and MRI scans can detect herniated disks, pinched nerves, tumors, or other abnormalities affecting blood vessels or bones.
- Nerve function tests. To detect nerve damage, electromyography (EMG) records the electrical activity of your muscles. To measure electrical activity in the muscle, an electrode is inserted (thin needle).
An EMG technician or doctor may also perform an electromyogram. Usually, this is after a nerve conduction study. A low current electric current is applied to the skin using flat electrodes. Your doctor will take a detailed record of the nerve responses to the electric current.
For additional nerve function tests, you might be able to take an autonomic screen, which records the function of your autonomic nerve fibers, or a sweat test. This test measures your body’s sweat production, as well as sensory tests, which record how you feel heat, vibration, touch, and vibration.
Nerve biopsy. This involves removing a small amount of a nerve (usually a sensory nerve) to examine for abnormalities.
Skin biopsy. To check for nerve endings, your doctor may remove a small amount of skin.
What is the Treatment For Neuropathic Pain?
The treatment goals are to treat the neuropathy and to alleviate symptoms. However, your doctor may recommend that you wait to see if there is an underlying condition.
Bring a friend or family member along to your appointment to help you remember what treatment is suggested for you.
Here are some questions you should ask your doctor about peripheral neuropathy.
What is the most likely reason for my symptoms?
- Do you think there are other causes?
- What are the tests I need?
- Is the condition temporary?
- Which treatments are you familiar with, and what do they recommend?
- What side effects should I expect?
- Is there another approach to your primary suggestion?
- I also have other medical conditions. How do I manage them all together?
- What restrictions should I make?
- Do you have brochures or any other printed material that I could use? Which websites would you recommend?
Ask any questions you may have.
The treatment goals are:
It is essential to address the underlying cause of the problem (e.g., radiation or surgery to shrink tumors pressing on nerves).
- Provide pain relief
- Maintain functionality.
- Increase your quality of life
- For neuropathic pain, multimodal therapy is often required. This includes medication, physical therapy, and sometimes surgery.
The doctor often prescribes Anti-seizure medications to treat neuropathic pain.
- Carbamazepine (Tegretol(r)).
- Gabapentin (Neurontin(r)).
- Lamotrigine (Lamictal(r)).
- Pregabalin (Lyrica)
- Topiramate (Topamax(r).
Doctors also prescribe antidepressants.
- Amitriptyline (Elavil(r).
- Duloxetine (Cymbalta(r)).
- Nortriptyline (Pamelor(r).
- Venlafaxine (Effexor(r).
Your doctor may prescribe anti-seizure medication or antidepressants. However, this does not necessarily mean that you are having seizures or are depressed. Anxiety and depression can make chronic pain worse.
To the affected area, you can apply topical treatments such as capsaicin or lidocaine–creams, patches, or ointments. The effectiveness of opioid analgesics in treating neuropathic pain is less. They may also have side effects that could prevent them from being used for a long time.
Pain specialists can also inject steroids, local anesthetics, or other medications into the nerves to treat it.
If you have neuropathic pain and have not responded to any of the above therapies, spinal cord stimulation, peripheral neurostimulation, or brain stimulation can be used.
In addition to medications that treat peripheral neuropathy conditions, medications that relieve symptoms and signs of peripheral neuropathy include:
Pain relievers. Mild symptoms can be relieved with nonsteroidal anti-inflammatory drugs and over-the-counter medications. For more severe symptoms, your doctor might prescribe painkillers.
Tramadol (Conzip), Ultram, and others can cause dependence and addiction. Therefore, these drugs are generally not prescribed unless the other treatments have failed.
Anti-Seizure Medications. Gabapentin (Neurontin, Gralise, Horizant) and pregabalin [Lyrica] are medications produced to treat epilepsy. They may help ease nerve pain. Side effects include dizziness and drowsiness.
Topical Treatments. Capsaicin cream is a compound found in hot peppers that can help to treat peripheral neuropathy symptoms. However, the cream can cause skin irritation and burning, which usually subsides with time. In addition, some people can’t tolerate the cream.
Lidocaine patches can be applied to your skin and may provide pain relief. However, side effects include dizziness, numbness, drowsiness, and dizziness around the patch site.
Antidepressants. Tricyclic antidepressants such as amitriptyline and doxepin (Silenor and Zonalon), Nortriptyline, and Pamelor are known to relieve pain by interfering in the chemical processes that cause pain in your brain.
It is possible to ease peripheral neuropathy pain caused by diabetes using the serotonin and norepinephrine reuptake inhibitor duloxetine.
Antidepressants can cause dry mouth, dryness of the lips, dizziness, nausea, drowsiness, and dizziness.
Some treatments and procedures help to alleviate the symptoms and signs of peripheral neuropathy.
- Transcutaneous electrical nerve stimulation (TENS). The skin is stimulated by gentle electrical currents delivered at different frequencies through electrodes. For approximately a month, TENS should be used for 30 minutes each day.
- Plasma exchange and intravenous immunoglobulin. These procedures can help suppress immune system activity and may be beneficial for people suffering from certain inflammatory conditions.
- Plasma exchange is the process of removing blood from your body, then removing any antibodies or other proteins and returning them to you. Immunoglobulin therapy is a treatment that uses high levels of proteins to create antibodies.
- Physical therapy. Physical therapy is an excellent option for muscle weakness. A cane, walker, or hand brace may be necessary.
- Surgery. Surgery may be required if you suffer from neuropathies due to nerve pressure, such as tumor pressure.
People with external neuropathy may try complementary therapies to find relief. These therapies are promising, even though researchers have not studied as extensively as other medications.
- Acupuncture. The use of thin needles to insert into different points on the body may reduce symptoms of peripheral neuropathy. It may take several sessions to see improvement. When performed by a licensed practitioner, acupuncture is considered safe.
- Alpha-lipoic Acid. This treatment has been used in Europe for many years to treat peripheral neuropathy. Talk to your doctor about alpha-lipoic acids as they can affect blood sugar levels. Side effects include skin rash and stomach upset.
- Herbs. Some herbs, like evening primrose oil, might reduce neuropathy pain for people with diabetes. You should discuss any herbs with your doctor as they can interact with medication.
- Amino acids. People who have had chemotherapy or have diabetes might benefit from amino acids such as acetyl L-carnitine. Side effects include nausea and vomiting.
Lifestyle and Home Remedies
To help you manage peripheral neuropathy:
- Diabetes patients should take extra care of their feet. Every day, check for calluses, blisters, and cuts. Soft, loose socks made of cotton and padded shoes are recommended. To keep your feet cool and protected from the sun, you can purchase a semicircular hooped sold in medical supply shops.
- Exercise. Walking three times per week can help reduce neuropathy pain, increase muscle strength, and control blood sugar. Gentle activities like yoga or tai-chi may also be beneficial.
- Stop smoking. Smoking cigarettes can cause circulation problems, leading to foot problems and other neuropathy complications.
- Healthy eating is vital. It is essential to eat healthy meals. Include fruits, vegetables, and lean proteins in your diet.
- Avoid excessive alcohol. Excessive alcohol can exacerbate Peripheral neuropathy.
- Monitor your blood glucose levels. This will keep diabetes under control and may improve your neuropathy.
What Are The Prospects For Patients With Neuropathic Pains?
Although it can be challenging to manage, neuropathic pain is not usually life-threatening. Combining rehabilitation with support for your mental, emotional, and social wellbeing will yield the best results. With the assistance of a pain specialist, you will be able to manage your pain to the degree that improves your quality of life.