On Your Last Nerve: Diagnosing and Treating Neuropathic Pain
It is safe to say that every one of us has experienced some type of pain before. Whether we’ve broken a bone, cut our finger, or burned ourselves on the oven, we have inevitably felt the sting of what is known as nociceptive pain—the most common type of pain, caused by tissue damage. However, there is another category of chronic pain as well, called neuropathic pain.
Neuropathic pain is different from the everyday pain that might be caused by a small injury. Nociceptive pain is the result of nerves recognizing harmful stimuli in the environment and sending electrical signals to the brain that lead to the sensation of pain. Neuropathic pain, on the other hand, occurs when our nerves become damaged in some way, typically after an injury, and can no longer function properly. These neurons then send incorrect pain signals to the brain, typically resulting in shooting, stabbing, or burning sensations of pain.
But how does one’s nerves become damaged in the first? There are many ways in which nerve damage can occur, or conditions from which neuropathic pain can result as a side effect. Some of the most common causes are alcoholism, amputation, chemotherapy, diabetes, facial nerve pain, HIV infection, or shingles. With so many ways in which neuropathic pain can develop, it is no surprise that quite a significant portion of the population may experience it; research has indicated that as many as 1 in 10 adults over the age of 30 suffer from some type of neuropathic pain.
But sometimes, it can be difficult to recognize neuropathic pain, especially because it is possible for it to occur simultaneously with nociceptive pain. However, if you suspect that you may be suffering from neuropathic pain, you should consult your doctor immediately. Diagnosing neuropathic pain most often includes the conduction of an interview and a physical exam, and perhaps supplementary blood and nerve tests to assess any nerve damage.
Luckily, those that are experiencing neuropathic pain have a variety of treatment options and procedures that are available to them. The first thing to be considered is whether there is an underlying cause of the neuropathic pain the patient is experiencing. For instance, if the patient is suffering from diabetes, it is likely that they are experiencing as a side effect diabetic neuropathy, and treatment of the root disease may lead to less discomfort.
Patients also have a variety of medicinal options for the treatment of neuropathic pain. The most conventional treatment is tricyclic antidepressant medications. These antidepressants are used to lessen neuropathic pain by way of disrupting how the nerves transmit signals, and they are not used to treat depression in this context. These antidepressants usually begin to ease pain within a span of a few days to three weeks, but they may take over a month to work at maximum potential. Another antidepressant known as duloxetine has been used to ease diabetic neuropathy, and may be explored as a treatment option for other sources of neuropathic pain as well.
As an alternative to antidepressants, anti-epileptic medicines may also be an effective treatment. In clinical trial the drugs gabapentin and pregabalin have been found to be the most effective. Epileptic drugs target nerve signals and stop them from being transmitted to prevent seizures, and this action also interferes with the nerve signals that cause neuropathic pain.
While typical painkillers such as Ibuprofen are unlikely to be of much help to those suffering from neuropathic pain, stronger painkillers may be of some aid. Opiate painkillers, including morphine and codeine, may be used, but these are not-recommended as a first option due to the issue of possible drug dependence as well as a variety of complications that may come with long-term usage.
If medicinal options are not possible for the patient or do not yield any results, topical drugs, which are applied to the skin, may be looked in to as yet another alternative. Capsaicin cream, which is applied about 3-4 times a day and prevents nerves from sending pain messages, may be an effective option. Lidocaine gel patches may also provide some relief from neuropathic pain.
Physical approaches can also be taken to help with neuropathic pain. In certain cases, pain specialists may recommend procedures such as acupuncture or electrical nerve stimulation as an option. Nerve blocks are also a common procedure in which the electrical signal causing pain is disrupted by some means. For instance, a local anesthetic may be injected into the area surrounding the afflicted nerves, or nerves may be frozen to prevent the transmission of pain messages in a procedure called cryotherapy. Finally, in certain cases even psychological approaches may be taken to lessen neuropathic pain. It is possible for anxiety or depression to worsen the symptoms of pain, and if relevant, counseling and stress-management may be another recommended approach.
The most important thing to remember when dealing with pain is to reach out for help. If you believe you may be suffering from neuropathic pain, consult a pain specialist to consider treatment options and map out a personalized solution to recovery.
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