Neuropathic pain, unlike ordinary pain, which is the signal function of the body, has no connection with the disturbance of the work of any organ. This pathology has recently become an increasingly common ailment: according to statistics, 7 out of 100 people suffer from neuropathic pain of varying degrees of severity. This kind of pain can make it painful to perform the simplest actions.
Neuropathic pain, like "ordinary" pain, is acute and chronic.
There are also other forms of pain:
- Moderate neuropathic pain in the form of burning and tingling. It is more often felt in the extremities. It does not cause special anxiety, but it creates psychological discomfort in a person.
- Pressing neuropathic pain in legs. It is felt mainly in the feet and legs, it can be quite pronounced. Such a pain makes walking difficult and causes serious inconveniences in a person's life.
- Short-term pain. It can last only a couple of seconds, and then disappears or moves to another part of the body. Most likely, it is caused by spasmodic phenomena in nerves.
- Excessive sensitivity when exposed to skin temperature and mechanical factors. The patient experiences unpleasant feelings from any contact. Patients with this disorder wear the same familiar things and try not to change their postures in a dream, since a change in position interrupts their sleep.
Causes of Neuropathic Pain
Pains of a neuropathic nature can arise as a result of damage to any parts of the nervous system (central, peripheral and sympathetic).
Let's list the main factors of influence for this pathology:
- Diabetes. This metabolic disease can lead to nerve damage. This pathology is called diabetic polyneuropathy. It can lead to neuropathic pains of a different nature, mainly localized in the feet. Painful syndromes are worse at night or when wearing shoes.
- Herpes. The consequence of this virus may be postherpetic neuralgia. More often this reaction occurs in older people. Neuropathic postherpic pain can last about 3 months and be accompanied by severe burning in the area where rashes were present. Also, pain can occur from touching the skin of clothing and bedding. The disease disturbs sleep and causes increased nervous excitability.
- Spinal trauma. Its effects are caused by long-term pain symptoms. This is associated with damage to nerve fibers located in the spinal cord. It can be strong stitching, burning and spasmodic pain sensations in all parts of the body.
- Stroke. This serious brain damage causes great damage to the entire human nervous system. The patient who has suffered this disease, for a long time (from a month to a year and a half) can feel the painful symptoms of a burning and burning character in the affected side of the body. Especially bright such sensations are shown at contact to cool or warm subjects. Sometimes there is a feeling of freezing of limbs.
- Surgical operations. After surgical interventions caused by the treatment of internal diseases, some patients are concerned about unpleasant sensations in the suture area. This is due to damage to peripheral nerve endings in the surgical intervention area. Often, such pains arise from the removal of the breast in women.
- Neuralgia of the trigeminal nerve. This nerve is responsible for the sensitivity of the face. When it is squeezed as a result of trauma and the expansion of a nearby blood vessel, intense pain can occur. It can occur when talking, chewing, or touching the skin. It is more common in the elderly.
- Osteochondrosis and other diseases of the spine. The compression and displacement of the vertebrae can lead to the pinched nerves and the appearance of pain sensations of a neuropathic nature. The compression of the spinal nerves leads to the appearance of radicular syndrome, in which pain can manifest itself in completely different areas of the body - in the neck, in the extremities, in the lumbar region, and also in the internal organs - in the heart and stomach.
- Multiple sclerosis. This damage to the nervous system can also cause neuropathic pain in different parts of the body.
- Radiation and chemical effects. Radiation and chemicals have a negative effect on the neurons of the central and peripheral nervous system, which can also be manifested in the development of painful sensations of a different nature and intensity.
Clinical picture and diagnosis with neuropathic pain
For neuropathic pain, a combination of specific sensitivity disorders is characteristic. The most characteristic clinical manifestation of neuropathy is the phenomenon, called in medical practice "allodynia".
Allodynia is a manifestation of the pain response in response to a stimulus that in a healthy person does not cause pain.
A neuropathic patient can experience severe pain from the slightest touch and literally from the breath of air.
Allodynia can be:
- Mechanical, when pain occurs when pressure is applied to certain areas of the skin or irritated with fingertips;
- Thermal, when the pain manifests itself in response to a temperature stimulus.
Certain methods of diagnosing pain (which is a subjective phenomenon) do not exist. However, there are standard diagnostic tests to assess the symptoms, and on their basis to develop a strategy for therapeutic effects.
Serious help in diagnosing this pathology will be the use of questionnaires for the verification of pain and its quantification. It will be very useful to accurately diagnose the cause of neuropathic pain and to identify the disease that led to it.
To diagnose neuropathic pain in medical practice, the so-called method of three "C" is used - to watch, listen, and correlate.
- Look - i.e. To identify and assess local disorders of pain sensitivity;
- Listen carefully to what the patient is saying and mark the characteristic signs in describing his pain symptoms;
- Correlate the patient's complaints with the results of an objective examination;
It is these methods that allow us to identify the symptoms of neuropathic pain in adults.
Neuropathic pain - treatment
Treatment of neuropathic pain is often a long process and requires a comprehensive approach. In therapy, psychotherapeutic methods of influence are used, physiotherapeutic and medicamental methods.
The main methods of drug treatment of neuropathic pain This is the main technique in the treatment of neuropathic pain. Often, this pain does not lend itself to the relief of conventional pain medications. This is due to the specific nature of neuropathic pain. Treatment with opiates, although quite effective, results in tolerance to the drugs and can contribute to the formation of drug dependence in the patient.
In modern medicine, lidocaine (in the form of an ointment or plaster) is most often used. The preparation gabapentin and pregabalin are also used - effective medicines of foreign production. Together with these funds, antidepressants are used - sedatives for the nervous system that reduce its hypersensitivity.
In addition, the patient can be prescribed drugs that eliminate the consequences of diseases that led to neuropathy.
Physiotherapy plays an important role in the therapy of neuropathic pain. In the acute phase of the disease, physical methods of cupping or reducing pain syndromes are used. Such methods improve blood circulation and reduce spasmodic phenomena in muscles.
At the first stage of treatment diadynamic currents, magnetotherapy, acupuncture are used. Later, physiotherapy procedures are used to improve cellular and tissue nutrition - laser, massage, light and kinesitherapy (medical treatment).
In the recovery period, physiotherapy is given great importance. Also, various relaxation techniques are used to help eliminate pain.
In the period of remission, patients are recommended active lifestyles and regular health gymnastics. The positive effect is swimming, walking on fresh air.
Treatment of neuropathic pain with folk remedies is not particularly popular. Patients are categorically forbidden to use folk methods of self-medication (especially warming up procedures), because neuropathic pain is caused most often by inflammation of the nerve, and its heating is fraught with serious damage until it completely dies.
It is acceptable phytotherapy (treatment with herbal decoctions), but before using any herbal remedy, consult a doctor.
Neuropathic pain, like any other, requires an attentive attitude. In time, the treatment begun will help to avoid severe attacks of the disease and prevent its unpleasant consequences.
Neuropathic pain occurs due to damage or dysfunction of the peripheral or central nervous system, rather than stimulation of pain receptors. Neuropathic pain should be thought if neurologic examination reveals a discrepancy between the intensity of pain and the nature of damage, dysesthesia (burning, tingling), and symptoms of nerve damage. Despite the effectiveness of opioids in the treatment of neuropathic pain, it is recommended to use auxiliary painkillers (antidepressants, anticonvulsants, baclofen, topical preparations).
Pain can develop after damage to the nervous system at any level, peripheral or central, and also due to the involvement of the sympathetic nervous system, leading to sympathetic pain. Specific syndromes include postherpetic neuralgia (Symptoms and signs), nerve root injuries, traumatic mononeuropathy with pain syndrome, polyneuropathy with pain syndrome (most often diabetic syndrome- diabetes mellitus: diabetic neuropathy), central pain syndromes (due to any lesion at any level ), Postoperative pain syndromes (for example, postmastectomy syndrome, post-thoracotomy syndrome, phantom pain) and complex regional pain syndrome (reflex sympathetic Dystrophy and causalgia-Reflex sympathetic dystrophy).
Neuropathic pain occurs due to damage or dysfunction of the peripheral nerve. Examples are mononeuropathies (for example, in carpal tunnel syndrome, radiculopathy), plexopathy (often due to compression of the nerves, for example, neurinoma, tumor or disc hernias) and various polyneuropathies (often developing due to metabolic disorders-Some Causes of Peripheral Nervous System Disease). Pathophysiological mechanisms are diverse and may include an increase in the number of Na + channels in the regenerating nerves.
It has been established that neuropathic pain syndromes of the central genesis are associated with the restructuring of the central somatosensory signal processing and include deafferentation pain and sympathetically mediated pain. Both concepts are complex and, although apparently interrelated, differ in their essence.
Deafferentation pain occurs due to the partial or complete interruption of peripheral or central afferent pathways. Examples are postherpetic neuralgia, central pain (pain after CNS trauma) and phantom limb pain (pain is felt in the amputated part of the body - Complications). The mechanisms of their occurrence are not completely known, but, apparently, they can be related to the sensitization of central neurons, a decrease in the activation threshold, and the expansion of receptor fields.
Sympathetically mediated pain is associated with increased efferent sympathetic activity. Complex regional pain syndrome sometimes includes sympathetically sustained pain. Other types of neuropathic pain in some cases have a sympathetically mediated component. Pathophysiological mechanisms include pathological sympathic-somatic compounds (euphases), changes at the spinal cord level and local inflammation.
Symptoms and signs
A typical manifestation of neuropathic pain is dysesthesia (spontaneous burning pains, which are often accompanied by pains of shooting character), but a deep, dull, constant pain is possible. Other pathological sensations are possible, for example, hyperesthesia, hyperalgesia, allodynia (pain in response to the effect of non-bellicose stimuli), hyperpathy (especially unpleasant excessive pain reaction). Symptoms are observed for a long time, usually remaining after the resolution of the primary cause (if any) due to CNS sensitization and remodeling.
Diagnosis. Clinical evaluation.
The diagnosis of neuropathic pain is posed in the presence of typical symptoms, in case of damage or suspected nerve damage. In some cases, the cause of neuropathy is obvious (for example, limb amputation, diabetes mellitus). In others, the diagnosis can be made based on the description of the pain syndrome by the patient himself. If the pain is arrested after the blockade of the sympathetic nerve, it is sympathetically mediated.
Complex approach to therapy (for example, the use of psychological techniques, physical methods, antidepressants or anticonvulsants, sometimes surgical methods).
The success of the treatment is provided by an integrated approach, taking into account the precise diagnosis, the use of rehabilitation techniques and the correction of individual psychosocial problems. In the defeat of the peripheral nerve, the affected limb should first be mobilized to prevent trophic changes, atrophy due to inactivity and ankylosis of the joint. Surgery may be required to reduce compression. From the very beginning, psychological factors must be constantly taken into account. Anxiety and depression should be treated appropriately. In the event that dysfunction is fixed, patients can benefit from an integrated approach to therapy in specialized pain management clinics.
Several classes of drugs are moderately effective (medications used for neuropathic pain, see also the recommendations of the European Federation of Neurological Societies on the drug treatment of neuropathic pain: the 2010 edition), but complete or almost complete release is unlikely. Antidepressants and anticonvulsants are often used. The effectiveness of many of them is proved.
Opioid analgesics can bring some relief, but, as a rule, they are less effective for acute nociceptive pain; Adequate anesthesia can be prevented by undesirable phenomena. To treat peripheral syndromes, topical preparations and lidocaine patches can be used.
Other potentially effective treatments include
- Stimulation of the spinal cord of certain types of neuropathic pain (for example, chronic pain in the leg after surgical intervention on the spine) with the help of an electrode placed epidurally.
- In some chronic neuralgia, the electrodes are implanted along the peripheral nerves and ganglia
- Sympathetic blockade is usually ineffective, except in cases of complex regional pain syndrome
- Neuropathic pain can result from efferent activity or interruption of afferent activity.
- The possibility of neuropathic pain is considered if patients experience dysesthesia or pain disproportionate to tissue damage and if there is a suspected nerve damage.
- Treat patients with several methods (for example, psychological treatment, physical methods, antidepressants or anticonvulsants, pain medications, with the help of surgery) and recommend rehabilitation if necessary.