What is Neuropathic Pain?
Neuropathic pain is defined by the International Association for the Study of Pain (IASP) as ‘Pain caused by a lesion or disease of the somatosensory nervous system’.
Neuropathic pain is estimated to affect up to 10% adults over the age of 30 in the UK.
This can affect the central nervous system (Brain or spinal cord) i.e. post stroke pain, trigeminal neuralgia, spinal cord injury or the peripheral nervous system i.e. post herpetic neuralgia (shingles pain), diabetic neuropathy, post amputation pain or sciatic pain.
What does neuropathic pain feel like?
People who suffer from neuropathic pain typically describe a very severe, intense pain which is relentless, burning, sharp, stabbing or electric shock-like in character. The damaged nerves frequently demonstrate impaired function with disability. Hypersensitive of the affected area can often be experienced. This intense, relentless nerve pain frequently leads to distress, anxiety and even depression.
It is common for nerve pain to appear in many forms and often goes misdiagnosed and mistreated.
What are the Common Types of Neuropathic Pain?
There are numerous varieties of chronic neuropathic pain. These are the most common types seen
- Sciatica is caused by compression or irritation of the sciatic nerve roots, resulting in a characteristic pain that radiates down leg into the foot or ankle.
- Post Surgical Pain. This is pain that persists unduly after a surgical procedure, long after the surgical would has healed up. This is most commonly seen after hernia surgery, but can occur after any surgery.
- Postherpetic neuralgia is neuropathic pain that is brought on by an outbreak of shingles and persists after the condition has cleared.
- Trigeminal neuralgia is characterized by brief, but frequent episodes of shooting neck and facial pain. This is typically felt around the jaw, facial or forehead area. The pain is often worse with touch and may make activities, like shaving, very painful.
- Phantom limb pain is pain that is experienced in a limb, even after it has been amputated. This can be very persistent is distressing for the sufferer, particularly if the amputation was done to relieve pain.
- Diabetic neuropathy causes burning or stabbing pain in the hands and feet of some people who suffer from diabetes.
- Carpal tunnel syndrome is caused by compression of the main nerve of the forearm, causing pain in the wrist, thumb and fingers.
- Occpitial Neuralgia. This is a headache in the occipital area of the head (back of the head) caused by irritation of the occipital nerves as they pass over the joints of the neck. Degeneration of cervical facet joints is often the cause of this headache.
- Central pain syndrome can occur after nervous system damage, such as a stroke. It can also be caused by neurological diseases such as multiple sclerosis.
How is Neuropathic pain treated?
Neuropathic pain is not normal pain and does not tend to respond to normal pain killers. Your specialist will do a full assessment and recommend a plan for therapy that best suits your needs.
This type of pain is usually best treated with medication, as this lead to greater independence for the sufferer. The two main groups of drugs used to treat this pain are the anti-epileptic drugs (AED’s) and tricyclic antidepressants (TCI’s). These are very specialist drugs and your pain specialist will be experiences in prescribing these. Paracetamol, anti-inflammatory drugs and opioid based pain killers tend not to be so effective for this type of pain.
Various interventional treatments can aid the management of neuropathic pain, including
- Epidural injections for sciatica (Usually both sides)
- Nerve root injections / transforaminal epidural injections (Usually one side)
- Peripheral nerve blocks
- Botox injections – usually for migraine. Also for neuropathic skin pain
- Spinal cord stimulators
- Radiofrequency treatments for scar pain or trigeminal neuralgia
- Pulsed radiofrequency treatments
Your specialist will discuss options available to you to help you make the best choice for your particular pain and needs.