Neuropathic (nerve) Pain
Neuropathic pain occurs as a direct consequence of a lesion or disease affecting the somatosensory system. This could involve the peripheral nervous system, central nervous system, or both. Common descriptors used to describe neuropathic pain may include a sharp, shooting, burning, electric shock-like pain in the distribution of a nerve. It can affect any nerve within your body. Certain medications may be more effective in treating neuropathic pain (ie. anticonvulsants, TCA, SNRI). Certain procedures may also be beneficial for neuropathic pain (ie. epidural steroid injection or nerve root sleeve injections for sciatica). A careful assessment will be undertaken to determine the cause of the neuropathy so that appropriate evidence-based managed can be applied for your condition.
Common types of neuropathic pain we see include:
Low back pain with nerve root irritation
This occurs when the nerve root is impinged/compressed by a herniated disc, narrowing of the foramen or osteophyte. Often a sharp shooting pain is experienced. If a nerve root is irritated in the lumbar spine, this often causes a pain going down the leg. If a nerve root is irritated in the cervical spine, this can cause a pain going down the arm. There may be associated sensations of numbness and tingling. An epidural steroid injection, or nerve root sleeve injection may be of benefit in this situation.
Painful diabetic neuropathy
Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. Half of all people with diabetes will develop neuropathy. It commonly affects the nerves in the feet and hands, but any nerve can be involved. Often the feet will become numb, although many people will also experience significant discomfort and pain. This often requires multidisciplinary involvement and optimization of analgesia with a focus on evidence-based treatments.
Post-herpetic neuralgia
Post-herpetic neuralgia is a painful condition that affects your nerves as a complication of shingles which is caused by herpes zoster. The virus remains dormant in the dorsal root ganglion of the spinal cord, and becomes re-activated in later life which causes shingles. By definition, post-herpetic neuralgia begins when pain persists for longer than 3 months. It is estimated that approximately 1 in 5 patients with shingles will go on to develop post-herpetic neuralgia. Timely anti-viral therapy within onset of shingles, as well as TCA prophylaxis has shown to reduce the risk of developing PHN. Multidisciplinary input is often required for long-term sufferers.
Spinal cord injury
Pain experienced after a spinal cord injury can be quite variable in different people depending on the level of spine affected and the extent of the injury itself. Commonly neuropathic pain is experienced at the level of the injury, which is often described as a sharp shooting pain that radiates out from that level of the spine. There may be associated below-level pain which is the same pain sensation but at a few levels below the injury. Some patients may experience above-level pain which can display features of complex reigonal pain syndrome, or of a compressive neuropathy (ie carpal tunnel syndrome). Pain management often requires multidisciplinary team involvement. Other types of pain may be experienced including visceral pain (from constipation, urinary retention) and somatic pain (ie pressure sores).
Multiple sclerosis
Chronic pain is experienced in 64-69% of patients suffering from multiple sclerosis. Pain is due to a direct result of demyelination, axonal loss and MS lesions which can significantly interfere in the ability to perform activities of daily living. Common descriptors used by patients suffering from MS pain include itching, crawling, tingling, burning, sharpness, stabbing, numbness, throvving. Common areas affected include the lower extremities, back and upper extremities. Some patients may describe heat hyperalgesia (sensitivity to heat) and allodynia to touch or cold. Asides from neuropathic pain, other symptoms can include headaches, muscle spasms and abdominal pain.
Post-stroke pain
Neuropathic pain experienced after a stroke can be quite variable depending on the location and extent of the stroke itself. A combination of neuropathic, visceral and somatic pin may be experienced. This requires a comprehensive assessment and formulation of a multidisciplinary plan to address the biopsychosocial issues identified.
Helpful Resources:
- PainDetect Questionnaire
- NPS: Helping patients lives with neuropathic pain information sheet
- Pain Australia: Neuropathic (nerve) pain fact sheet
- Educational video: Sciatica
- Musculoskeletal Australia: Managing your pain
- The Pain Toolkit
DisclaimerThe above information is for general education only and is not intended as a substitute for your own independant health advice. At Western Pain clinic we comprehensively assess each patients pain condition and provide advice using the latest evidence-based treatments. If you would like to find out more information about nerve (neuropathic) pain, please discuss this with our doctor during your consultation.