Neuropathic literally means “a dysfunction of the nervous system”. Physicians use the term “Neuropathic pain” to describe pain that originates from impaired function of the nervous system.
Types of Neuropathic Pain
Neuropathic pain can be divided into central causes (brain and spinal cord) or peripheral causes (the nerves running from the spinal cord to the skin) of disruption to the nervous system.
Central causes of neuropathic pain include stroke, traumatic brain injury, traumatic injury to the spinal cord, multiple sclerosis, brain tumours, inflammation or infection of the brain or spinal cord.
Peripheral causes of neuropathic pain are shingles, traumatic nerve injuries such as brachial plexus avulsions, trigeminal neuralgia, diabetic neuropathy, alcoholic neuropathy, multiple sclerosis and amputation.
Symptoms of neuropathic pain.
Neuropathic pain typically causes feelings of burning, electrical shooting pain, unpleasant tingling, pins and needles, a feeling of water running down the limb, a crawling feeling beneath the skin and increased sensitivity to non pain full stimulation (hypersensitivity) as well as pain to non painfull stimulation (allodynia).
Time course of Neuropathic Pain
Neuropathic pain does not tend to get better and if it does it takes a long time to do so.
a) Anticonvulsants such as pregablin or gabapentin
b) Tricyclic antidepressants such as nortriptyline
c) Opioids such as morphine
d) NMDA receptor antagonists such as ketamine
e) Sodium channel blockers such as lidocaine
f) Canabinoids such as sativex
2. Stimulation therapy
a TENS and spinal cord stimulation
3. Psychological management
a) Coping skills
b) Pain management programmes
4. Mirror box therapy as part of a graded exercise programme.