What Are Neuropathic Pain? Diagnosis And Treatment

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Neuropathic Pain

Pain in any part of the body indicates a problem in some functions and helps to take precautions.

Similarly, neuropathic pain is a warning pain that indicates a disorder in the lesions in the nervous system. Damage to the nerve cell causes structural changes in the area and causes the pain to become permanent. These pains, which progress with more than one symptom, concern approximately 2 per cent of the population.

What Are Neuropathic Pain?

Neuropathic pain is defined as pain that occurs in the pain transmission regions of nerves and does not go away easily with pain medications. These pains indicate a very complex syndrome and originate from areas such as the brain, spinal cord, arms, and legs.

This type of pain progresses independently of damage formation and persists for a long time. Some neuropathic pains progress for weeks, months, and years, becoming more severe. Neuropathic pains are pains that do not have a single cause and are difficult to explain.

The difference from normal pain can also be explained in this way, ordinary pains usually originate from deformations in body tissues. Substances released as a result of this damage stimulate nerves and cause the sensation of pain.

Therefore, for pain to occur in the body, the tissues must first be damaged. In neuropathic pains, however, since the nervous system is directly affected, such a situation is not the case.

Neuropathic pains, which are expressed as “nerve pain” in terms of their meaning, can develop suddenly without showing any symptoms and are caused by the normal processing of information carried in nerves. In this type of pain, rather than tissue damage as in ordinary pain, nerve damage is involved, and this situation can be caused by many reasons.

Symptoms Of Neuropathic Pain

Neuropathic pain can have different symptoms, but the most common symptoms are as follows

  • Pain
  • Numbness
  • Combustion
  • Sinking
  • Feeling of freezing
  • Chills
  • Felting
  • Tingling
  • Pain sensation on light touch
  • Abnormal skin structure

In addition, neuropathic pain is sometimes accompanied by persistent pain and can be characterised by sudden seizures.

What Causes Neuropathic Pain?

Neuropathic pain develops due to long-standing and persistent damage to the nervous system. This nerve damage is recognised by the brain as an “unpleasant sensation” and additionally causes the spinal cord and brain nerves to become sensitised to the damage. As a result, the brain begins to respond abnormally to the nerve damage.

Many conditions such as neuralgia, hand and foot nerve compression, nerve inflammation, vitamin B deficiencies, diabetes, rheumatic diseases, genetic nerve diseases, lumbar and cervical hernias, narrowing of the canal and poisoning cause nerve damage. In addition, brain diseases and spinal cord-related problems can also cause neuropathic pain.

Different problems may be involved in neuropathic pain, which usually does not occur as a result of a single disorder. Damage to the spinal cord as a result of traffic accidents, severe injuries, strokes and various disorders can manifest itself as neuropathic pain. Blockage of the vessels supplying the nerves for any reason can also cause nerve cells to be deprived of oxygen and cause pain. Other causes of pain can be listed as follows:

  • Nutritional problems such as diabetes and uremia
  • Infectious diseases such as HIV
  • Nutrition problems
  • Cancer cells
  • Hereditary causes
  • Toxins
  • Inflammatory problems
  • Idiopathic diseases

What are The Diagnostic Methods In Neuropathic Pain?

In order to treat neuropathic pain, diagnostic methods must first be applied and the source of the problem must be learnt. One of the most important points for the correct diagnosis and the application of diagnostic methods is that the patient expresses himself properly.

Many findings point to the nervous system and their findings in physical examination help to make a diagnosis.

If an abnormal sensation is found in the patient’s history, necessary pathological examinations are performed and it is determined whether the problem is caused by infectious, metabolic problems or autoimmune diseases. The level of pain is then determined. Sleep problems, psychological problems and physical strain are also subject to evaluation.

Colour changes in the affected area, the presence of oedema, skin and nail problems are evaluated in the diagnosis. In cases requiring further examination, the following methods are applied:

  • Electroneuromyography (EMG)
  • Magnetic Resonance (MR)
  • Functional MR (FMR)
  • QST (Quantitative Sensory Test)
  • PET (Poitron Emission Tomography)

Treatment Methods In Neuropathic Pain

The treatment of neuropathic pain is primarily medication, but it may not be easy to find the right medication for every patient. In most patients, trial and error method can be applied to find the right medication, so it may take some time to find an effective method in the treatment of neuropathic pain.

By investigating and treating the problem causing neuropathic pain, it is aimed to relieve patient complaints and eliminate the underlying problem.

For example; the main source of most neuropathic pain is diabetes, and therefore, in order to relieve the pain, the diabetes problem must first be eliminated. At this stage, a treatment aimed at controlling blood sugar and nourishing the nerves is applied.

Neuropathic pain does not respond to painkillers; therefore, the medications used are treatment-specific drugs such as specific muscle relaxants, morphine-like drugs, epilepsy drugs and local anaesthetics.

The treatment of neuropathic pain is multifaceted, may require different medications and, in patients who do not respond to medication, alternative treatment methods may be used. Other treatment modalities include

  • Physical medicine and rehabilitation
  • Interventional pain treatment methods
  • Relaxation technique applications
  • Meditation
  • Pilates and yoga
  • Cognitive and behavioural therapies
  • Complementary medicine applications
  • Nutrition regulations

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