What is neuropathy?
Neuropathy is a condition arising as a direct sequence of damage
or injury to the somato sensory system that is the integrated functioning of
nerves which are responsible for carrying sensations from the various body
parts to brain and in turn deliver motor impulses so that the body parts can
perform an activity.
In cases where there is a potential injury to the nerve, the
nerve fibers send incorrect stimulus to the brain which give rise to production
of chemical irritants and pain producing receptors. This kind of pain generated
is referred to as neuropathic pain.
What are the clinical
features of neuropathy?
Sharp pain
There is a prolonged discomfort and patient describes it as
stabbing or shooting pain all the way down till fingers or toes and especially
that the pain is like an ‘electric shock’.
Tingling
The patient experiences pins and needles kind of sensation
and the area may get numb.
Allodynia
Pain is produced even by lightest stimuli like a simple
touch.
Hyperpathia
There is often a short episode of discomfort followed by
severe and prolonged pain.
Hyparalgesia
The overall sensitivity of the patient for pain is increased
and there is more of psychological contribution to it.
Common causes of
neuropathic pain
- Diabetes
- Stroke - Hemiplegia, paraplegia or tetraplegia.
- Spinal cord injuries (accidents)
- Facial nerve palsy
- Herpes zoster infections
- Multiple sclerosis
- Cancer, as the tumor compresses the nerve trunk.
- After amputation due to misfiring of nerve fibres towards the phantom limb.
- AIDS
- Post spinal cord surgeries
- Alcoholism
What is the mechanism
behind neuropathic pain?
The mechanism of neuropathic pain is largely based upon the
nervous system from which the nerve arises. Neuropathic pain treatment is known
to provide about 40-60% relief.
Peripheral lesions
A peripheral lesion generally takes place as a result of unexpected
sudden jerk or stretch to the nerve somewhere in between its course of supply.
While the regeneration starts, the neurons become sensitive and develop
abnormal excitability which in turn increases the nerve sensitivity to
chemicals, heat and mechanical stimulus.
Central lesions
Damage at the level of spinal cord disrupts the normal
pathway between the cord and brain which is carrying the stimulus and bringing
the motor impulses. As there is spontaneous ongoing activity at the peripheral
end, the responses to pain along this pathway abnormally increases. Hence a
sensitization is established and becomes a prime reason for persistent
troubling pain.
What are the
treatment options?
The primary goal of neuropathic pain treatment is to relieve
patient of pain, tingling and reduce the hypersensitivity. This is achieved by
following:
Medications
- Steroidal injections
- Oral medications according to the specific underlying cause.
- Nerve vitamins
- Anti depressants and sedatives in advanced cases.
Physical therapy
Trans electrical nerve stimulation (TENS) and hot pack
provides considerable amount of relief in pain by producing a placebo effect
and relaxing the muscles.
Non pharmacological
treatment
- Psychological counseling to help overcome the emotional consequences.
- Patient education and postural training.
- Relaxation techniques
- Acupressure / Acupuncture
