What is it?
Neuropathic pain is another term for nerve pain.
There are a number of different causes. Common ones are pain following shingles (postherpetic neuralgia), diabetic neuropathy and trigeminal neuralgia.
Other conditions affecting the nerves also cause neuropathic pain. These include cancer and pain after chemotherapy, HIV infection, phantom limb pain, multiple sclerosis, alcoholism, atypical facial pain and other common nerve disorders.
There are two types of pain:
Nociceptive pain is caused by damage to tissue e.g. cuts, burns, injuries etc... This type of pain is sharp or aching. Common painkillers like paracetamol, anti-inflammatories, codeine and morphine can ease this pain.
Neuropathic pain is caused in the nerves themselves. The sensations caused by this type of pain feel like burning, shooting, stabbing or an electric shock. There are particular types of medications which may ease this pain. Common painkillers are unlikely to work.
Nociceptive and neuropathic pain have different causes and thus require different medications. However, you can have both types of pain simultaneously. This is common in cancer, for example.
Neuropathic pain has some unusual aspects. It can get worse with a touch, prod or stimulus that normally would not cause pain. You may even feel pain when there is no touch or stimulus. This is often in the form of pins and needles or electric shock sensations.
Neuropathic pain can have a significant impact on quality of life. Your doctor will discuss your symptoms with you and try to pinpoint the nature and extent of your pain. Visual scales and charts may be used to help you and it is important to try to describe the nature of the pain, e.g. aching, shooting, burning etc...
Treatment for neuropathic pain
There are a number of treatments that may be tried by your GP or specialist. The type of treatment and dosage is individualised and different approaches may be tried before there is symptom relief. Your doctor will discuss treatment options with you and set out realistic goals - in some cases symptoms may be greatly eased but will not necessarily go away altogether.
In combination with medication, other therapies may be beneficial such as counselling, coping strategies, physiotherapy, electrical nerve stimulation and heat and cold packs. People with pain may become depressed or anxious and it is important that these are addressed as well as the physical pain.
Some antidepressants are used to treat neuropathic pain, particularly neuralgia. Unlike common pain medicines, these do not have an immediate effect but can take days or weeks before a difference is seen and the pain eases.
A more recent antidepressant, duloxetine, is also suitable for treating neuropathic pain, particularly diabetic peripheral neuropathic pain.
Pregabalin, which was originally an anti-epileptic medication, is used specifically for treating neuropathic pain. The dose is individualised and will be adjusted to suit the particular individual.
Another option is Tramadol, which is a strong pain medication. Other strong medications may be considered if you are seeing a specialist.
Strong cream may be applied to ease the pain if medicines are not effective. This appears to work by blocking the nerves from transmitting pain messages. This is applied several times a day, but can take several days before it becomes effective.
Your GP may try different doses of these medications, sometimes in combination. If the pain persists, you may be referred to a specialist pain clinic. At clinics, other physical treatments may be offered, including nerve blocks and other stimulations and devices. There are also pump implants which release drugs directly into the system.
How pain management is approached depends on individual circumstances. Seek the advice of a health professional and offer as much information as you can about your symptoms. Keeping a pain diary can be useful.
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