Chronic Neuropathic Pain
Neuropathic pain is pain that is caused by damage to the central or peripheral nervous system. This damage can happen because of a disease process or because of an injury, and can come from the central nervous system (CNS) or peripheral nervous system (PNS). While "normal" pain happens when something (such as contact with a hot surface) stimulates the body's pain receptors, neuropathic pain happens for no obvious reason. It can become chronic, and can seriously interfere with a sufferer's ability to function.
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Features
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According to the Merck Manual, neuropathic pain is usually a burning or stabbing type of pain, but it can also be a deep ache. Sometimes it can be triggered by things that should not be painful, such as a light touch--this is called allodynia. The pain can be very strong and out of proportion to the situation--this is called hyperalgesia. The pain can be accompanied by strange, abnormal sensations, such as tingling, a condition called dysethesia. Neuropathic pain is long-lasting, and will continue even after the original problem, such as an injury, is gone.
CNS Pain
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Neuropathic pain can be a result of a problem with the central nervous system, which includes the brain and the spinal chord. It seems that, in some people, the CNS can "remember" previous pain, two and reorganize itself to repeat the perception of pain. The 2 main types of CNS neuropathic pain are deafferentation pain and sympathetically maintained pain.
Deafferentation pain is caused by a lack of information being sent to the CNS. An example of this type of pain is "phantom limb syndrome," in which a person feels pain from a limb that has been Mamputated. The Merck manual also lists postherpetic neuralgia (pain after an infection with one of the herpes viruses) and CNS injury, such as a spinal cord injury, as examples of deafferentation pain.
Another type of CNS neuropathic pain is sympathetically maintained pain. The sympathetic nervous system controls the body's response to trauma, and it can be involved in neuropathic pain if it is not functioning properly. According to the Merck Manual, complex regional pain syndrome (CRPS, also called reflex sympathetic dystrophy and causalgia) may have a sympathetic nervous system component. Post-surgical pain syndrome may also have a CNS component.
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PNS Pain
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The peripheral nervous system (PNS), which includes the nerves in the body outside of the brain and spinal cord, can also be involved in chronic neuropathic pain. According to the Merck Manual, injuries to single nerves ("mononeuropathies"), such as carpal tunnel syndrome and radiculopathy, and injuries to several nerves ("plexineuropathies"), such as with herniated discs, neuromas, tumors and nerve compressions, are all examples of peripheral neuropathies. Polyneuropathies, such as diabetic neuropathy, are also examples of PNS neuropathic pain.
Treatments
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According to the Merck Manual, while neuropathic pain can be helped somewhat by opioid medications, such as hydrocodone and oxycodone, it is usually helpful to use medications that work differently than common pain relievers. These medications can include baclofen, antidepressants such as amitriptyline or duloxetine, anticonvulsants such as gabapentin or phenytoin, or other types of medications. People with chronic neuropathic pain can also sometimes benefit from specialized physical therapy and psychological care to deal with the stress caused by the pain. Many clinics specialize in the treatment of chronic pain.
Considerations
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Any type of chronic pain can seriously interfere with all aspects of your life. Chronic pain is a complex problem that can be challenging to treat. If you are experiencing chronic pain, it is a good idea to contact a physician who specializes in pain treatment and pain management, because she will have a thorough knowledge of all of the options for treating your pain. If your pain does not improve, tell your physician, and do not be afraid to get a second opinion. Keep in mind that medical researchers are always discovering more ways to treat neuropathic pain.
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References
Resources
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