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Neuropathic pain

What is neuropathic pain?

Pain is something that people often think will disappear when the original cause heals, such a broken limb. However, neuropathic pain is different. It is a chronic condition which is caused by damage or dysfunction in the nervous system. Neuro means nerves, and pathy means abnormality. It is difficult to predict the pattern of neuropathic pain as it can continue long after the initial cause has resolved.

Neuropathic pain is very difficult to describe and is different for everyone. It can vary from a constant burning pain to intermittent sharp shooting pains.

What causes neuropathic pain?

Pain is normally felt through nerve endings called nociceptors (no-si-sep-ters) which send messages from the site of the injury, such as a strained muscle, to the brain. If the nerves within the peripheral or central nervous system are damage in some way this can lead to incorrect nerve signals being sent to the brain which in turn results in continuous chronic pain.

The pain that is felt is real but the cause can often be difficult to discover. Patients with a wide range of medical conditions can develop neuropathic pain, these can include trauma caused by an accident or surgery, infection, vascular disease, cancer and metabolic conditions such as diabetes. Occasionally no identifiable cause is found which is incredibly frustrating for the individual experiencing the pain.

How do you treat neuropathic pain?

The primary goals of treatment for neuropathic pain are to reduce the pain as much as possible, balance the negative side effects of the treatment, and help patients manage any unresolved pain. Individuals with chronic pain may be able to attend a pain clinic for assessment, management and advice on living with chronic pain. More information can be found on the British Pain Society's website.

There are various treatments available for neuropathic pain and often it is a ‘trial and error’ process to find what is best suited, here is a brief outline of the most common ones:

Anti-convulsant (epilepsy) medication

Examples: Carbamazipine, Gabapentin, Pregabalin

Primarily used for the treatment of epilepsy, however, it is also stabilises irritable nerve membranes thus reducing pain. Being prescribed an anti-convulsant does not mean you have or are at risk of developing epilepsy.

Common side effects: feeling ‘spaced out’, dizziness and headaches

Tri-cyclic anti-depressants

Examples: Amitriptyline, Dothiepin, Clomipramine

Primarily used for depression however it has been found that this group of drugs also inhibits nerve pain. Being prescribed an anti-depressant does not mean that you have or are at risk of developing depression. It can take several weeks for this group of drugs to build up to an effective level in the body.

Common side effects: Sedation and dry mouth

Capsicum Cream

Derived from chilli peppers. The cream is absorbed through the skin to reduce levels of Substance P, the neuro-transmitter which is associated with inflammation and pain. Beneficial effects may be experienced with regular use (3-4 times a day).

Common side effects: Localised heat and redness.

Anti-spasmodics/muscle relaxants

Examples: Baclofen, Diazepam (also an anti-depressant)

Common side effects: drowsiness, confusion, dizziness and poor co-ordination

NSAIDs (non steroidal anti-inflammatory drugs)

Examples: Ibuprofen and Diclofenac (Voltarol)

Only has limited use for neuropathic pain, effects tend to be short term.

Common side effects: irritation of stomach

Trans Electrical Nerve Stimulation (TENS)

A machine which produces a mild electrical impulse. Electrodes from the machine are placed on the skin over the area of pain. It is believed that selective stimulation of certain nerve fibres could block signals carrying pain impulses to the brain. TENS can be self administered however it is advisable that individuals should be given a supervised trial prior to use.

Common side effects: allergic reaction/skin irritation to electrodes

Opioids

Examples: Morphine, Oxycodone, Fentanyl, Tramadol

Until recently neuropathic pain was thought to be resistant to opioids, however some individuals do find them beneficial.

Common side effects: feeling ‘spaced out’, constipation, drowsiness, nausea

Injections/nerve blocks

Examples: usually a combination of a local anaesthetic agent, opioids and steroids.

Nerve blocks are not a permanent cure but can reduce the pain for several days or weeks before it returns to severity.

Side effects: infection, allergic reaction

Pain management programmes

Example: NHS Expert Patient Programme that provides opportunities for people who live with long-term chronic conditions, such as neuropathic pain, to help develop new skills to manage their condition better on a day-to-day basis. For more information visit the Expert Patients Programme website.

Acupuncture

Acupuncture is a system of healing which involves the insertion of fine needles into specific points/energy channels on the body. It is believed that this stimulates the body’s own healing response and helps restore a natural balance. Acupuncture needles are very fine and when inserted the sensation is often described as a tingling or dull ache. If you are considering having acupuncture it is suggested that you visit a practitioner who is a member of the British Acupuncture Council.

Other complementary therapies

There are many other therapies that can be used in conjunction or as an alternative to conventional treatment. These include therapies such as reflexology, aromatherapy and homeopathy.

Bio feedback/relaxation

A technique based on the idea that you can learn to control and influence some of the things that your body does automatically. Most patients who benefit from biofeedback are trained to relax and modify their behaviour. It is believed that relaxation is a key component in biofeedback treatment.

Living with neuropathic pain

Pain is a very complex condition and each person is affected differently. It has many physical and psychological components and individuals can experience fatigue, anxiety, mood changes and depression.

As pain cannot be seen, it is hard to explain to someone exactly what it feels like and therefore it is hard for others to understand just how much it can affect every day life. An organisation called Pain Concern has lots of information on coping with pain when conventional treatment is not as successful as hoped.


This information was last checked in October 2012.

References

See a list of medical references that we used to research this article.