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Neuropathic pain

This article discusses neuropathic pain and some ways to manage it.

What is neuropathic pain?

Neuropathic pain is caused by damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscles and other parts of the body.

The pain is usually described as a burning sensation and affected areas are often sensitive to the touch. Symptoms of neuropathic pain may also include excruciating pain, pins and needles, difficulty correctly sensing temperatures and numbness. Some people may find it hard to wear thick clothes as even slight pressure can aggravate the pain.

What causes neuropathic pain?

Common causes of neuropathic pain include nerve pressure or nerve damage after surgery or trauma, viral infections, cancer, vascular malformations, alcoholism, neurological conditions such as multiple sclerosis and metabolic conditions such as diabetes. It may also be a side effect of certain medications. Occasionally no identifiable cause is found which can be distressing for the individual experiencing the pain.

Chronic neuropathic pain is common and may be related to an underlying health condition such as cancer or diabetic neuropathy, or it could be related to treatments such as chemotherapy.

How do you treat neuropathic pain?

The primary goals of treatment for neuropathic pain are to manage the pain as much as possible and to minimise the negative side effects of the treatment. Individuals with chronic neuropathic pain may be referred to a pain clinic for assessment, management and advice on living with chronic pain.

Every person is different and your doctor will take into consideration your needs so as to suggest the most suitable treatment for you. There are various treatments available for neuropathic pain and often it is a ‘trial and error’ process to find the best option for an individual.

Regular painkillers such as non-steroidal anti-inflammatory drugs or NSAIDs (for example ibuprofen, aspirin and paracetamol) are usually not effective for neuropathic pain.

Here is a brief outline of the most common treatments:

Anti-epileptics

Examples: gabapentin, pregabalin

Primarily used for the treatment of epilepsy, these drugs can also reduce nerve pain and ease neuropathic symptoms. Being prescribed an antiepileptic medication does not mean you have or you are at risk of developing epilepsy. The drug carbamazipine is usually used for people with a diagnosis of trigeminal neuralgia.

Common side effects: drowsiness, dizziness and headaches

Antidepressants

Examples: amitriptyline, duloxetine

Primarily used for depression, this group of drugs has also been found to have an effect on managing nerve pain. Being prescribed an antidepressant does not mean that you have or you are at risk of developing depression.

Common side effects: drowsiness and dry mouth.

Opioids

Examples: codeine, dihydrocodeine and morphine, oxycodone, fentanyl, buprenorphine

The evidence of benefits in using opioids to treat neuropathic pain is not clear however some individuals find them beneficial. It is suggested to discuss with your doctor about the potential benefits and risks before you start taking an opioid.

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

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.

Lidocaine patch

It can ease pain which affects a small area of the skin.

Common side effects: irritation and redness.

Injections/nerve blocks

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

Nerve blocks do not have a long-term effect but they can reduce the pain for several days or weeks.

Common side effects: numbness or tingling in the area injected, increased discomfort for a few days.

Transcutaneous electrical nerve stimulation (TENS)

A TENS machine produces a mild electrical impulse. Electrodes (the sticky pads) 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 and spinal cord which may help to relax the muscles and ease the pain. TENS can be self administered however it is advisable to give individuals a supervised trial prior to use.

Common side effects: allergic reaction/skin irritation from electrodes.

Percutaneous electrical nerve stimulation (PENS)

This method is often suggested to people with neuropathic pain that is difficult to treat (refractory). The procedure is similar to TENS (transcutaneous electrical nerve stimulation), but involves inserting an electrode under the skin with a needle rather than using a sticky pad (electrode) on the skin.  The needles are connected to an electrical stimulator machine.

Common side effects: bruising and tenderness where the needle was inserted.

Acupuncture

Acupuncture is a treatment which originates from ancient Chinese medicine and it involves the insertion of fine needles into specific points/energy channels on the body. It is believed that this stimulates the nervous system and the body’s own healing response which in turn helps with pain management. Acupuncture needles are very fine and when inserted through the skin 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 therapies

People may also find benefits in other therapies that can be used in conjunction or as an alternative to conventional treatment. These include therapies such as meditation, reflexology, aromatherapy and homeopathy. A change in lifestyle may also be beneficial for managing pain. Changes include following a balanced diet, doing gentle exercise (in agreement with your doctor), drinking plenty of water and avoiding smoking and drinking alcohol.

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 everyday life. The organisation Pain Concern provides information and support to people affected by pain.

 


 

This information was last checked in November 2016. Due for review in November 2019.

Should you wish to view the references for this publication, please contact luke.stamatis@brainandspine.org.uk