Neuropathic Pain Overview

Contents 


OVERVIEW

NEUROPATHIC PAIN
  • Pain arising as a consequence of a lesion or disease of the peripheral &/or central nervous system affecting the somatosensory system
  • Characterized by burning, stabbing & electrical pain which may be constant, aching or paroxysmal, pins & needles
  • Nerve conduction blockage causes nerve dysfunction, leading to numbness, weakness & loss of deep tendon reflexes in the area of involved nerve
  • Neuropathic conditions (eg brain infarction, spinal cord trauma, ischemic neuropathies) also cause aberrant symptoms of spontaneous & provoked pain

Below is the overview of disease management of Neuropathic Pain:

Overview of management of neuropathic pain

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Clinical History

  • History & clinical examination are required to confirm the presence of a neuropathic pain syndrome & also an important step in reaching an etiologic diagnosis for neuropathic pain
  • Rapid & correct diagnosis of neuropathic pain (NP) should be done so that appropriate treatment can be started earlier

Refer to Symptoms for more information

Common Neuropathic Pain Syndromes

Central Neuropathic Pain

  • Pain may be burning, shooting, aching, or pricking & is often associated with dysesthesia, hyperalgesia or allodynia to brush or cold
  • Seen among post-stroke, spinal cord injury & multiple sclerosis patients

Painful Diabetic Peripheral Neuropathy (DPN)

  • Symmetrical sensory loss & burning, shooting, stabbing or severe deep aching pain of both lower extremities among patients w/ diabetes mellitus (DM)
  • Affects about 50% of DM patients
  • Pain may be accompanied by allodynia & hyperalgesia
  • Symptoms may worsen at night

Postherpetic Neuralgia (PHN)

  • Pain persisting for >3 mth after herpes zoster skin lesions have healed
  • Risk factors for developing PHN:
    • All patients >50 yr w/ herpes zoster virus (HZV) infection
    • Patients w/ a greater degree of skin surface area involved & more severe pain at presentation of HZV infection
    • Patients w/ HZV ophthalmicus
    • Patients who experience sensory dysfunction on the affected dermatome
    • Painful prodrome prior to rash
  • Patients at greatest risk for developing PHN should be offered antiviral treatment
  • Diagnostic clinical features of PHN:
    • Pain localized to the dermatome affected by the herpes zoster rash
    • Pain may be described as burning, throbbing, sharp or shooting
    • Allodynia
    • Pain accompanying movement
    • Areas of scarring of hypopigmentation caused by herpes zoster rash
    • Presence of psychosocial stress

Trigeminal Neuralgia (TN)

  • Characterized by intermittent unilateral facial pain following the unilateral sensory distribution of the trigeminal nerve, typically radiating to the maxillary or mandibular area
    • Ophthalmic division pain alone occurs in <5% of patients
  • Pain is quite severe, stabbing electric shock-like sensation
  • Pain may be brief & paroxysmal but may occur in multiple attacks several times a day, w/ no pain between episodes
  • Typically w/ normal PE findings, although mild light touch or pin perception loss has been described in the central area of the face
  • Average age of pain onset in idiopathic TN is usually the 6th decade of life, but may occur at any age
  • Symptomatic or secondary TN tends to occur in younger patients
  • Common triggers precipitating pain attack include light touch or vibration & activities such as shaving, face washing or chewing

Postsurgical Neuropathic Pain

  • Peri-incisional sensory loss, pain & allodynia for >3 mth after surgery; phantom pain following amputation or mastectomy

HIV-Related Neuropathy

  • Symmetrical painful paresthesias, most prominent in the toes & soles of the feet among HIV patients

Lumbosacral Radiculopathy (Herniated Intervertebral Disc)

  • Lancinating pain radiating into the anterior thigh (L2/3) or lower leg (L4-S1) w/ motor weakness or sensory loss

Complex Regional Pain Syndrome

  • Regional (eg limb) pain together w/ edema, cutaneous blood flow & sweating abnormalities

Below is the overview of disease management of common neuropathic pain syndromes:

Overview of management of common neuropathic pain syndromes

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Overview of management of common neuropathic pain syndromes 2

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Version: 30 Sep 2015

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