Neuropathic Pain: What You Need to Know

Neuropathic pain is an exaggerated pain sensation that accompanies various diseases and disorders. Let's see what the experts say about it.

Neuropathic pain is pain that some patients experience due to an injury or disease of the somatosensory system. According to researchers, it affects between 3% and 17% of the population worldwide. It’s characterized by a hypersensitivity to external stimuli, or hyperalgesia. It also occurs with stimuli that originally shouldn’t cause pain (allodynia).

Contrary to popular belief, neuropathic pain isn’t a homogeneous condition. The causes are very varied, its symptoms differ between patients, and treatment options don’t have the same effect in everyone. In the next few lines, we’ll explain what we know about it.

Symptoms of neuropathic pain

The main characteristic of neuropathic pain is pain. Patients experience different sensations related to this, some of which prevent them from being able to function on a day-to-day basis. The four most common types of pain during outbreaks of pain are:

• Allodynia: Allodynia is defined as pain conditions that are triggered in the presence of stimuli that originally shouldn’t be painful. Despite the fact that the stimulus isn’t harmful, patients experience pain. For example, small frictions or contacts with objects of different temperatures.
• Hyperalgesia: In this case, it refers to an exaggerated sensitivity to any type of stimulus that causes pain. In this sense, a light blow can trigger an extraordinary reaction that isn’t related to the stimulus.
• Hyperesthesia: This consists of an increase in the way sensations are processed. It can occur in any of the five senses, although in this case it’s mainly related to touch. As a consequence, interactions with any object or with the outside environment are more intense and vivid, which can lead to pain according to intensity.
• Hyperpathy: This is also characterized by increased sensitivity to external stimuli, although this time especially against those carried out repeatedly. Permanent contact or interaction with different things can trigger episodes of chronic pain.

Clinical manifestations

In summary, these are the four most common manifestations of neuropathic pain. We can highlight the following signs and symptoms among patients:

• A sharp pain in the face of contact with external stimuli.
• A tingling or numbness on slight friction with an object. It can also occur in the presence of indirect triggers (sunlight, for example).
• Limited movement or muscle atrophy in the affected areas.
• Joint ankylosis (making it difficult to move the joints).
• General numbness

These symptoms persist even after you have moved away from the presumed source of pain. All these sensations are known as dysesthesia and can compromise the patient’s day-to-day life. For example, sleeping, sitting, or getting up from an armchair, going for a walk on a sunny day, hugging someone, or taking a bath can be a painful experience.

Causes of neuropathic pain

As the evidence shows, neuropathic pain is due to disease or injury to the brain or spinal cord. Many different conditions can trigger this pain, and we can highlight the following:

• Multiple sclerosis
• Parkinson’s disease
• Ictus
• Optic neuromyelitis
• Transverse myelitis
• Cancer
• Diabetes
• Syringomyelia
• Infectious processes
• Guillain Barre syndrome
• Trauma to the spinal cord or brain

Excessive alcohol intake and recreational drug use (or uncontrolled drug intake) can also lead to this condition. It’s important to note that not all patients with these diseases develop this type of pain. For example, it’s estimated that up to 26% of diabetic patients develop neuropathic pain.

Diagnosis of neuropathic pain

Neuropathic pain isn’t an easy condition to diagnose. In principle, it varies according to the possible episodes that are triggering it. When a nerve injury is suspected, and the episodes are consistent with the symptoms, then specialists can determine it more quickly.

However, sometimes the clinical situation is very vague and there’s no disease or injury that can determine nerve damage. Experts point out that there’s no standard test for its detection, and the diagnosis of the condition is carried out by the doctor’s medical judgment.

In this way, during the appointment, the specialist will assess the patient’s history, and the possible presence of underlying diseases, and evaluate the characteristics of the pain. This will allow you to rule out other explanations in order to determine a positive diagnosis.

Treatment options

Just as there are no diagnostic protocols, researchers also caution that there’s currently no consensus on the treatment of neuropathic pain. In view of this, the options vary according to each region, the judgment of the specialist, and the randomized trials that have shown some degree of progress during their application.

Brain & Spine Foundation notes that a standard therapy for the condition is usually based on the following options:

• Antiepileptics
• Antidepressants
• Opioids
• Capsaicin cream
• Lidocaine patches
• Nerve block injections
• Transcutaneous or percutaneous electrical nerve stimulation

You can also opt for psychological therapies in cases where the causes are more subjective than physical. The choice, in any case, is made by the specialist according to the symptoms. If the triggering condition is detected, it should be treated immediately to prevent pain symptoms from evolving into chronic conditions.

Other alternatives such as aromatherapy, acupuncture, and other natural medicine options are not scientifically based. However, provided they have the endorsement of the specialist, patients can try them if they haven’t found an option to help them control the pain.

Sessions with a physical therapist can also be used as an adjunct while benefitting from the main treatment. This can teach techniques for sitting or lying down that minimize the impact of pain. It’s important for patients to avoid situations that cause them to trigger these symptoms.