Neuropathic pain is defined as the shooting or burning pain as a result of nerve damage. The intensity of pain is often severe and impacts the overall quality of life.
Conditions like brain injuries, diabetes, vitamin deficiencies, autoimmune disorders, cancer, alcoholism and use of certain medications increase the risk of neuropathic pain.
Medications along with physiotherapy, relaxation and massage therapy, are known to improve the symptoms.
Neuropathic pain can lead to a feeling of hopelessness or anger due its chronic nature. It can interfere with normal activities such as sleep, exercise, and sex. Surrounding oneself with friends and family along with psychological help can make one deal with the emotional aspect of the disease.
The symptoms of neuropathic mostly start appearing after a long time of injury. It may take from several months to years. Initially, a person may experience pain in their digits which can be progressed to limbs.
The pain may be mild or severe but often worse at night. The symptoms may persist even beyond the healing period.
Trouble in sleeping
Emotional problems
Changes in sensation
Weakness
Muscle wasting (decrease in size of a body part or tissue)
Neuropathic pain interferes with normal activities such as sleep, exercise, and sex. It can lead to emotional problems such as:
Mood swings
There are several types of neuropathic pain depending on different criteria.
Neuropathic pain can be of two types according to the quantity of nerve involves:
If the neuropathic pain is due to the damage to one nerve, it is termed as mononeuropathy.
The most common example is carpal tunnel syndrome that involves the compression of a single nerve of the wrist.
The pain that arises due to the damage to two or more nerves is known as polyneuropathy.
The development of neuropathic pain in diabetes is polyneuropathy.
Based on the types of nerves involved, NT can be of following types:
It affects the nerves of the peripheral nervous system (nerves that present outside the brain and spinal cord).
Ex: Diabetic neuropathy. Uncontrolled blood sugar damages the nerves, particularly those in the toes and feet.
Affects the nerves in the brain, or more specifically, the nerves that branch out from your brainstem.
Affects the nerves that control bodily functions, such as urination, bowel movements, heart rate, and blood pressure.
Before understanding the cause of neuropathic pain, it is important to know the concept of neuron and mechanism of pain.
These are nerve cells that send messages all over the body.
Neurons receive sensory input from the external world and send motor commands to our muscles after processing in the brain.
There are approximately 86 billion neurons present in the human brain.
There is a huge involvement of neurons in the perception of pain.
Any painful stimulus such as pressure, pinch, heat, chemical, and burn activates the pain receptors (nociceptive receptors) that are widely distributed in the skin and deep tissues.
These pain receptors send signals to the brainstem (bottom part of brain) via first order neurons
There is a release of calcium in the brainstem which leads to the release of a chemical called glutamate
The released glutamate binds to special receptors present on the second order neurons
These neurons then cross over in the spinal cord and reaches to to the cerebral cortex (part of the brain that is involved in sensation of pain)
Note: An inhibitory pathway is also present in the brain stem which travels down the spinal cord. This pathway has several connecting neurons that release chemicals such as serotonin, noradrenaline, and gamma amino butyric acid (GABA) which avoid the feeling of pain.
Pain cessation results in the dominance of inhibitory pathways whereas pain enhancement is the outcome of stimulatory pathway dispensing upon the painful stimuli.
There are multiple theories behind neuropathic pain. Although the exact mechanism is not clear, neuropathic pain may arise due to the:
Increased activity of the first-order neurons if they are partially damaged
Impairment of inhibitory pathway
Development of a memory of pain in the second and third-order neurons due to alterations in the central processing of pain
Increase in the sensitivity of neurons
Reduced the activation threshold of neuron
Several brain injuries increase the risk of neuropathic pain. These injuries include:
Spinal cord injuries
There is a role of various vitamins in maintaining the overall health of neurons. Vitamin B1, B6, and B12, and E deficiency can increase the risk of neuropathic pain.
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People with some inflammatory condition such as vasculitis (inflammation of the blood vessels) are more prone to develop neuropathic pain.
Autoimmune diseases refers to the group of diseases in which the immune system attacks our own body. Some autoimmune diseases such as Guillaine Barre syndrome, Sjogren’s syndrome, lupus, and rheumatoid arthritis increase the risk of neuropathic pain.
Diabetes increases the risk of neuropathic pain to several fold. Approximately 50% of the patients with diabetes develop neuropathic pain.
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Some infections such as Lyme disease, Epstein-Barr virus, Hepatitis C, Shingles, Leprosy, HIV are associated with neuropathic pain.
Exposure to certain chemicals such as lead, mercury, arsenic and thallium can predispose to neuropathic pain.
Amputation refers to the removal of any body organ. It is also associated with an increased risk of pain within the first week after amputation.
Chronic alcoholism increases the risk of neuropathy either through direct toxic effect on neurons or through malnutrition.
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Long-term use of the following medications may be associated with neuropathic pain:
Some tumors can press on the peripheral nerves in the body which increases the risk of peripheral neuropathy.
There can be multiple causes of neuropathic pain. So, it is very important to uncover the primary cause of it. The diagnosis involves the understanding of medical history. The doctor may also inquire about:
Exposure to toxins
Medications
Trauma
Nutritional deficiencies
Consumption of alcohol
There are no standard tests to diagnose neuropathy. However, following tests may aid in diagnosis.
In this test, individuals are given some sort of stimuli to induce pain.
The stimuli is given in ascending and descending orders of magnitude.
QST measures the perception of mechanical, thermal, and painful stimuli.
It is useful to assess allodynia and hyperalgesia.
This technique does not diagnose other conditions with the same sensory abnormalities as neuropathic pain.
In this test, two electrodes are placed on the skin. One electrode stimulates the nerve and the other electrode records the time taken by the muscle to contract in response to the electrical pulse.
This involves examination of a small sample of skin tissue under a microscope. It helps to detect nerve degeneration or the presence of any lesions under the skin as a possible cause of neuropathic pain.
Some other tests are also performed to determine the other disorder with similar set of symptoms or to diagnose the exact cause of neuropathic pain. These include:
Vitamin and mineral (copper, thiamine, pyridoxine, folate, Vitamin B12, and Vitamin E)
Metal (mercury, lead, and arsenic)
Infectious disease (Lyme disease, Epstein-Barr virus, HIV, and syphilis)
Antibody testing for specific autoimmune diseases known to cause peripheral neuropathies such as Sjogren syndrome, lupus, and rheumatoid arthritis.
MRI or CT scans in cases where compression of the nerve is of concern
Nerve biopsy
Genetic testing (for inherited neuropathies)
Urine test
Almost all cases of neuropathic pain arise are associated with some disease. So, the best way to prevent neuropathic pain is to manage any underlying conditions.
A wholesome well- balanced diet that includes carbohydrates, good fats, protein, vitamins and minerals is the backbone to prevent any disease.
Vitamin B12 is a key constituent of a neuron. Make sure to consume rich sources of Vitamin B12 like meats, fish, eggs, low-fat dairy foods and fortified cereals.
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Exercise at least 30 minutes to one hour of exercise at least three times a week.
Avoid risk factors like exposure to toxic chemicals, smoking and consumption of alcohol trigger nerve damage that can further lead to neuropathic pain.
Neuropathic pain is a prominent complication of diabetes. Nearly half of the diabetic population developed neuropathic pain over a period of time.
The best way to prevent or delay this complication is to keep the blood sugars in check. This can be achieved by:
Indulging in regular physical activity
Losing weight if you’re overweight
Limiting or avoiding alcohol
Quitting smoking
Following a well guided healthy diet plan
Avoiding late night meals
Adhering to the medications as prescribed by your doctor
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One should seek immediate medical care in case of unusual tingling, weakness, or pain in your hands or feet. The early diagnosis and treatment helps in controlling the symptoms faster. It will also prevent further damage to the nerves.
The speciality of doctor that can help in managing neuropathic pain include:
Neurologist
Physical therapist
Occupational therapist
Endocrinologist
Rheumatologist
Psychiatry & addiction medicine
Surgeon
Oncologist
A neurologist helps in diagnosing the condition as they are specialized in treating disorders that affect the brain, spinal cord, and nerves.
Individuals with neuropathic pain find it hard to do even basic functions. Physical therapists help design activities and exercises to build motor skills and strength and to improve muscle control, posture, and balance.
Occupational therapists help to build skills needed for daily functioning.
Since neuropathic pain is mostly associated with endocrine disorders such as diabetes, an endocrinologist helps in managing and treating NP due to that sort of disorder.
Rheumatologists help in managing NP associated with conditions such as arthritis.
Psychiatry & addiction medicine specialists are helpful for individuals having alcohol-induced peripheral neuropathy.
Surgeons help in managing pain that is developed as a result of some surgery.
Oncologists help in managing the NP that arises due to cancer.
To get the right diagnosis, it is important to consult the right doctor. Consult India’s best doctors online.
Drug and non-drug therapies are usually used in combination for management of neuropathic pain.
1. The treatment usually focuses on the underlying disease such as-
2. Chronic neuropathic pain is usually treated using corticosteroids.
3. Neuropathic pain that develops due to small-fiber neuropathies, does not typically respond to pain relief medications. Such severe pain requires the use of certain anti-epileptics, and tricyclic antidepressants.
It includes the following class of drugs:
1. Antidepressants: They are effective against steady burning and aching pain. The common examples include:
Tricyclic antidepressants (TCAs): Amitriptyline, imipramine, nortriptyline and doxepin
Selective serotonin reuptake inhibitors (SSRIs): Fluoxetine, paroxetine, sertraline and citalopram.
Serotonin-norepinephrine reuptake inhibitors (SNRIs): Venlafaxine
2. Anti-epileptic drugs: These drugs act via enhancing the effect of inhibitory chemicals such as GABA. The common examples are carbamazepine and gabapentin.
3. Opioid analgesics: These drugs act via decreasing pain impulses from the brain. Oxycodone is the most commonly used opioid in relieving neuropathic pain.
4. Local anesthetics: They work by desensitization of the affected part. The 5% lidocaine patch is used for post-herpetic neuralgia.
In case of chronic neuropathic pain that has failed to respond to conservative medical management, the following approaches are considered:
It is essential to add vitamin B rich foods to your diet including eggs, milk, and other dairy products.
Hot and cold compresses are an effective therapy for neuropathic pain.
A warm compress over the painful area helps in relieving pain by increasing the blood flow. It also reduces muscle stiffness and spasms.
A cold compress is also helpful in subsiding the pain through reducing swelling.
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The severe neuropathic pain especially in feet can be managed to a great extent by soaking the feet in epsom salt and warm water. It can help ease the pain and discomfort. The magnesium sulfate in the salt helps reduce inflammation and promote healing.
One can also try a few home remedies that can act as adjunct to conventional treatment. However, if the nerve pain is severe, one shouldn't rely on home remedies and consult a doctor.
It also advisable to seek advice from a healthcare provider before initiating any of these:
The anti-inflammatory properties of turmeric help in easing out nerve pain. You can consume it raw, cooked, with milk or as a supplement.
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It is loaded with magnesium, phosphorus, calcium, potassium and anti-inflammatory properties which augment relief from nerve pain.
It can be consumed by adding 1-2 tbsp of apple cider vinegar in a glass of warm water.
The chronic ongoing neuropathic pain can lead to serious complications:
1 Injuries: The loss of sensations increases the chances of injuries and wounds due to lack of feeling of pain.
2. Gangrene: Untreated infected wounds can even lead to gangrene – death of a tissue due to reduced blood supply. In rare cases, it can even lead to amputation (removal of a body part) in order to prevent the infection from spreading.
3. Loss of bladder control: Neuropathy can even cause involuntary urination due to loss of sensation in the bladder. Diabetic neuropathy is the most common cause of this condition, but it is also seen in people with Guillain-Barré syndrome, and HIV infection.
4. Disturbed sleep: The constant pain hampers the quality of sleep in most of the individuals with neuropathic pain.
5. Anxiety and Depression: Many people with neuropathic pain develop mood swings, anxiety and depression due to the chronic nature of the condition.
Many patients with neuropathic pain pursue complementary and alternative treatments that include:
Acupuncture is the practice of penetrating the skin with thin needles. These needles are then activated through gentle and specific movements of the practitioner's hands or with electrical stimulation.
The technique might release chemicals that numb pain, or block the pain signals sent from the nerves.
In this, nerves are stimulated through electrodes placed under the skin. This makes the muscles contract which helps in relieving pain.
There is another technique called transcutaneous electrical nerve stimulation, in which electrodes are placed on the skin.
Nerve damage can lead to muscle weakness and wasting. Physiotherapy helps in improving muscle tone, balance and coordination. It includes guided movements, massages and application of stimuli such as heat, cold, and electrical currents.
This therapy is recommended in individuals who have trouble coordinating normal physical movements such as walking up or down stairs, kicking balls, or jumping.
Massage is helpful in providing symptomatic relief. Massage applied to specific muscles often increases blood flow and releases knots of muscle tension which helps in reducing overall pain.
It involves various innovative exercises and movements to target neuropathic pain.
Cognitive behavioral therapy (CBT) is a talking therapy that helps individuals to cope better with the emotional symptoms of severe neuropathic pain.
The following measures help in managing the pain:
Individuals with neuropathic pain should indulge in exercise regularly. Stretching and yoga are found to be very effective in increasing the flexibility of muscles and reducing the severity of pain.
Individuals with neuropathic pain in the feet should use compression socks. They help to reduce swelling and inflammation and overall pain.
People should take regular breaks from normal activities such as walking, standing, and other activities. Adequate rest also helps in repairing the nerves faster.
Individuals with NP should avoid alcohol as it may hamper recovery. This is because alcohol negatively affects the absorption of several vital vitamins and minerals that are required for the normal functioning of the nerves.
Living with neuropathic pain can develop a feeling of hopelessness, anger or even depression due to the constant pain.
People may start withdrawing themselves from people and may stop doing the fun things you used to do. The following measures may help in managing the emotional chaos:
Surround yourself with friends, family and people who give you support.
Be open to activities you love and that bring you happiness.
Explore activities that will stimulate you mentally, such as reading or puzzles.
Be open with the people you live with and others close to you.
