Neuropathic Pain (Neuralgia)

What is Neuropathic Pain

Neuropathic pain, or nerve pain, is one of the most intense forms of chronic pain caused by a problem with one or more nerves themselves. The function of the nerve is affected in a way that it sends abnormal pain messages to the brain.

Symptoms of Neuropathic Pain

Neuropathic pain is often described as

• sharp shooting or electrical shock
• burning
• tingling, “pins and needles” or “pricking”

It can occur all the time or come in spurts. Likewise, it can range in intensity from being mild and nagging to severe and disabling

What causes Neuropathic pain?

Various conditions can affect nerves and may cause neuropathic pain. These include the following:

• Trigeminal Neuralgia
• Post Herpetic Neuralgia (Pain following shingles)
• Diabetic neuropathy
• Phantom limb pain following surgical removal (amputation) of a limb.
• Pain following chemotherapy
• Alcoholism
• Cancer
• Atypical facial pain
• Various other uncommon nerve disorders

Diagnosing Neuropathic Pain

To diagnose neuropathic pain, your doctor will conduct an interview and physical exam. He or she may ask questions about how you would describe your pain, when the pain occurs, or whether anything specific triggers the pain. The doctor will also ask about your risk factors for neuropathic pain and may also request both blood and nerve tests.

How do we treat Neuropathic Pain?

Neuropathic pain does not respond to traditional painkillers like paracetamol or diclofenac. Treatment is more comprehensive and includes:

• Treating the underlying cause (if possible): eg controlling Diabetes, though this may not immediately help in relieving pain, it may help in preventing further nerve damage and exacerbation of pain
• Medications:

• Antidepressants (eg Amitriptyline, Duloxetine) and anticonvulsants (eg Gabapentin, Pregabalin) are commonly used to manage neuropathic pain. These medications may ease the pain within a few days but it may take 2-3 weeks. It can take several weeks before you have maximum benefit. Some people give up on their treatment too early. It is best to persevere for at least 4-6 weeks to see how well the medicines are working.
• Topical treatment with patches like 5% lidocaine
• Tramadol is a weak opioid which may help to reduce neuropathic pain

• Nerve Blocks: Relevant nerve blocks under image guidance may be required
• Psychological treatments: Pain can be made worse by stress, anxiety and depression. Also, the feeling (perception) of pain can vary depending on how we react to our pain and circumstances. Appropriate counseling may be required in certain patients.