Neuropathic pain

what is neuropathic pain?

Neuropathic pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system, either at the peripheral or central level.

This means that pain is caused by damage or disease of the nervous system either peripherally (ie damage to a nerve) or centrally (ie damage to the brain or spinal cord).

There are numerous causes of neuropathic pain, ranging from trauma,  stroke, viral infection, diabetes or cancer. As it can affect any part of the nervous system, it can present in numerous ways. The pain can be severe,  intense, relentless and debilitating for the sufferer. The nerve damage may be  associated with  loss of function with disability and often the affected area can be hypersensitive.  This relentless nerve pain may be associated with distress and anxiety, potentially leading to depression.

Unfortunately, as there are so many causes of  neuropathic pain, it is relatively common condition and presents in a great variety of ways. In the UK it affects about 2% of the overall population. It is present in up to 10% of adults and tends to be more prevalent with increasing age.

There are about 1 million sufferers of  neuropathic pain in the UK and approximately  36,000 in Northern Ireland.


common presentations of neuropathic pain?

Neuropathic pain is caused by damage to any nerve and therefore it can present in many different ways. These are some of the more common presentations of neuropathic pain.

  • SCIATICA –  (Learn More) is  caused by compression or irritation of the sciatic nerve roots, as they leave the spine. This results in a characteristic pain that radiates down leg into the foot or ankle.
  • OCCIPITAL NEURALGIA –  is a headache in the occipital area of the head (back of the head) caused by irritation of the occipital nerves as they pass over the joints of the neck. Degeneration of cervical facet joints is often the cause of this headache.
  • COMPLEX REGIONAL PAIN SYNDROME – (CRPS) is a debilitating condition, characterised by pain in a limb, in association with sensory, vasomotor, sudomotor, motor and dystrophic changes. It commonly arises after an injury to that limb
  • TRIGEMINAL NEURALGIA – is characterized by brief, but frequent episodes of shooting neck and facial pain. This is typically felt around the jaw, facial or forehead area. The pain is often worse with touch and may be aggravated by activities such as  shaving, eating or brushing teeth.
  • POST HERPETIC NEURALGIA  – is a neuropathic pain that appears during an outbreak of shingles, but persists long after the condition has cleared.
  • PAINFUL DIABETIC NEUROPATHY  – is a burning or stabbing pain in the hands and feet of some people who suffer from diabetes. it is caused by damage to the small peripheral nerves due to poor blood flow.
  • POST SURGICAL PAIN –  is pain that persists inappropriately after a surgical procedure, long after the surgical would has healed up. This can occur after any surgical procedure.
  • PHANTOM LIMB PAIN – is pain that is experienced in a limb, even after it has been amputated. Phantom sensations such as itch or movement sensations are relatively common. Phantom pain, when it occurs, often mimics the pain prior to amputation and can be very persistent is distressing for the sufferer. Phantom sensations can also be experienced following amputation of other body parts such as breast, eye, tongue or testis. 
  • CARPEL TUNNEL SYNDROME – is caused by compression of the main nerve of the forearm, causing it to swell slightly. This causes pain in the wrist, thumb and fingers.
  • CENTRAL PAIN SYNDROME –can occur after nervous system damage, such as a stroke. It can also be caused by neurological diseases such as multiple sclerosis.

how is neuropathic pain treated?

As the nerves themselves are the source of the pain, this is not normal pain and therefore does not respond to normal painkillers. The mainstay treatment for most forms of neuropathic pain is with medications, but, like most chronic pain conditions, this is tailored to the needs of the individual sufferer and within the context of a multi-modal and multi disciplinary approach. 

Injections can be considered for specific conditions such as sciatica or occipital neuralgia. These tend to give short term benefit, but can also have diagnostic value.

In some circumstances, more invasive procedures such as spinal cord stimulators or radiofrequency nerve ablations can be considered, but these are only offered in specialist units

young lady with chronic migraine or facial pain

Useful links

Multiple Sclerosis is often associated with neuropathic pain

Other frequently seen chronic pain conditions

i am happy to consult on a number of other chronic pain conditions, including:-

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