Neuropathic pain (also referred to as nerve pain or neuralgia), is pain caused by damage, injury or dysfunction of nerves. This is the result of trauma, disease, surgery or chemotherapy.
Types of nerve pain include:
- Postherpetic: post shingles pain that affects the nerves where the shingles rash was present.
- Trigeminal: pain in the jaw or cheek
- Occipital: pain at the base of the skull that can spread to the back of the head.
- Pudendal: pain in the “saddle area” between the legs
- Cluneal: pain associated with the cluneal nerve in the lower back
Certain conditions can cause neuropathic pain. These include:
- Infections (Shingles for example)
- Phantom limb pain (neuropathic pain following amputation surgery)
- Multiple sclerosis
- Sciatica (pressure on nerves of lower back)
- Cancer and treatment of cancer (including radiation, surgery or chemotherapy)
- Trapped nerves (Such as carpel tunnel)
- Peripheral neuropathy (damage to peripheral nerves)
- Shooting, stabbing or burning sensation
- Tingling, pins and needs, numbness, itching or prickling
- Sharp and sudden pain described like an electric shock
- Sensitivity to touch or temperature
- Allodynia (pain to non-painful stimulus)
- Often described as worse at night
People with chronic neuropathic pain often find implications occur as a result in other important areas of their live as well including mood, sleep, relationships, work and exercise.
A thorough history and physical examination underpin the diagnosis of neuropathic pain. A patient may also be recommended for any/all of the following tests:
- Nerve Conduction Studies (study to measure how quickly nerves carry electrical signals)
- CT or MRI Scan (to assess if there is any underlying cause of the neuropathic pain)
Understanding neuropathic pain and underlying pathology is essential to be able to address symptoms with the appropriate treatment strategy, although neuropathic pain can be one of the most difficult to treat of all chronic pain conditions. The goal of treatment is to reduce disability and improve overall wellbeing.
There are a variety of ways in which neuropathic pain can be treated. These include treating the underlying cause, if there is one. Treatment should be multi-modal to ensure a personalised pain management plans is implemented and may include the following management options:
- Pharmacology: Common pain medications such as paracetamol don’t usually prove effective in reducing symptoms/pain associated with neuropathic pain, although for some patients, together with an anti-inflammatory there is some reduction in their symptoms. Other medications may also be used to manage the symptoms. These medications include Pregabalin (Lyrica), Gabapentin (Neurontin) or Amitriptyline. Stronger pain medications such as Opioids are not recommended for long term use in controlling the persistent pain or neuropathic pain. If an opioid medications is being used, it is important to use the lowest dose possible to manage symptoms and ensure the least side effects as these medications can be associated with issues of tolerance, dependence and withdrawal if ceased too soon/suddenly. Your pain specialist will work with you to find the best medications for your pain. Medicinal cannabis is other medication which for patients who meet a strict criteria, may find benefit from.
- Exercise Physiotherapy: Ensuring patients with chronic neuropathic pain keep active and moving is vital. Contrary to popular belief, research has shown that patients who participate in regular exercise will have overall better outcomes. A trained exercise physiotherapist who specialises in chronic pain management is a great place to start and your pain specialist will recommend one for you. This will involve active participation on the patient’s behalf to ensure the appropriate exercise is selected for the patient’s level of fitness. It is important to remember to start slow and pace yourself – this is not a race! Low impact or water-based exercises are good starting points.
- Lifestyle Factors: Getting enough sleep, reducing caffeine intake and having a routine for sleep and waking up is also important. Eating a balanced diet that includes plenty of Omega-3 fats (such as oily fish, fish oil supplements, linseed or linseed oil, canola oil and walnuts) has also been shown in research to help ease the symptoms of chronic pain by helping to naturally reduce inflammation. In addition, drinking green tea regularly has also been shown in some research to help naturally reduce inflammation. Maintaining a healthy weight may also improve the symptoms of your neuropathic pain. It is also highly recommended that if a patient suffers with chronic neuropathic pain and is smoking, they work with their GP on quitting as this will have an impact on the pain a person experiences (Studies have shown that patients who smoke will report higher levels of pain compared to those who are non-smokers). Together with other treatment options, lifestyle factors can help manage pain.
- Psychological Support: The overall impact from chronic neuropathic pain can be significant. Involvement of a trained pain psychologist is recommended to help patients gain better control of their pain, reduce stress, symptoms of anxiety and/or depression, and help patients be able to cope with their condition in everyday life. A referral to a trained pain psychologist may be recommended by your pain specialist.
- Interventional Procedures: Your pain specialist may recommend you for an interventional procedure. Based on your underlying pathology, procedures such as nerve blocks, radiofrequency neurotomy or even more advanced procedures such as spinal cord stimulation. These procedures aim to give maximum pain reduction but will not provide a cure.
It is important to note that neuropathic pain affects people in different ways and one person’s response to treatment will be different from another person’s. Your pain specialist will work out a plan on how best to treat you and your symptoms.
**This information sheet has been written for patients affected by neuropathic pain and provides general information only**
References: Pain Australia; Health Direct; NPS Medicinewise.