NEURALGIA AND NERVE DISORDERS: NEUROPATHIC PAIN

Neuropathic pain is a type of pain that follows an injury to the nervous system. The nervous system is composed of nerves, the spinal cord and the brain. Most conditions that lead to neuropathic pain involve an injury to nerves. Nerves are like electric cables that are distributed throughout the body. Nerves help to tell individuals about different types of feelings experienced throughout the body. Some nerves, for example, tell us about how painful, hot or cold something is, while other nerves may be better at sensing pressure or just light touch. Neuropathic pain tends to occur when a nerve that normally senses hot, cold or pain is injured in some way.

Researchers estimate that almost 4 million people in the United States have neuropathic pain. The most common cause of neuropathic pain is pain from spine disorders. These disorders are very common in the general population. Fortunately, not everyone with back pain or a spinal disorder has persistent neuropathic pain. Another cause of neuropathic pain is diabetes. Diabetes also is very common in the general population, and may lead to damage of small nerves. Pain following an episode of shingles (an outbreak of localized chicken pox) also is a very common cause of neuropathic pain. This type of pain is called post-herpetic neuralgia, and affects elderly persons more often than other age groups.

Fast Facts

· Neuropathic pain affects up to 4 million persons in the United States.

· Neuropathic pain is caused by damage to nerves, the spinal cord or brain.

· Neuropathic pain symptoms include burning, shock-like, electric or tingling pain sensations.

· Diabetes is a common cause of neuropathic pain.

· Pain following an outbreak of shingles — called post-herpetic neuralgia — is a serious neuropathic pain problem, especially in the elderly.

Myths and Misconceptions

Many persons with neuropathic pain do not respond to common pain medications like ibuprofen or acetaminophen (Tylenol). In the past, doctors and researchers thought neuropathic pain did not respond to potent pain medications, like opioids (morphine-like drugs); however, current research has demonstrated that neuropathic pain may respond to these types of medications. Another misconception about neuropathic pain is that patients and doctors may believe that because a certain injury has healed, the pain should have gone away. Neuropathic pain may outlast the normal healing process.

How the Disease Happens

Neuropathic pain most likely occurs after an injury to some part of the nervous system. Changes in the nervous system very likely occur as nerves attempt to heal or become persistently active after an injury. Some injuries are associated with changes in the body's system for detecting normal sensations. For example, some persons with neuropathic pain have pain from a simple light touch on the skin. This is the result of abnormal activity in the body's sensing mechanisms. These changes can become persistent.

Disease Types

There are different types of disease that cause neuropathic pain.

· Nerve diseases — diabetes, peripheral neuropathy, post-herpetic neuralgia

· Spinal diseases — degenerative disc disease, radiculopathy, failed low back surgery syndrome

· Spinal cord diseases — spinal tumors, spinal cord injury

· Brain diseases — stroke, traumatic brain injury

Getting Help

Neuropathic pain takes many forms and there are a variety of physicians and health care providers who can help treat it. This is most likely to happen if the doctor is board-certified in Pain Medicine by the American Board of Pain Medicine or holds a special certificate in Pain Management from the American Society of Anesthesiologists. Ideally, the doctor should work in a recognized pain clinic that includes several types of treatment, but such clinics are not available in all areas of the country. Be aware that many doctors and other health care practitioners call themselves pain specialists, but may not be as well trained or experienced in treating chronic pain conditions.

The important thing is to shop around — and get multiple consultations, if necessary — until you are completely satisfied that the health care practitioner or facility can help you with your neuropathic pain. Some questions to ask your doctor:

· How many cases of neuropathic pain have you treated?

· What are your special qualifications to treat neuropathic pain?

· What is your philosophy of pain management in terms of medications and complementary therapies?

· What types of medications do you generally prescribe?

· What types of non-drug therapies do you use?

· Where do you refer patients who need additional treatment?

· Is your clinic listed with any professional societies? (You can check this out yourself by going to the Web sites of the professional societies.)

· Do you have seven-days-a-week, 24-hour coverage if I need help?

Here are some places and people that can help manage neuropathic pain:

· Comprehensive Pain Centers. Such centers provide multi-modality, interdisciplinary treatment.

· Pain Medicine Physicians. Pain medicine has become a medical specialty in recent years. Pain medicine physicians specialize in treating many different pain conditions. Depending on background and interest, many treat neuropathic pain. Ask about their experience and interest in treating neuropathic pain and whether they incorporate a variety of therapeutic (multi-modality) approaches.