Neuropathic pain is a complicated chronic pain that is typically accompanied by some kind of injury to the tissues. With this condition, the nerve fibers might be damaged, injured or dysfunctional, causing the fibers to transmit wrong signals to the nerve centers in the body. An example of this is the phantom limb syndrome, where an amputated limb still receives impulses from the brain, causing pain.

Causes and Symptoms

There are many kinds of neuropathic pain so the causes vary, but the most common are spine surgery, shingles, multiple sclerosis, HIV or AIDS and facial nerve problems. Other possible causes are diabetes, chemotherapy, amputation, alcoholism and injuries to the hip, leg and back.

The symptoms of neuropathic pain are tingling, numbness and a burning or shooting pain. The severity of the symptoms will vary from case to case, however, and diagnosis will be necessary. Although there are different kinds of neuropathic pain, it is usually caused by a problem with the nerve. In simple terms, the nerve’s ability to function is affected so that pain messages are transmitted to the brain. It is the problem with the nerves that causes the feeling of stabbing, shooting and numbness. Unlike typical body aches, neuropathic pain is usually not receptive to ordinary painkillers and treatment.

Diagnosis

Neuropathic pain is diagnosed by a doctor via a physical examination. You will also be asked questions about your condition, the kind of pain you feel, when the pain strikes and if there are any specific triggers you know. Depending on the severity of the condition, nerve and blood tests will also be done.

As you are being diagnosed, the doctor might check for conditions that are related to it such as allodynia, meaning the pain gets worse. An example of this would be touching your face causes pain, a condition known as trigeminal neuralgia. Another one is diabetic neuropathy, where the pressure brought by bedclothes causes physical pain.

Hyperalgesia on the other hand, refers to the kind of pain you get from a touch or stimulus that would otherwise only result in mild discomfort. Paraesthesia meanwhile, is a condition marked by painful and unpleasant feelings even if there is no contact or stimulus. An example of this would be the “needles and pins” sensation or something like an electrical shock.

Given all the facts above, it should be clear why diagnosis is important. Without it, you will not know what treatment to get, and if no action is taken, the condition will get worse and could lead to depression, anxiety and other disorders.

Treatment

There are many ways to treat neuropathic pain, the most commonly prescribed being non-steroidal anti-inflammatory drugs, although more powerful painkillers may be needed if the symptoms are severe, such as antidepressants and anticonvulsant drugs. If the pain is accompanied by another medical condition like diabetes, then other medications may be required.

If the neuropathic condition is hard to treat and is complicated, your doctor might recommend an implantable device to reduce the pain, while in other cases electrical stimulation of the nerves may be performed to lessen pain symptoms. Aside from these, there are other treatment options available such as acupuncture, physical therapy, massage therapy and more. However, these treatments are usually good only for mild cases of neuropathic pain, and severe cases require medication.

Gabapentin

Gabapentin (Neurontin) is one of the most widely used drugs for treating neuropathic pain, although it was originally developed as a treatment for epilepsy. The drug is most often recommended and prescribed for neuropathic pain brought about by central neuropathic pain, post-herpetic neuralgia and diabetic neuropathy. Gabapentin may also be prescribed by doctors to treat other conditions such as bipolar disorder, insomnia and restless leg syndrome.

Side Effects

The drug is not without side effects however, the most frequently reported being drowsiness, weight gain, fatigue and dizziness. The majority of symptoms manifest among the elderly that have been prescribed high dosages. In addition, some children might suffer from mild mood swings, hyperactivity and difficulty concentrating.

Antidepressants

Antidepressants like pregabalin, anticonvulsants, and selective serotonin-norepinephrine reuptake inhibitors (SNRI’s) might be prescribed as well. Tramadol and opioid analgesics are recognized too but they are not first line treatments. Today, the majority of pharmacologic treatments for treating this condition work the same way, and that is by reducing the sensitivity of the nociceptive receptors and preventing the transmission of pain signals. The way antidepressants work in neuropathic pain is not the same as when it is used to treat depression, as the drug is able to limit the pain signals that reach the brain.

The most effective antidepressants are the tricyclic group, as they interfere with the transmission of nerve impulses. Usually it takes a couple of days for the drug to work and it might take a few weeks before the full extent of the medication is felt.