Neuropathic pain

PAIN, PAIN, PAIN!!!

Pain is a natural defence mechanism that helps protect us from harm. Without it, we could unknowingly expose ourselves to dangers that might seriously threaten our well-being. However, pain can be very unpleasant and, when severe, can significantly affect daily life. Pain can come from physical causes, mental stress, or both.

All physical pain is felt because of signals sent through our nerves. There are two main types of pain:

• Neuropathic pain: This happens when the nerves themselves are irritated or damaged, causing pain.
• Nociceptive pain: The most common type of pain, which occurs after an injury, like a cut or burn.

Understanding these types of pain helps in getting the right treatment and relief.

Key Message

Neuropathic pain and nociceptive pain can overlap or coexist after a nerve injury, making the experience of pain more complex.

Example

Imagine someone cutting their wrist. The tiny nerve endings in the skin at the wound site are activated due to local tissue damage, sending signals to the brain that are perceived as sharp, intense pain—this is nociceptive pain. However, if the cut is deep enough to damage the median nerve, the resulting nerve injury can cause additional pain signals to be sent directly via the nerve to the brain. This pain is often felt as an electric shock or shooting sensation, which is neuropathic pain.

Other Symptoms of Neuropathic Pain

• Allodynia: This is when a normally harmless touch, such as lightly stroking the skin, causes pain. Even gentle contact can feel extremely uncomfortable.

• Hyperalgesia: This refers to an exaggerated response to something that is usually painful. For example, a light tap on a sore area may cause intense pain, indicating increased sensitivity.

• Paraesthesia: This is when you feel tingling or "pins and needles" sensations without any obvious cause. The location of these sensations can help identify the affected nerve.

Methods of Treatment

1. Desensitisation Therapy: Focuses on reducing sensitivity and encouraging normal use of the affected limb to gradually decrease pain.

2. Pain Specialist Care: A pain specialist may use a combination of approaches, including:

   • Medications: Often, a combination of painkillers is needed to manage symptoms effectively.
   • Peripheral Nerve Blockade: Injections that block pain signals from the affected nerve.
   • Infusion Therapy: Continuous delivery of pain-relieving medications to the injured limb.
   • Pulsed Radiofrequency Treatment: A procedure that uses controlled electrical pulses to modulate nerve activity, helping to reduce pain without damaging the nerve. It can be particularly useful for managing neuropathic pain.

3. Neuromodulation: Techniques that use electrical stimulation to modify nerve activity, helping to relieve chronic pain by altering how pain signals are processed by the nervous system.

4. Ultrasound-Guided Hydrodissection: A minimally invasive procedure in which fluid is injected around the nerve to gently separate it from surrounding tissues. This helps relieve pain caused by nerve compression and improves mobility.

5. Surgical Interventions:

   • Nerve Repair: If the nerve is cut, it may be repaired.
   • Neurolysis: If the nerve is scarred, it may be freed from surrounding tissue.
   • Neuroma Management: In cases of a painful nerve ending (neuroma), the nerve may be buried in muscle or bone, away from the injury site.

6. Advanced Neurological Techniques: In severe cases, spinal cord stimulation or deep brain stimulation may be considered. These options involve neurosurgery and are usually reserved for the most difficult cases.

7. Psychological Support: Chronic pain can be very distressing and affect your quality of life. A psychologist can help by teaching coping strategies to manage the pain. This doesn't mean the pain is "in your head" or related to mental health issues—it’s about helping patients deal with pain alongside medical treatments.

Key Message

Neuropathic pain due to an injured nerve may benefit from a range of treatment options, including surgical intervention in some cases. A multidisciplinary approach is recommended to ensure comprehensive management and improve outcomes.