Why does neuropathic pain occur

What are the causes of neuropathic pain?

Neuropathic pain is caused by direct damage to structures of the nervous system. The most frequent is when the peripheral nervous system is damaged: the nerves and nerve roots. These can be damaged by compression (herniated disc, carpal tunnel syndrome, pelvic floor pain), but also by a multitude of diseases (diabetes, herpes zoster, trigeminal neuralgia).

Neuropathic pain can also occur when the central nervous system (brain, spinal cord) is damaged. The spinal cord is often damaged by trauma, infections and demyelinating diseases. In the brain, the most frequent cause is stroke, when it damages the areas of sensory and pain perception.

How does this pain manifest itself?

Neuropathic pain is usually easy to identify because it is different from other types of pain. First, the affected area usually has numb or corky skin. The sensation of pain in this area usually involves unpleasant tingling, burning pain, and often electric shock pain as well.

To what extent can it be disabling for the patient?

One of the characteristics of neuropathic pain, especially when it becomes chronic, is that it is very resistant to conventional treatment. Up to 2/3 of patients with neuropathic pain have problems controlling the pain with the usual pharmacological treatment. To prevent it from becoming chronic, it is important to identify the cause of the pain and treat it as soon as possible. Due to the characteristics of neuropathic pain, it often affects sleep and, in the long term, the patient’s mood.

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How can it be treated?

The ideal management of neuropathic pain is to identify its originating cause as soon as possible and treat it. For example, if it is due to compression of a nerve by a herniated disc, trauma or tumor, it should be treated as soon as possible and compression and irritation of that area of the peripheral nervous system should be avoided.

The next action should be pharmacological. In this sense, the ideal initial treatment is usually with antiepileptic drugs or certain tricyclic drugs, which are known to be very effective against neuropathic pain.

Also effective are physical therapies such as rehabilitation, desensitization techniques and, especially when neuropathic pain becomes chronic, psychotherapy together with other complementary therapies such as acupuncture or clinical hypnosis. Therefore, when neuropathic pain becomes complicated, treatment should be multidisciplinary.