Neuropathic Pain
Original Editor - Kerstin McPherson
Top Contributors - Andeela Hafeez, Melissa Coetsee, Kerstin McPherson, Vanessa Rhule, Riccardo Ugrin, Lucinda hampton, Kim Jackson, Admin, Evan Thomas, Chrysolite Jyothi Kommu, Kapil Narale, Temitope Olowoyeye, Jo Etherton, WikiSysop, Vidya Acharya, Lauren Lopez, 127.0.0.1, Carina Therese Magtibay, Wendy Walker, Oyemi Sillo and Amanda Ager
Definition[edit | edit source]
Complex type of pain initiated or caused by a primary lesion or dysfunction in the nervous system (IASP, 2012).
“pain initiated or caused by a primary lesion or dysfunction in the nervous system.”[1] One example of neuropathic pain is called phantom limb syndrome.[2]
Cause[edit | edit source]
Damage can be caused by trauma, surgery or disease processes including diabetes,infection (eg after shingles infection - post-herpetic neuralgia) and cancer.
Has a peripheral origin and may develop central sensitization but "primary afferent input is critical for maintaining neuropathic pain in peripheral nerve injury and distal polyneuropathy" [3]
Pain may be generated in peripheral nerve, dorsal root ganglion,There are many reasons that patients may develop neuropathic pain. However, on a cellular level, one explanation is that an increased release of certain neurotransmitters which signal pain, combined with an impaired ability of the nerves to regulate these signals leads to the sensation of pain originating from the affected region. Additionally, in the spinal cord, the area which interprets painful signals is rearranged, with corresponding changes in neurotransmitters and loss of normally-functioning cell bodies; these alterations result in the perception of pain even in the absence of external stimulation. In the brain, the ability to block pain can be lost following an injury such as stroke or trauma. Over time, further cellular damage occurs and the sense of pain persists.[4]
Trigeminal neuralgia.[5]
Pain following shingles (postherpetic neuralgia).
Diabetic neuropathy - a nerve disorder that develops in some people with diabetes.
Phantom limb pain following an amputation.
Multiple sclerosis.
Pain following chemotherapy.
HIV infection.
Alcoholism.
Cancer.
Atypical facial pain.
Various other uncommon nerve disorders.
Assessment[edit | edit source]
Screening questionnaires are suitable for identifying potential patients with neuropathic pain, but further validation of them is needed for epidemiological purposes. Clinical examination, including accurate sensory examination, is the basis of neuropathic pain diagnosis. For more accurate sensory profiling, quantitative sensory testing is recommended for selected cases in clinic, including the diagnosis of small fiber neuropathies and for research purposes.[6]
Step 1. A clinical history of disease or lesion of the somatosensory system suggests a possible diagnosis of neuropathic pain
Step 2. Confirmation by either clinically reproducible signs or investigations would suggest a probable diagnosis of neuropathic pain
Step 3. If the history, clinical examination and investigations are positive, this would support a definite diagnosis of neuropathic pain[7]
Sensory examination - light touch, temperature, painful stimulus, vibration and proprioception. Motor testing tone, strength, reflexes and coordination. Look for autonomic changes in colour, temperature, sweating and swelling.
Examination of a Patient with Peripheral Neuropathic Pain shows a real patient with multiple mononeuropathy due to isolated peripheral nervous system vasculitis. He is suffering from neuropathic pain in his left hand and both legs. Functional assessment and sensory and motor examination of both upper and lower limbs is demonstrated.DN4 – QUESTIONNAIRE Assists with neuropathic pain assessment
Use when neuropathic pain is suspected[8]
References[edit | edit source]
- ↑ Redefinition and a grading system for clinical and research purposesfckLRfckLRR. -D. Treede, MD, T. S. Jensen, MD, PhD, J. N. Campbell, MD, G. Cruccu, MD, J. O. Dostrovsky, PhD, J. W. Griffin, MD, P. Hansson, MD, DMSc, DDS, R. Hughes, MD, T. Nurmikko, MD, PhD and J. Serra, MD
- ↑ http://www.webmd.com/pain-management/guide/neuropathic-pain
- ↑ Haroutounian S, Nikolajsen L, Bendtsen TF, Finnerup NB, Kristensen AD, Hasselstrøm JB, & Jensen TS (2014). Primary afferent input critical for maintaining spontaneous pain in peripheral neuropathy. Pain, 155 (7), 1272-9
- ↑ Medical Author: Danette C. Taylor, DO, MS, FACN Medical Editor: Charles Patrick Davis, MD, PhD
- ↑ http://patient.info/health/neuropathic-pain
- ↑ NeuPSIG guidelines on neuropathic pain assessment Maija Haanpääa, b, , , Nadine Attalc, d, Miroslav Backonjae, Ralf Baronf, Michael Bennettg, Didier Bouhassirac, d, Giorgio Cruccuh, Per Hanssoni, Jennifer A. Haythornthwaitej, Gian Domenico Iannettik, Troels S. Jensenl
- ↑ Adapted from Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008;70:1630–5
- ↑ Bouhassira D, Attal N, Alchaar H, et al. "Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4)." P
