Neuropathic Pain

Neuropathic Pain

Neuropathic Pain Treatment, Symptoms, Causes, Diagnosis

Neuropathic pain is related to the nervous system and is categorized as a sensation of shooting pain or a burning sensation. Symptoms can fluctuate from extreme & chronic to mild & spontaneous which can make neuropathic pain difficult to identify and treat. If you or a loved one have been suffering from undiagnosed pain, it could be the result of nerve damage, a neuropathic disorder, or a malfunctioning nervous system. Due to the complex nature of this pain, it is recommended that you enlist the help of a qualified neuropathic pain doctor that can help identify the source of pain and create a treatment plan designed to help reduce pain symptoms. Dr. Kathy Omrani at the Headache TMJ Pain Clinic in Los Angeles has the experience necessary to help treat your neuropathic pain.

CONTACT US TODAY AT (310) 422-4246 OR BOOK YOUR APPOINTMENT

“I was very pleased with Dr. Omrani’s evaluation and treatment.She consults with my other doctors and also provides me with the best treatment.“

– Satisfied Patient

view all patient testimonials

 

Table of Contents

What is Neuropathic Pain?

Neuropathic pain is defined as “pain caused by a lesion or disease of the somatosensory nervous system.” This typically occurs when there is dysfunction somewhere within your body’s nervous system. This can be caused by damage or disorder to the peripheral nerves, the spinal cord, and brain which results in chronic mild to extreme pain. The central nervous system is made up of your brain and spinal cord. The peripheral nervous system is made up of the peripheral nerves that reach extremities and organs. If any of the nerves suffer from damage, proper signaling will fail and pain signals will be sent to the brain. Neuropathy is when one or several nerves fail or change in function. Due to the nature of nerve pain, it is not always easy to confirm the source of pain and there are several diseases that are linked to neuropathy. Peripheral neuropathy is related to damage to nerves outside of the central nervous system. This generally results in weakness, numbness, and pain in the extremities.

Neuropathic Pain Treatment

Neuropathic pain treatment can be complex because it needs to treat the underlying cause of nerve pain, provide pain relief, maintain function, and improve quality of life. To achieve these goals, it isn’t uncommon to require several treatment modalities to ensure that the benefits from each treatment options are unlocked.

Neuropathic Pain Medications

Doctors can prescribe different medications to try and alleviate neuropathic pain symptoms. It is important to speak to an experienced doctor to ensure that the medication that is prescribed is the best option for you. Determining an effective regiment of medications usually takes some trial and error and will be prescribed in small trial doses to get the medication levels correct. This is because several of the medication options have side effects that need to be weighed against the benefits. Medications generally do not treat the cause of pain, but instead mask symptoms or block pain signals.

  • Anticonvulsant medications: Gabapentin, Pregabalin, Topiramate, Carbamazepine, Lamotrigine
    • Effects: Blocks the pain of trigeminal neuralgia which causes intense, short-term pain.
    • Side effects: Chest pain, constipation, confusion, drowsiness, nausea, heart problems, & allergic reactions
  • Antidepressant medications: Amitriptyline, Nortriptyline, Venlafaxine, Duloxetine
    • Effects: Reduces pain by fixing imbalances in the nervous system’s neurotransmitters.
    • Side effects: Heart problems, constipation, drowsiness, light headedness, weight gain, dry mouth, nausea, & suicidal thoughts
  • Opioid analgesics: Tramadol, Oxycodone, Oxycontin, Roxicodone
    • Effects: Provides significant pain reduction and relief.
    • Side effects: High chance of abuse, overdose, dependence, adverse long-term effects, drowsiness, constipation, vomiting, breathing problems, & nausea
  • Topical treatments: Lidocaine, Capsaicin creams
    • Effects: Provides local relief by numbing pain where medication is applied.
    • Side effects: Swelling, burning, skin irritation, cough, tightness in chest, trouble breathing
  • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Aleve, Motrin
  • Localized treatments: Steroid injections, local anesthetic

There is also the possibility that the nerve pain is being caused by some other ailment that may require its own set of medications to help reduce neuropathic pain symptoms.

Neuropathic Pain Therapies

When medication has failed to produce results, there are therapies that can also help alleviate nerve pain symptoms.

Physical Therapy: Muscle weakness can come as a result of nerve pain so exercising and regular movement will help strengthen surrounding muscles. This will improve mobility and could help improve nerve pain caused by pinched or compressed nerves.

Relaxation Therapy: On going stress leads to higher levels of cortisol being released in your system. This can result in muscle tension and a chronic state of inflammation which can exacerbate neuropathic pain symptoms. Finding time for self-care can help improve your body’s ability to handle stress and can potentially reduce nerve pain through activities like yoga and meditation which reduce stress and help with circulation.

Acupuncture: This therapy uses sterilized needles to activate pressure points around your body. This is said to reduce neuropathy symptoms and inflammation.

Neuropathic Pain Surgeries

Some of these therapies are slightly more invasive and require a minor procedure.

Plasma Exchange: This procedure is designed to suppress the immune system to help reduce inflammation. It involves removing blood and isolating certain proteins and antibodies before returning the blood back to your body.

Spinal Cord / Peripheral Nerve / Brain Stimulation: These treatments require an implant that delivers electrical stimulation to different parts of your nervous system to interrupt pain signals that are sent to the brain.

Additional surgeries can help address other ailments that are contributing to nerve pain. This could include the removal of tumors that are adding pressure to nerves.

Neuropathic Pain Lifestyle Changes

Sometimes the underlying cause of neuropathic pain is a disease like diabetes. When this is the case, adjusting your lifestyle to reduce diabetes symptoms will also help minimize the neuropathic pain symptoms as well. This can include:

  • eat healthy
  • cut back on sugars
  • watch your weight
  • exercise regularly
  • quit smoking
  • avoid alcohol and drugs
  • maintain glucose levels
  • take care of feet

Neuropathic Pain Relief

Sometimes the cause of neuropathic pain isn’t easy to identify so the cause can’t be treated. This makes treating neuropathic pain focus more on pain relief and methods of improving quality of life and daily function. Without being able to treat the underlying problems, a multimodal treatment plan will help reduce pain symptoms. It is important that early treatment is implemented to help prevent other problems that come with nerve pain. By treating nerve pain early, there is a chance that outcomes like depression, sleeplessness, and restricted function can be avoided.

Different Types of Neuropathic Pain

Neuropathic pain can encompass several types of peripheral neuropathy. This can include:

  • Mononeuropathy: Affects one primary nerve
  • Mononeuritis Multiplex: Affects several nerves
  • Polyneuropathy: Affects all the nerves in the nervous system

Polyneuropathy is the most common type that most people deal with. It affects people differently, but pain is generally felt in the longest nerves first. This means that most people will feel the impacts of polyneuropathy in their feet and legs first before it eventually starts to affect their arms and hands. This is commonly caused by diabetes which results in diabetic polyneuropathy.

It is also important to identify which nerves can be impacted by neuropathy. Nerve pain and dysfunction can impact:

  • Sensory nerves: These are nerves that perceive sensation like temperature, pain, touch, and vibration.
  • Motor nerves: These nerves control muscle movement
  • Automatic nerves: These nerves control normal bodily functions like blood pressure, heart rate, digestion, and bladder use

Neuropathic Pain Causes

Discovering the cause of neuropathic pain can be difficult given the wide variety of ailments that can lead to nerve damage. Some of those diseases / disorders that can lead to or contribute to nerve pain are:

  • Cancer / Tumors (Myeloma, Lymphoma, Amyloidosis)
  • Stroke
  • Diabetes
  • Malnutrition (Vitamin B1, B6, B12, E deficiencies)
  • Infection (Chicken Pox, Shingles, Syphilis, HIV, AIDS, Lyme Disease, Hepatitis B & C, Leprosy, Diphtheria)
  • Autoimmune system disorders (Lupus, Rheumatoid Arthritis, Guillain Barre Syndrome, Sjogren’s syndrome)
  • Hormone / Thyroid disorders
  • Excessive alcoholism
  • Chemotherapy & radiation therapy
  • Amputation (Phantom Limb Syndrome)
  • Nerve compression & inflammation (Carpal Tunnel Syndrome, herniated disc, trapped median nerve)
  • Central nervous system disorders (Parkinson’s, Multiple Sclerosis)
  • Nerve trauma / damage / injuries (vehicle accidents, traumatic injuries, falls, sports injuries)
  • Surgery
  • Genetics (Charcot Marie Tooth Disease)
  • Organ disease / dysfunction (kidney disease, liver disease, connective tissue disorders)

 

This list is not all encompassing of the potential causes for nerve pain. There are also cases where the case of nerve pain is classified as idiopathic which means that there is no discernable cause. These cases usually result in pain relief to reduce nerve pain symptoms.

Neuropathic Pain Symptoms

Symptoms of neuropathic pain may present themselves in different ways. These symptoms often affect different nerves like sensory nerves, motor nerves, and automatic nerves:

  • Spontaneous pain: This pain is classified as pain that is shooting, burning, stabbing, or shocking. It also results in tingling, numbness, or what is generally referred to as “pins and needles.”
  • Evoked pain: This is pain that is caused by what is normally non-painful stimuli. This can be the result of change in temperature or pressure.
  • Dysesthesia: This is classified as an unpleasant and irregular sensation.
  • Hypoalgesia: This is classified as pain that is less than what would be expected from a normal pain inducing stimulus.
  • Trouble sleeping: This reaction is usually the result of pain like symptoms that prevent sleep.
  • Loss of balance / coordination: Nerve pain can result in numbness which can cause loss of balance and coordination as other muscles try and compensate for muscle inactivity.
  • Muscle weakness / paralysis: Nerve dysfunction can impact motor nerves which control muscle movement.
  • Digestive problems: Automatic nerve damage can result in difficulty digesting food and controlling bladder and bowel function.
  • Difficulty regulating blood pressure: Automatic nerve damage can also make regulating blood pressure difficult.

When to See a Neuropathic Pain Doctor

Early diagnosis is important to treating nerve pain and dysfunction so that long term impacts can be mitigated. If nerve pain goes undiagnosed it can develop even further which can cause more significant impacts down the line. Be sure to see an experienced neuropathic pain doctor as soon as you experience any early symptoms of peripheral neuropathy. This is even more important if a patient is dealing with other ailments that prove to exacerbate neuropathy or nerve pain, like diabetes, injury, or stroke.

Preparing to See Your Doctor

Once nerve pain has been identified as the problem, you will most likely be sent to a specialist who is trained to deal with nervous system disorders. In preparation of your doctor visit, it is helpful to be able to provide the following information:

  • List of symptoms: Include all potential symptoms and when they started
  • Personal information: Include all relevant personal information pertaining to family history, recent changes, injuries, diseases, and alcohol usage
  • Current medications: Include any prescribed and OTC medications including supplements and vitamins

In addition to the above, be prepared to answer a series of qualifying questions that may include:

  • Do you have any preexisting medical conditions such as diabetes or kidney / liver dysfunction?
  • When did you first notice symptoms?
  • Is pain or discomfort sporadic or constant?
  • What type of pain is it and how intense is it?
  • Does anything help reduce the pain?
  • Does anything irritate or aggravate the pain?
  • Is there a family history of neuropathy?

Questions to Ask Your Doctor

  • What is prompting the neuropathic pain?
  • Is there more that one problem that is contributing to the nerve pain?
  • What tests will help diagnose the problem?
  • What is the long-term outlook with neuropathic pain?
  • Which treatments are available and recommended?
  • What side effects should be expected during and after treatment?
  • How do I manage any other health conditions with nerve pain treatment?
  • What actions / activities need to be reduced or stopped?
  • Where can I find additional information about neuropathic pain?

Neuropathic Pain Diagnosis

An experienced neuropathic pain doctor will need to conduct a neurological exam and review a patient’s medical history to gain further insight into potential neuropathic pain. This will help identify pain symptoms and inspect for injury in the search for the underlying cause of neuropathy. Physical examinations will normally test for sensation, strength, and reflexes. In addition to the physical exam, there are more tests that can be used to diagnose peripheral neuropathy. Blood tests can check for vitamin deficiencies, diabetes, and Charcot-Marie-Tooth disease. Specialized testing can also include:

  • Nerve conduction test: This involves using electrodes to release electrical shocks to stimulate nerves.
  • Electromyography: This involves injecting a small needle into muscle to evaluate electric activity.
  • Lumbar puncture: This requires taking a sample of spinal fluid to check for inflammation.
  • Nerve biopsy: This requires a sample of some peripheral nerve which is checked for abnormality under a microscope.
  • X-Ray / CT scan / MRI scan: Imaging test can reveal herniated disks, pinched nerves, tumors, and several other abnormalities that could be applying pressure to nerves.

Neuropathic Pain Outlook

Neuropathic pain is complex so it can be difficult to treat. That being said, the multi modal treatment strategies have become increasingly effective at significantly reducing neuropathic pain symptoms. In addition to treatment, preventative and on-going rehabilitation will be critical to maximizing quality of life. Neuropathic pain is not typically life threatening but can have an overall negative impact by causing depression, sleeping problems, anxiety, and more. Finding the correct treatment strategy is critical to ensuring that pain symptoms are minimized while still being able to live a fulfilling life.

CONTACT US TODAY AT (310) 422-4246 OR BOOK YOUR APPOINTMENT

“I was very pleased with Dr. Omrani’s evaluation and treatment.She consults with my other doctors and also provides me with the best treatment.“

– Satisfied Patient

view all patient testimonials

Neuropathic Pain FAQs

What is the best treatment for neuropathic pain?

The best treatment for neuropathic pain is generally a multi modal approach that combines medication, therapy, and exercise. The treatment is completely dependent on the person and any underlying condition they have so there is no blanket fix all treatment designed for neuropathic pain.

Can neuropathic pain be cured?

There is no single cure for neuropathic pain since it is something that is caused by several different underlying conditions. Even if the underlying condition is completely healed, the damage to the nerves may persist causing neuropathic pain.

What is the first line treatment for neuropathic pain?

The first line of treating neuropathic pain is using antidepressants or anticonvulsants like pregabalin, gabapentin, duloxetine, and amitriptyline. This is because the side effects of using these drugs are far less intense or habit forming when compares with lidocaine or opiates.

Which safe drug is used to treat neuropathic pain?

Recently, SSRIs (serotonin and norepinephrine reuptake inhibitors) are a new antidepressant that have milder side effects compared to tricyclic antidepressants.

 

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