What is a Neuropathic Pain?
Neuropathic pain is a relatively common form of pain. It is often difficult to treat and is linked to impaired quality of life by affecting the ability to perform day to day tasks (Murnion, 2018). Neuropathic pain is often referred to as nerve pain. The pain occurs when there is damage to part of the nervous system that controls sensations such as pressure, pain or warmth.
It may occur in any part of the body. People with neuropathic pain often experience shooting, stabbing or burning. Sensitivity to touch or cold occurs often and pain may be felt from stimuli that would ordinarily not be painful such brushing against the skin (Health Direct, 2020).
There are different types of neuropathic pain including:
- post-herpetic — this can happen after you have had shingles (herpes zoster) and affects the same area as the shingles rash
- trigeminal — causing pain in the jaw or cheek
- occipital — causing pain at the base of your skull that can spread to the back of your head
- pudendal — causing pain in the ‘saddle area’ between the legs
Causes
There are many possible causes of neuropathic pain. Occasionally there may be no identifiable cause (Back & Spine Foundation, 2016). Causes may include:- damage after surgery
- trauma
- viral infection
- cancer
- vascular malformations
- neurological conditions such as multiple sclerosis
- metabolic conditions such as diabetes
- a side effect of medication
Treatments
Like all types of pain neuropathic pain is best treated by considering biological, psychological and social factors that may impact on the pain. Typically, the first step in treatment is managing the underlying cause. Following this, treatment consists of easing pain through drug and non-drug therapies. Each person is different and what may work for you will not necessarily work for someone else.
Medicines
Simple pain relief often has little success in neuropathic pain, however, may contribute to pain relief as part of a treatment plan for mild to moderate neuropathic pain. Prescription medications are commonly used in the treatment of neuropathic pain and should be used following the directions of your doctor. Your pharmacist can provide you will additional advice and supporting material to help get the best possible outcomes from your treatment. Topical treatments applied to the skin may be used as add-on therapy to oral medicines. They are beneficial in that they have less side effects and are generally better tolerated by patients (Casale et al, 2017). Vaccines may reduce the risk of infection by certain viruses that can lead to neuropathic pain (Giovannini et al.,
2021). Speak to your pharmacist or GP to discuss whether vaccination is right for you.
Non-drug therapies
Whilst treatment with one or more medicines is the mainstay of neuropathic pain treatment, some non-drug therapies may be of benefit when added as part of a treatment regimen. Studies have shown there may be some benefit from acupuncture as a treatment for neuropathic pain (Franconi et al., 2013). Physical therapies such as heat and cold, massage and TENS have demonstrated efficacy in treating neuropathic pain. Transcutaneous electrical nerve stimulation (TENS) has shown benefits in treating post-operative, diabetic neuropathy and spinal cord injury (Giovannini et al., 2021). Psychological treatments such as cognitive behavioural therapy can help patients change how they think and hence how they feel about pain are important part of a treatment plan (Giovannini et al., 2021). Exercise is important in maintaining health and should be recommended for all patients,
however, its effectiveness in treating neuropathic pain is dependent on the cause of the pain (Giovannini et al., 2021). If you are concerned about your pain, please contact one of our friendly pharmacists or your GP.
REFERENCES
Brain & Spine Foundation. (2016). Neuropathic Pain. Retrieved from
https://www.brainandspine.org.uk/information-and-support/living-with-a-neurological-problem/neuropathic-pain/
Casale, R., Symeonidou, Z., & Bartolo, M. (2017). Topical Treatments for Localized Neuropathic Pain. Current pain and headache reports, 21(3), 15. Retrieved from https://doi.org/10.1007/s11916-017-0615-y
Franconi, G., Manni, L., Schroder, S., Marchetti, P. & Robinson, N. (2013). A systematic review of experimental and clinical acupuncture in chemotherapy-induced peripheral neuropathy. Evidence-Based Complementary and Alternative Medicine, vol. 2013. Retrieved from https://doi.org/10.1155/2013/516916
Giovannini, S., Coraci, D., Brau, F., Galluzzo, V., Loreti, C., Caliandro, P., Padua, L., Maccauro, G., Biscotti, L., Bernabei, R. (2021). Neuropathic pain in the elderly. Diagnostics, 11, 613. Retrieved from
https://doi.org/10.3390/diagnostics11040613
Health Direct. (2020). Nerve pain (neuralgia). Retrieved from https://www.healthdirect.gov.au/nerve-pain
Murnion, B. (2018). Neuropathic pain: current definition and review of drug treatment. Australian Prescriber 41:60–3. Retrieved from https://doi.org/10.18773/austprescr.2018.022
