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Neuropathic Pain
Treatment in Bengaluru
arising as a direct consequence of a lesion or disease affecting the somatosensory system
Signs and symptoms
- Patients typically have symptoms of pain as
- electric shock,
- burning,
- shooting,
- pin and needles.
- atypical sensations like worms crawling,
- loss of sensation,decreased sensation,
- pain at the area of decreased sensation,
- numbness,
- hyperalgesia
- allodynia..
Types of Neuropthaic Pain
Site of Injury
Peripheral
- CRPS I/CRPS II (involvement of Sympathetic nervous system)
- Painful Polyneuropathy
- Lancinating Neuralgias
- Phantom Pain (+/- involvement of Sympathetic nervous system)
- Nerve Compression
- Neuroma Formation
Mixed
- Avulsion of Plexus (+/- involvement of Sympathetic nervous system)
- Postherpetic Neuralgia (+/- involvement of Sympathetic nervous system)
Central
- Central Pain (+/- involvement of Sympathetic nervous system)
Predominating pain mechanism
Predominating “central” pain generator
- Deafferentiation Pain (response to either peripheral or CN system injury)
- Sympathetically Maintained Pain (associated with focal autonomic dysfunction)
Predominating “Peripheral” pain generator
- Painful polyneuropathies (multiple mechanisms probably involved)
- Painful mononeuropathies
1. Lancinating Neuralgias
2. Nerve Compression or Inflammation Nerve Transection
CAUSES:
Polyneuropathy
- Diabetes (IDDM & NIDDM)
- Alcoholism
- Human Immunodeficiency virus
- Hypothyroidism
- Renal failure
- Chemotherapy induced (vincristine, cisplatinum, paclitaxel, metronidazole)
- Anti-HIV drugs
- B12 and folate deficiencies
Mononeuropathy
- Entrapment syndromes
- Traumatic injury
- Diabetes
Plexopathy
- Diabetes
- Avulsion
- Tumour
Root syndromes and radiculopathy
- Compressive lesions
- Inflammatory
- Diabetes
Post-herpetic neuralgia
Trigeminal neuralgia
Phantom limb pain
RSD/causalgia/CRPS
Management
Pharmacotherapy
Non-pharmacotherapy
Interventions
Pharmacotherapy
- Tricyclic antidepressants & SSRNI’s/SSRI’s
- Anticonvulsants
- Opioids
- Topical agents
- NMDA Antagonists
- Other drugs
Non Pharmacological treatment
- Physical Therapy
- TENS Therapy
- Occupational Therapy
- Cognitive Behaviour Therapy
Interventions
- Neural blockade– nerve blocks have been used by physicians for generations for the treatment of neuropathic pain,
- Implanted Neural Stimulator or spinal cord stimulators– implanted stimulators of the dorsal column of the spinal cord or of the injured peripheral nerve
- Implanted Intrathecal Infusion Pumps
Evidence for the efficacy of pumps administering morphine, hydromorphone, and Baclofen - Decompressive Neurosurgery
Select patients with well-defined lesions may benefit from surgical exploration and decompressionWell accepted for carpal tunnel syndrome, but unfortunately underutilized for patients with painful nerve compressions elsewhere - Ablative Neurosurgery
Procedures are rarely indicated, and are performed far less frequently now than in the past. Cutting nerves usually relieves pain only temporarily, if at all.