Neuropathic pain results from damage or dysfunction in the nervous system. It is often chronic and can manifest with various symptoms such as burning, stabbing, shooting, tingling, pins and needles, numbness, or sensations resembling electric shocks.
Common Causes of Neuropathic Pain:
- Diabetic Neuropathy: Resulting from uncontrolled diabetes
- Postherpetic Neuralgia: Occurs after a shingles outbreak (herpes zoster)
- Post-Trauma or Surgery: Nerve injury sustained during accidents or operations
- Complex Regional Pain Syndrome (CRPS): pain following an injury or surgery
- Chemotherapy-Induced Peripheral Neuropathy
- Central post-stroke pain: after a stroke
- Multiple Sclerosis
- Spinal Cord Injury
- Trigeminal Neuralgia: facial pain caused by irritation of the trigeminal nerve
- Phantom Limb Pain: after amputation
Assessment and Diagnosis:
A thorough evaluation is necessary to determine the underlying cause.
– Comprehensive history and assessment
– Investigations: X-ray, MRI, CT scan, Electromyography (EMG) or nerve conduction studies
– Follow-up for a personalised multimodal management plan
– Referrals to specialists (e.g. Neurologist, Gynaecologist)
Multimodal Treatment:
Treatment varies based on the underlying cause and may include:
– Oral analgesics, including anti-neuropathic medication
– Lidocaine and Capsaicin patch treatment for localised neuropathic pain
– Pain interventions such as nerve blocks and pulsed radiofrequency of the nerves
– Spinal cord stimulation (SCS): Implantable devices that deliver electrical signals to modulate pain perception
– Peripheral nerve stimulation (PNS): For specific peripheral nerves
– Physical therapy aimed at improving strength, flexibility, and function
– Lifestyle and dietary changes
– Psychological support: stress management and cognitive behavioural therapy (CBT)
