2023-06-28 21:18:24
The pain can be acute – for example, as with appendicitis, and even burning – as if you touch a hot kettle. Or the prickly feeling when you come home from a walk in the cold without mittens.
Neuropathy is a condition where a person experiences various types of pain, but painkillers do not help him. We spoke with neurologist of the network of clinics “Scandinavia” Evgenia Pervova about how this is possible and how to treat neuropathic pain.
What is neuropathic pain and what is its peculiarity
Neuropathy, or neuropathic pain, occurs due to damage to nerves or the central nervous system. At the same time, a person experiences unpleasant painful sensations.
Burning, numbness, tingling, a feeling of a prick or electric discharge – as soon as they do not describe neuropathy. What people feel is associated with a change in the sensitivity of the skin, as with numbness and tingling, or the work of motor nerves – while muscle weakness is disturbing.
Evgenia Pervova, neurologist of the chain of clinics “Scandinavia”:
“We cannot explain why people with neuropathy describe their pain differently. This is probably due to different perception of pain, pain threshold and genetic factors.
It is not always possible to determine the cause of neuropathy. But it can last for months and years, and it is very important to find the cause in order to understand how to relieve the pain.
Why is it so unbearably prickly, burns and bakes
The International Association for the Study of Pain defines neuropathic pain as “pain caused by a lesion or disease of the somatosensory nervous system”. That is, this is not a diagnosis, but a condition, the cause of which still needs to be found.
Evgenia Pervova:
– Damage or disease of the somatosensory nervous system means a conflict between the body and the sensitive system. That is, the connection between the nerves and the centers that control them is broken. Because of this, specific pain occurs. They differ in that they disturb a person for a long time and do not go away after taking painkillers.
Neurologists identify neuropathies by impaired sensitivity, that is, a person reacts to pain too much or does not react at all. It happens that a simple touch causes pain in him – this is called allodynia.
Clinical examination allows the diagnosis of neuropathy. Other methods complement the picture of the disease and help to find the cause of neuropathic pain.
In practice, doctors use scales and questionnaires. The most reliable and valid are the Leeds Neuropathic Pain Rating Scale, the DN4 Diagnostic Neuropathic Pain Questionnaire, and the painDETECT questionnaire. All three have been officially translated into Russian.
What diseases lead to neuropathy
Various diseases cause neuropathy.
The most common causes are diabetes mellitus, shingles, and circulatory disorders in the brain. Phantom pain during limb amputation and damage to the facial nerve is also referred to as neuropathy, but this is less common.
Peripheral neuropathy, which affects only the limbs, develops with prolonged alcohol abuse, vitamin B12 deficiency, chronic kidney and liver diseases.
The mechanism of pain in neuropathy varies. It determines the reason.
In diabetes, small blood vessels are damaged due to high levels of glucose in the blood. At first, this is manifested by pain. The vessels feed the nerves, and when this function is impaired, the nerve fibers stop transmitting signals. This happens when the disease progresses and no effective treatment is found. Sensitivity in the limbs is impaired, and if you touch the tips of your toes with your eyes closed, you won’t notice it. With shingles, inflammation due to the herpes virus, the immune system attacks and damages nerve cells. After a stroke, central neuropathy occurs. This means that the disease has damaged the brain and its structures. Because of this, a person’s transmission and perception of different types of sensitivity is disturbed – tactile, pain, temperature, and also the feeling of one’s own body in space.
Evgenia Pervova:
Neuropathy is not limited to neurological diseases. Often it occurs among patients with rheumatological diseases. For example, in rheumatoid arthritis or systemic lupus erythematosus, people complain of neuropathic pain. Cancer patients also experience neuropathy due to tumor growth into nerve structures, nerve damage from chemotherapy and radiation therapy, and after major surgeries.
In addition, pain is associated with damage and inflammation of the muscles and internal organs. It is difficult to make a correct diagnosis and distinguish one pain from another in these cases.
How to treat neuropathic pain
Treatment for neuropathy depends on the cause that caused the condition. Sometimes it is enough to remove it for the pain to go away. For example, if neuropathy is a consequence of a tumor in the brain that presses on the nerves in the literal sense.
If the cause is unclear, the disease is not treatable, or the condition is irreversible, then therapy is aimed at relieving pain, restoring the functioning of the nervous system and improving the quality of life of a person.
The main method of treatment is medication. Studies have shown that antidepressants and anticonvulsants are effective in relieving pain. Their neurologists prescribe first. Opioid painkillers are also prescribed, but they are dangerous for the development of dependence.
In the United States, this has created an opioid crisis, a pandemic that claims the lives of people due to opioid overdose. The famous Dr. House is also a victim of addiction to the painkiller Vicodin.
Medicines are also prescribed in the form of patches, creams and gels. They mainly contain painkillers lidocaine and capsaicin. They usually help if the pain is limited to one place. At the same time, studies write that the role of the placebo effect in such treatment is high.
Drug injections are also done. For example, injections with botulinum toxin, as well as steroids and local painkillers, will relieve pain.
Evgenia Pervova:
– If the drugs do not help with pain, try other methods of treatment. For example, transcutaneous stimulation of peripheral nerves. During the procedure, electrical discharges act on the skin in those places where the nerves that cause pain pass. Nerve stimulation causes the body to release endorphins, natural pain relievers.
What is the result
Neuropathy is a condition in which a person experiences a variety of pain due to nerve damage or malfunction of the nervous system. The cause of these pains is not always found. But often it develops against the background of diabetes, herpes and after a stroke. The main drugs for treatment are antidepressants and anticonvulsants.
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