User Tools

Site Tools


neuropathic_pain

Neuropathic pain

Neuropathic pain is a localized sensation of unpleasant discomfort caused by damage or disease that affects the somatosensory system.

It is a common and debilitating consequence of neuromyelitis optica spectrum disorder (NMOSD) myelitis, with no satisfactory treatment.

The IASP's widely used definition of pain states: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

Neuropathic pain constitutes a significant portion of chronic pain.

Does not involve sympathetic hyperactivity but may be associated with vegetative signs (eg, fatigue, loss of libido, loss of appetite) and depressed mood. People vary considerably in their tolerance for pain.

Epidemiology

Neuropathic pain constitutes a significant portion of chronic pain.

Up to 7% to 8% of the European population is affected, and in 5% of persons it may be severe.

Types

Central neuropathic pain

Chronic neuropathic radicular pain

Neuropathic pain may result from disorders of the peripheral nervous system or the central nervous system (brain and spinal cord). Thus, neuropathic pain may be divided into peripheral neuropathic pain, central neuropathic pain, or mixed (peripheral and central) neuropathic pain.

Peripheral neuropathic syndromes have received greater attention in the research literature than central pain, and studies of syndromes such as postherpetic neuralgia and painful diabetic neuropathy provide the basis for current knowledge of neuropathic pain.

Etiology

Peripheral nerve injury is associated with microvascular disturbance; however, the role of the vascular system has not been well characterized in the context of neuropathic pain.

Is caused by damage or disease that affects the somatosensory system.

Clinical Features

Patients with neuropathic pain are usually more heavily burdened than patients with nociceptive pain. They suffer more often from insomnia, anxiety, and depression. Moreover, analgesic medication often has an insufficient effect on neuropathic pain.

It may be associated with abnormal sensations called dysesthesia, and pain from normally non-painful stimuli (allodynia). Neuropathic pain may have continuous and/or episodic (paroxysmal) components. The latter resemble an electric shocks. Common qualities include burning or coldness, “pins and needles” sensations, numbness and itching. Nociceptive pain, by contrast, is more commonly described as aching.

Treatment

Chronic, intractable neuropathic pain has no satisfactory treatment.

Spinal cord stimulation constitutes a therapy alternative that, to date, remains underused. In the last 10 to 15 years, it has undergone constant technical advancement.

Current developments are high-frequency stimulation and peripheral nerve field stimulation 1).

see Motor cortex stimulation

Hypoxia and the Na(+)/K(+) ATPase ion transporter may be a novel mechanistic target for the treatment of neuropathic pain. Findings support the possibility of using hypoxia activated pro-drugs to localize treatments for neuropathic pain and nerve injury to injured nerves 2).

Research

For genetic research to contribute more fully to furthering our knowledge of neuropathic pain, we require an agreed, valid, and feasible approach to phenotyping, to allow collaboration and replication in samples of sufficient size. Results from genetic studies on neuropathic pain have been inconsistent and have met with replication difficulties, in part because of differences in phenotypes used for case ascertainment. Because there is no consensus on the nature of these phenotypes, nor on the methods of collecting them, this study aimed to provide guidelines on collecting and reporting phenotypes in cases and controls for genetic studies. Consensus was achieved through a staged approach: (1) systematic literature review to identify all neuropathic pain phenotypes used in previous genetic studies; (2) Delphi survey to identify the most useful neuropathic pain phenotypes and their validity and feasibility; and (3) meeting of experts to reach consensus on the optimal phenotype(s) to be collected from patients with neuropathic pain for genetic studies. A basic “entry level” set of phenotypes was identified for any genetic study of neuropathic pain. This set identifies cases of “possible” neuropathic pain, and controls, and includes: (1) a validated symptom-based questionnaire to determine whether any pain is likely to be neuropathic; (2) body chart or checklist to identify whether the area of pain distribution is neuroanatomically logical; and (3) details of pain history (intensity, duration, any formal diagnosis). This NeuroPPIC “entry level” set of phenotypes can be expanded by more extensive and specific measures, as determined by scientific requirements and resource availability 3)

1)
Wolter T. Spinal cord stimulation for neuropathic pain: current perspectives. J Pain Res. 2014 Nov 18;7:651-663. eCollection 2014. Review. PubMed PMID: 25429237; PubMed Central PMCID: PMC4242499.
2)
Lim TK, Shi XQ, Johnson JM, Rone MB, Antel JP, David S, Zhang J. Peripheral nerve injury induces persistent vascular dysfunction and endoneurial hypoxia, contributing to the genesis of neuropathic pain. J Neurosci. 2015 Feb 25;35(8):3346-59. doi: 10.1523/JNEUROSCI.4040-14.2015. PubMed PMID: 25716835.
3)
van Hecke O, Kamerman PR, Attal N, Baron R, Bjornsdottir G, Bennett DL, Bennett MI, Bouhassira D, Diatchenko L, Freeman R, Freynhagen R, Haanpää M, Jensen TS, Raja SN, Rice AS, Seltzer Z, Thorgeirsson TE, Yarnitsky D, Smith BH. Neuropathic pain phenotyping by international consensus (NeuroPPIC) for genetic studies: a NeuPSIG systematic review, Delphi survey, and expert panel recommendations. Pain. 2015 Nov;156(11):2337-2353. PubMed PMID: 26469320.
neuropathic_pain.txt · Last modified: 2017/02/02 08:09 (external edit)