Patient perspectives

The impact of neuropathic pain on quality of life has been under-researched and poorly understood though survey and focus group research is helping to gain better insights into what patients suffer Neuropathic pain can result in significant sleep disturbance, fatigue, and low mood (that sometimes leads to suicidal ideation), and side-effects from drug treatment are common...

Spinal cord stimulation

Electricity has been used for centuries to relieve pain but spinal cord stimulation (SCS) came about with the Gate Control Theory in the 1960s SCS was originally thought simply to close the gate by activating A fibres but its effect is more complex. It is likely that it helps to normalize the dysfunction that manifests as neuropathic pain...

Intrathecal drug delivery and neurolytic blocks

Intrathecal drug delivery (ITDD) allows drugs to be placed near to central receptors Drug side-effects may be reduced as small doses are required compared to with systemic administration External or internal ITDD systems are available ITDD requires careful patient selection and preparation Opioids, local anaesthetics, and clonidine are the most commonly used intrathecal drugs; ziconotide can be used as first line treatment...

Local anaesthetics and other pharmacological approaches

While antidepressants, antiepileptics, and opioids form the mainstay of neuropathic pain management, alternative approaches are needed because not all patients respond to these drugs and side-effects can limit their use in others Topically applied drugs such a lidocaine 5% patches and capsaicin cream can produce local analgesic effects, though lidocaine is better tolerated...

Cancer neuropathic pain

Around a third of cancer pains may have a neuropathic component and mixed pathology is more usual than pure neuropathic pain Compression and infiltration of nerves by tumour are the most common causes Treatment-induced damage (chemotherapy-induced neuropathy, radiation plexitis, surgical trauma) and paraneoplastic syndromes are less common causes...

Complex regional pain syndrome

Complex regional pain syndrome is the current name for the conditions previously called reflex sympathetic dystrophy (now CRPS type I) and causalgia (now CRPS type II). It occurs in distal limbs following trauma or surgery, is not related to intensity of initial insult, and is idiopathic in 10% of cases. There are around 10,000 cases in the UK and it is four times more common in females....

Peripheral neuropathic pain

Damage to peripheral nerves, including cranial nerves and spinal nerve roots, can result in peripheral neuropathic pain Speed of onset and associated symptoms and signs can point towards possible causes Common conditions include diabetic neuropathy, post-herpetic neuralgia, and post-surgical neuropathies including phantom limb pain Less common conditions result from Guillain-Barr syndrome, deficiency states, and toxic neuropathies...

Screening tools and measurement tools for neuropathic pain

Verbal description differs between neuropathic and nociceptive pain and can contribute important information to the assessment process Screening tools alert the clinician to the possible presence of neuropathic pain mechanisms but they do not replace clinical diagnosis Measurement tools assess the intensity of particular qualities of neuropathic pain once a diagnosis has been made...

Opioids

Opioid receptor structure and function can be altered in neuropathic pain states, leading to reduced sensitivity to opioids Opioids were thought to be ineffective for neuropathic pain but substantial evidence exists to demonstrate analgesic efficacy, in some cases superior to more commonly used co-analgesics The most convincing evidence supports use of morphine, oxycodone, and tramadol in neuropathic pain...

Central neuropathic pain

Central neuropathic pain can arise following damage to spinothalamocortical pathways in the spinal cord and brain Stroke, multiple sclerosis, and spinal cord injury (trauma or disease) are the predominant causes Central neuropathic pain is wrongly considered a rarity; several tens of thousands of cases exist in the UK and it can develop up to two years after stroke...