Neuropathic chronic pain, also called nerve pain or neuropathy, is pain caused by an otherwise healed injury. While much is not known about this condition, it appears that certain nerves continue to send pain messages to the brain even though all damage related to any previous injury has disappeared. Many doctors believe that, in the case of neuropathic pain, the nerve fibers that transmit messages have somehow become damaged. Available treatments tend to reduce but not eliminate the pain from this condition.
The nervous system is the vast communications network that transmits information from the brain and spinal cord to every other part of the body. Nerve fibers are the thread-like extensions of the nerve cells that transmit sensory information. Damaged nerve fibers have the ability to regenerate, but the regeneration process can take months and could result in some damage left unhealed.
In chronic forms, neuropathic symptoms can begin subtly and may progress slowly over time. Some chronic neuropathies worsen over time, while others may get better and then relapse. Neuropathic pain is not fatal, but it can be associated with other more serious conditions.
One example of neuropathic chronic pain is phantom limb syndrome, in which the nerves continue to transmit pain messages to the brain regarding a missing arm or leg even after that limb has been amputated. Neuropathic chronic pain symptoms can include severe, sharp, shooting, or stabbing pain. Some patients state that it feels like burning, cold, or an ongoing numbness, tingling or weakness in the limbs. It can be felt traveling along the spine or down the arms and legs to the hands and feet.
While some causes of neuropathic chronic pain are not known, other causes can include alcoholism, amputation, chemotherapy, diabetes, multiple sclerosis, shingles, and spinal surgery. Neuropathic chronic pain can be hard to treat, since the origin of the pain may be unknown. Multimodal treatments are often prescribed, including psychological treatment, physical therapy, pharmacological treatments, and sometimes surgery.
Pharmacological treatments can act to inhibit the transmission of the pain signals to decrease pain sensitivity. Favored pharmacological treatments include the administration of certain antidepressants, such as tricyclics and serotonin-norepinephrine reuptake inhibitors or SNRIs, as well as anticonvulsants, such as pregabalin and gabapentin, or a topical lidocaine. Opioids such as morphine and nonsteroidal anti-inflammatory drugs such as ibuprofen are generally ineffective in relieving most neuropathic chronic pain. Other treatments for neuropathic chronic pain can include injections to block the nerve, electrical stimulation of the nerve, or other more general chronic pain interventions. Complete or near-complete relief from neuropathic chronic pain is unlikely.
