What Is Neuropathic Pain?

Pain resulting directly from damage or illness of the somatosensory system. This disease can be caused by trauma and / or disease caused by damage to peripheral nerves, posterior roots of the spinal cord, and some parts of the central nervous system above the spinal cord.

Pain resulting directly from damage or illness of the somatosensory system. This disease can be caused by trauma and / or disease caused by damage to peripheral nerves, posterior roots of the spinal cord, and some parts of the central nervous system above the spinal cord.

Chinese name

Neuropathic pain

Foreign name

neuropathic pain

Causes of neuropathic pain and common diseases:

Age, gender, intensity of pain, and emotional and cognitive abilities suggest that the formation of chronic pain is the result of a combination of factors, not simply neurological damage.

Differential diagnosis of neuropathic pain :

1. Occipital great neuralgia:

It refers to paroxysmal or persistent pain in the area of the greater occipital nerve distribution (rear occipital region). It can also be exacerbated on the basis of persistent pain. The clinical manifestations are acupuncture, knife-cutting, or burning-like pain in one or both of the posterior occipital regions or the nape. The patient is afraid to turn his head when the pain occurs, and the head and neck are sometimes in a straight state. On examination, tenderness was found at the exit of the large nerve, and the area of the greater occipital nerve (C2-3), that is, from the top of the ear line to the hairline, was hyperalgesic or reduced.

2. Sciatica:

Refers to the sciatic neuropathy, which is a group of pain symptoms that occur along the sciatic nerve pathway, that is, waist, hips, posterior thighs, posterolateral calves, and lateral feet. The sciatic nerve is the main neural trunk that innervates the lower limbs. Sciatica refers to pain in the sciatic nerve pathway and its distribution areas (hip, back of thigh, back of calf, and outer side of foot).

3. Intercostal neuralgia:

Refers to recurring pain in one or several intercostal areas, with exacerbations. Primary intercostal neuralgia is rare, and secondary ones are related to viral infection, toxin stimulation, mechanical damage and foreign body compression. Its pain properties are mostly tingling or burning, and are distributed along the intercostal nerves. When intercostal neuralgia occurs, the pain can be seen from back to front, and the radiation is semicircular along the corresponding intercostal space; the pain is tingling or burning. Increased pain when coughing, breathing deeply, or sneezing. The pain is more common on one nerve on one side.

Physical examination of neuropathic pain :

The standard examination for patients with neuropathic pain should include the following aspects: touch, acupuncture, compression, cold stimulation, thermal stimulation, tremor, and "sum". Responses to these stimuli are classified as normal, decreased, or enhanced. Stimulation-induced (positive) pain is divided into hyperalgesia and hyperalgesia and is classified according to whether the stimulus is dynamic or static. Tactile sensation can be evaluated by gently stimulating the skin with cotton, acupuncture by stimulating the skin with sharp needles, deep pain by gently pressing muscles and joints, and cold and hot sensations by measuring the response to warm stimuli The response of the tuning fork assesses tremor.

Neuropathic pain treatment principles:

(1) Drug treatment:

The choice of medication for neuropathic pain should be based on the underlying pathogenesis of each patient. The drugs used to treat chronic neuropathic pain are mainly anticonvulsants, tricyclic antidepressants, N-methyl-D-aspartate (NMDA) antagonists, ion channel blockers, and non-steroidal anti-depressants. Inflammatory drugs (NSAID), local anesthetics, capsaicin receptor blockers, antihypertensive drugs, morphine drugs, and GABA receptor agonists. In recent years, some new types of drugs have appeared, such as gabapentin and antitumor drugs.

(B) Neuromodulation:

Neuromodulation methods that stimulate the spinal cord or cerebral motor cortex by placing electrodes in the epidural space or cerebral cortex have gradually been widely used to treat refractory central and peripheral neuropathic pain. The principle of this method is to properly stimulate the target nerve that can produce pain through the electrode, so as to produce a numb sensation to cover the pain area, so as to achieve the purpose of relieving pain. Clinical indications: neuropathic pain (such as back surgery syndrome, radiculopathy, chronic regional pain syndrome, and peripheral nerve injury), ischemic pain (such as peripheral vascular disease and angina), seizures, Parkinson's syndrome-related dyskinesias (such as tremor, paralysis, tonicity, and dyskinesia) and other dysfunctions. Neuromodulation methods are mainly spinal cord stimulation (SCS) and cerebral motor cortex stimulation (MCS).