Neuropathic pain is of very varied origin and difficult to relieve. Drug and non-drug treatments can reduce this pain.
Definition: what is neuropathic pain?
“Neuropathic pain is a pain related to damage or dysfunction of the peripheral (nerves) or central nervous system (nerve pathways from the spinal cord to the brain)“explains Dr. Christelle Créac’h, neurologist. Neuropathic pain is most often sequel pain of a nervous attack generating a hyperexcitability of the nerve whereas the nociceptive pains are due to the occurrence and persistence of inflammation. THE peripheral neuropathic pain refers to pain caused by damage to a nerve located outside the spinal cord. They oppose the central neuropathic pain characterized by involvement of the brain or spinal cord.
What causes neuropathic pain?
The causes of neuropathic pain are very broad. “These are all diseases or injuries that affect a nerve or a nerve pathway” informs the doctor. Among the most common causes of neuropathic pain are diabetes with neuropathic pains in the hands and feet, sequel pains of shinglesneuropathic pain post-operative when a nerve has been compressed or severedneuropathic pain secondary to a Cerebrovascular accident or multiple sclerosis. “Cancers are also very prone to neuropathic pain: a tumor is likely to compress or infiltrate a nerve; chemotherapy and radiotherapy in the long term can be toxic for the nerves“adds Dr. Créac’h. Many other diseases can lead to neuropathic pain: renal failure, hepatic failureVitamin deficiencies are also causes of neuropathic pain as well as repeated intake of alcohol.
Does stress increase neuropathic pain?
“Stress can be a aggravating factor of neuropathic pain but is not the cause” points out Dr. Créac’h. “The stress induced muscle contractions that increase the level of neuropathic pain“, she explains. In general, all negative life factors, such as sleep disturbances, anxiety exacerbate these pains.
What are the symptoms of neuropathic pain?
Neuropathic pain involves a area innervated by a nerve. “The nerve trying to recover tends to become hyperexcitable resulting in pain type burning or, on the contrary, painful cold sensations, with an impression of compression with sensations of electric shocks, cramps, itching” describes Dr Créac’h. Neuropathic pain is also characterized by allodynia (pain caused by a stimulus that does not usually cause pain) or a hypoaesthesia to pain (loss of sensitivity).
Neuropathic pain is one of the chronic pain. “It is not possible to regenerate the nerve so it is impossible to suppress neuropathic pain except in cases in which the compression of the nerve is stopped, for example if a tumor that compresses a nerve sees its volume reduced by treatments“Informs the specialist. On the other hand, it is possible to reduce neuropathic pain with drug strategies (anti-epileptics, antidepressants, local anesthetic plasters, capsaicin patch) and non-drug strategies (transcutaneous or cord neurostimulation, transcranial magnetic stimulation (rTMS) in pain centers).”Opioids should be avoided on the other hand because they these drugs often trigger long-term hyperalgesia“Informs Dr Christelle Créac’h.
What are the natural treatments for neuropathic pain?
“All techniques that improve well-being and relax are beneficial for people suffering from chronic pain, including neuropathic pain.“says the specialist. self-hypnosis for example, can make it possible to mute the pain for the duration of the session or to reduce, in the longer term, aggravating factors of pain such as insomnia and stress-related contractures. On the other hand, the so-called natural treatments have not proven recognized efficacy compared to the placebo, including the CBD which has a very weak effect on neuropathic pain. This does not prevent trying natural remedies, knowing how to stop them if it has no effect. “There may be a placebo effect“explains the doctor who emphasizes that each person suffering from neuropathic pain finds personal solutions.
Who to consult for neuropathic pain?
THE general practitioners and all specialists can diagnose neuropathic pain. “General practitioners can already set up many things and in particular prescribe first-line treatments (antiepileptics and antidepressants) having an effect on pain)“Informs Dr. Créac’h. When these treatments are not enough, it is better to consult a pain center to benefit from comprehensive care and more complex techniques that cannot be performed elsewhere: high dose capsaicin, transcutaneous neurostimulation, transcranial magnetic stimulation (rTMS). Dr. Créac’h recommends that people with cancer and suffering from neuropathic pain ask for supportive care. “Supportive care professionals are used to managing this type of pain” she explains.
Can neuropathic pain disappear?
There may be significant improvements but it is rare that neuropathic pain disappears, except in a few cases. “If a compressed nerve is no longer so the nerve can repairsays the doctor, for example.Many patients who have had neuropathic pain for 20 years describe less intense pain. They manage their pain better” informs the doctor who explains that if we accept to live with neuropathic pain, we are better. “There is a lot of clinical research on different new techniques to relieve neuropathic pain and the pharmaceutical industry continues to develop new molecules which opens up interesting prospects for the years to come” announces Dr. Créac’h.
Thank you to Dr. Christelle Créac’h, neurologist Head of Department of the Pain Assessment and Treatment Center (CETD) of the Saint-Étienne University Hospital.