Nerve pain

Nerve (neuropathic) pain, caused by a lesion or disease of the somatosensory nervous system. Global incidence of nerve pain is 7 to 8 %. Nerve pain may arise as a result of trauma, ischaemia, inflammation, application of neurotoxic substances, metabolic dysfunctioning or due to malignancy. Common examples are Diabetic neuropathy, carpal tunnel syndrome, trigeminal neuralgia, complex regional pain syndrome, post herpatic neuralgia, phantom limb pain and radiculopathy (cervical, thoracic, lumbosacral). People with nerve pain feel it in different ways like:

  1. Character– Burning, shooting, Electric shock like, Stabbing, or Lancinating Pain.
  2. Allodynia , Hyperalgesia & paresthesia
  3. Associated symptoms like numbness, tingling, pin prick sensation.

The mechanism involved in nerve pain may be ectopic discharges, loss of inhibition, peripheral and central sensitization .Diagnosis of nerve pain can be made by detailed history, examination and laboratory findings including nerve conduction velocities. Body diagram can be used to show where the pain is located and can provide vital clues about the neuroanatomical distribution of the pain and the extent of the neural lesion. Sensory testing is the most important part of the clinical examination. Here findings in the painful area are compared with the findings of contra lateral normal area. Pain detect tool is also an important tool to know where nerve component is present or not. Management of nerve pain is multidimensional. It may be pharmacological i.e. nonopioid analgesics, opioid analgesics (Tramadol), Antidepressants like TCA’s, SSRI’s, SNRI’s and antiepileptic medicines. Some of the intervention which is evidence based and proven efficacious are Sympathetic block using local anaesthetics , Neurolysis via a neurolytic agent, Radiofrequency ablation of corresponding nerve, percutaneous surgical procedures and Spinal cord stimulation. Therefore management of nerve pain should include consideration of cost effectiveness and a patient centric care with good communication between healthcare professionals and patient taking into account patient’s needs, preferences and cultural appropriateness.