What causes neuropathic pain and how is it diagnosed and treated? WebMD gives you an overview of the causes and treatment. Neuropathic pain is pain caused by damage or disease affecting the somatosensory nervous system. Neuropathic pain may be associated with abnormal. With neuropathic pain, the body sends pain signals to your brain unprompted. Here's what causes it and what you can do.
Peripheral neuropathy can result from traumatic injuries, infections, metabolic problems, inherited causes and exposure to toxins.
One of the most common causes is diabetes mellitus. People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling. In many cases, symptoms improve, especially if caused by a treatable condition. Medications can reduce the pain of peripheral neuropathy. Peripheral neuropathy care at Mayo Clinic. Every nerve in your peripheral system has a specific function, so symptoms depend on the type of nerves affected. Nerves are classified into:. Peripheral neuropathy can affect one nerve mononeuropathy , two or more nerves in different areas multiple mononeuropathy or many nerves polyneuropathy.
Carpal tunnel syndrome is an example of mononeuropathy. Most people with peripheral neuropathy have polyneuropathy. Seek medical care right away if you notice unusual tingling, weakness or pain in your hands or feet. Early diagnosis and treatment offer the best chance for controlling your symptoms and preventing further damage to your peripheral nerves. Not a single disease, peripheral neuropathy is nerve damage caused by a number of conditions.
Causes of neuropathies include:. The best way to prevent peripheral neuropathy is to manage medical conditions that put you at risk, such as diabetes, alcoholism or rheumatoid arthritis. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. Diagnosis is suggested by pain out of proportion to tissue injury, dysesthesia eg, burning, tingling , and signs of nerve injury detected during neurologic examination.
Although neuropathic pain responds to opioids, treatment is often with adjuvant drugs eg, antidepressants, anticonvulsants, baclofen , topical drugs. Pain can develop after injury to any level of the nervous system, peripheral or central; the sympathetic nervous system may be involved causing sympathetically maintained pain. Painful polyneuropathy particularly neuropathy due to diabetes.
Central pain syndromes potentially caused by virtually any lesion at any level of the nervous system. Postsurgical pain syndromes eg, postmastectomy syndrome, postthoracotomy syndrome, phantom limb pain. Complex regional pain syndrome reflex sympathetic dystrophy and causalgia. Mononeuropathies eg, carpal tunnel syndrome , radiculopathy. Plexopathies typically caused by nerve compression, as by a neuroma, tumor, or herniated disk.
Polyneuropathies typically caused by various metabolic neuropathies—see tables Causes of Peripheral Nervous System Disorders. Mechanisms presumably vary and may involve an increased number of sodium channels on regenerating nerves. Central neuropathic pain syndromes appear to involve reorganization of central somatosensory processing; the main categories are deafferentation pain and sympathetically maintained pain.
Both are complex and, although presumably related, differ substantially. Deafferentation pain is due to partial or complete interruption of peripheral or central afferent neural activity. Phantom limb pain pain felt in the region of an amputated body part. Mechanisms are unknown but may involve sensitization of central neurons, with lower activation thresholds and expansion of receptive fields.
Sympathetically maintained pain depends on efferent sympathetic activity. Complex regional pain syndrome sometimes involves sympathetically maintained pain. Other types of neuropathic pain may have a sympathetically maintained component.
Mechanisms probably involve abnormal sympathetic-somatic nerve connections ephapses , local inflammatory changes, and changes in the spinal cord. Dysesthesias spontaneous or evoked burning pain, often with a superimposed lancinating component are typical, but pain may also be deep and aching. Other sensations—eg, hyperesthesia, hyperalgesia, allodynia pain due to a nonnoxious stimulus , and hyperpathia particularly unpleasant, exaggerated pain response —may also occur.
Symptoms are long-lasting, typically persisting after resolution of the primary cause if one was present because the CNS has been sensitized and remodeled. Neuropathic pain is suggested by its typical symptoms when nerve injury is known or suspected. The cause eg, amputation, diabetes may be readily apparent.
If not, the diagnosis often can be assumed based on the description. Pain that is ameliorated by sympathetic nerve block is sympathetically maintained pain. Multimodal therapy eg, psychologic treatments, physical methods, antidepressants or anticonvulsants, sometimes surgery.
Without concern for diagnosis, rehabilitation, and psychosocial issues, treatment of neuropathic pain has a limited chance of success. For peripheral nerve lesions, mobilization is needed to prevent trophic changes, disuse atrophy, and joint ankylosis. Surgery may be needed to alleviate compression. Psychologic factors must be constantly considered from the start of treatment. Anxiety and depression must be treated appropriately.
When dysfunction is entrenched, patients may benefit from the comprehensive approach provided by a pain clinic. Several classes of drugs are moderately effective see table Drugs for Neuropathic Pain , but complete or near-complete relief is unlikely.
Antidepressants and anticonvulsants are most commonly used. Evidence of efficacy is strong for several antidepressants and anticonvulsants 1. First-line treatment for trigeminal neuralgia. Considered as efficacious as carbamazepine for trigeminal neuralgia and useful for other paroxysmal neuropathic pain. Unlike carbamazepine , no CBC or liver function monitoring necessary. Mechanism similar to gabapentin but more stable pharmacokinetics.
Not recommended for the elderly or patients with a heart disorder because it has strong anticholinergic effects. Better tolerated than amitriptyline ; adverse effect profile better with desipramine than nortriptyline. More norepinephrine reuptake inhibition at higher doses.
Neuropathic pain results from damage to or dysfunction of the peripheral or central nervous system, rather than stimulation of pain receptors. Diagnosis is. Neuropathic pain (also called neuropathy, neuralgia, or nerve pain) occurs in about 7 - 10% of adults over age 'Neuropathy affects people. Neuropathic pain can be contrasted to nociceptive pain, which is the type of pain which occurs when someone experiences an acute injury, such as smashing a.