Neuropathic pain is a chronic condition which is the result of damage or disease affecting the nerves. The pain may be associated with abnormal sensations (called dysesthesia pain) from normally non-painful stimuli (Allodynia). It may have continuous and/or episodic (paroxysmal) components.
Neuropathic Pain: Causes
Neuropathic pain may occur in isolation or in combination with other forms of pain. One can experience neuropathic pain if one has any of the following issues:
Herpes Zoster Infection (Shingles)
Infections such as Postherpetic neuralgia, HIV
Persistent post-surgery pain or trauma involving nerve damage
Post amputation - Phantom limb pain
Central causes such as spinal cord injuries, strokes, multiple sclerosis
Complex Regional Pain Syndrome
Drug-induced neuropathy including that after chemotherapy/radiotherapy
There are two types of neuropathic pain. These include:
Post Herpetic Neuralgia (PHN)
Herpes Zoster is caused by the reactivation of the virus that causes chickenpox. It produces a rash accompanied by pain, numbness, itching, skin pigmentation and sometimes scarring. One in five patients with Herpes Zoster develops PHN where the pain persists for more than 120 days after the onset of rash. It is most commonly observed in the chest wall region (thoracic dermatomes) and the distribution of the ophthalmic branch of the trigeminal nerve (around the eye).
Chronic Post Surgical Pain (CPSP)
Chronic Post-surgical pain (CPSP) is pain localized to the surgical site or a referred area persisting three months after surgery. CPSP is a common complication of surgery. Rates varying from 0-80 % have been reported in different studies with some surgeries such as amputations, thoracotomy, and mastectomy being more prone to develop CPSP. It is also observed after common operations such as hernia repair, caesarean sections, knee replacement etc. A significant proportion of the cases are attributed to nerve damage.
Neuropathic Pain: Signs and Symptoms
The signs of neuropathic pain include:
Pins and needles sensation
Neuropathic Pain: Expertise
Max Healthcare offers integrated pain management services for a wide variety of conditions, including neuropathic pain. The experts, including pain consultants, physiotherapists, psychologists, occupational therapists, wellness specialists and dieticians, work together as a team to maximize health gains. They provide non-surgical alternatives using a multidisciplinary approach and coordinated care that is bespoke and customized to suit individual needs.
Max Healthcare has well-established Pain Clinics with qualified pain specialists who are well-trained to manage all types of neuropathic pain. Along with medicines, the specialists use specific nerve blocks using Fluoroscopic/Ultrasound guidance or radiofrequency ablation to treat the pain. In addition to qualified pain physicians, Max Healthcare has state-of-the-art infrastructure for all treatment modalities. This includes detailed, comprehensive pain assessments with in-clinic diagnostic ultrasound scans and combined multidisciplinary assessments with physiotherapy and psychology specialists. Interventions offered by Max include closely supervised physiotherapy and rehabilitation, psychology input including cognitive behavioural therapy, and complementary therapies including acupuncture and meditation.
Neuropathic Pain: Approach
Neuropathic pain can be very difficult to treat, with only some 40-60% of people being able to gain partial relief. Therefore, a multidisciplinary approach is required. As a multidisciplinary approach is required, the Department of Cardiology, Department of Endocrinology, Department of Oncology and Department of Rheumatology works closely to treat patients.
To confirm neuropathic pain, a thorough diagnosis is done. The doctor first conducts an interview which is followed by a physical exam. He or she may then ask questions about how the patient would describe the pain, when the pain occurs, or whether anything specific triggers the pain. The doctor will also ask about the risk factors for neuropathic pain and may also request both blood and nerve tests. One of the most common ways to evaluate whether a nerve is injured is with electrodiagnostic medicine.
At Max Healthcare, patients are usually prescribed oral medications first. Depending on the response, the treatment is escalated gradually. All nerve block procedures are done on daycare admission basis, and there is an initial follow-up of 15 days. The doctors create personalized pain management plans on the lines of their Pain Management Programme. An experienced team assists, advises and supports patients in implementing lifestyle modifications that help sustain the benefits. The team works not only to reduce the pain but also its impact. The aim is to tailor the therapies to patients’ requirements and improve their quality of life.
Neuropathic Pain: Procedure
The most important challenge for any pain specialist is to identify the cause and treat the basic pathology leading to pain.
At Max Healthcare, treatment options for neuropathic pain include:
A) Medications: Doctors prescribe over-the-counter painkillers, antidepressants, anticonvulsants, topical agents to provide relief from the pain.
B) Nerve blocks: Nerves carry the sensation of pain to the brain, and this transmission can be reduced/stopped by nerve blocks. The nerves to be targeted will depend on the area involved and may include sympathetic blocks such as Stellate Ganglion Block, Hypogastric Plexus Block. Injecting steroids, local anaesthesia, or any other pain medication that helps keep the pain at bay.
C) Implantable intrathecal drug delivery devices: Through this device, electrical impulses are sent to the brain, which helps gain control over the condition.
D) Exercise, physical therapy, and psychotherapy: This helps ease out the muscles, which provides relief from the pain. As nerve injury/dysfunction may be accompanied by weakness/atrophy of muscles, physiotherapy forms an essential pillar of overall pain management. It helps in preventing deconditioning of muscles and preserving the functionality.
E) Psychology: Neuropathic pain has profound physiological effects on the brain, which can manifest as psychological disorders. This treatment can help deal with flare-up episodes and any accompanying mood disturbances. Patients can choose from cognitive behavioural therapy, coping strategies and relaxation techniques.
F) Surgical intervention: A team of experts and experienced neurosurgeons leads various neurosurgical interventions like microendoscopic discectomy for lumbar disc prolapse, cervical decompression and fixation procedures for cervical myelo-radiculopathies, carpal tunnel release for carpal tunnel syndrome and microvascular decompression (MVD) for trigeminal neuralgia etc. The team is committed to providing quality medical care and excellent patient service.