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- Defined as pain caused by direct nerve injury (1)
- Any injury to either the peripheral or central nervous system can lead to neuropathic pain.
- Can exist without ongoing disease
- Can arise from damage to nerve pathways at any point from the terminals of the peripheral nociceptors to the cortical neurons in the brain
- Causes include traumatic nerve injury, infection, metabolic injury, autoimmune disease, neoplasm, drugs, radiation, and neurovascular disorders.
- Includes various chronic conditions that affect up to 7–10% of the population (2)
- Approximately 20% of people with cancer have neuropathic pain as a result of either the disease or treatment.
- The lifetime incidence of herpes zoster (shingles) is ~25%. Between 2.6% and 10% will develop chronic postherpetic neuralgia (2).
- 33 million people infected with HIV across the world; ~35% have neuropathic pain.
- 0.8% of population has painful diabetic neuropathy (2).
Etiology and Pathophysiology
- Positive symptoms due to changes in peripheral nerves, loss of inhibitory mechanisms in CNS, and central sensitization
- Negative symptoms (sensory deficits) reflecting neural damage
- Associated with a predisposing factor, including:
- Demyelinating disorders (multiple sclerosis, Guillain-Barré syndrome)
- Neoplasm (primary/metastatic)
- Neurovascular (central poststroke syndrome, diabetes, trigeminal neuralgia)
- Autoimmune disease (Sjögren syndrome, polyarteritis nodosa)
- Structural disease (herniated disc disease) (3)
- General risk factors include older age, female gender, physical inactivity, and manual occupation.
- There is growing evidence of genetic factors.
- Includes factors that cause nerve damage as well as those that increase pain when nerves damaged:
- Herpes zoster
- Trigeminal neuralgia
- Lyme disease
- Cancer and chemotherapy
- Multiple sclerosis
- Limb amputation
- Nutritional deficiencies
Commonly Associated Conditions
- Substance abuse