Neuropathic Pain

Neuropathic Pain is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Defined as pain caused by direct nerve injury
  • An injury to either the peripheral or central nervous system (CNS) can lead to neuropathic pain.
  • Can exist without ongoing disease
  • Can arise from damage to nerve pathways at any point from terminals of the peripheral nociceptors to cortical neurons in the brain
  • Causes include traumatic nerve injury, infection, metabolic injury, autoimmune disease, neoplasm, drugs, radiation, and neurovascular disorders.

Epidemiology

Prevalence

Includes chronic conditions that affect up to 10% of the population (1)

  • Cancer—up to 20% have neuropathic pain from either cancer or treatment
  • Herpes zoster—lifetime incidence is ~25%. Up to 10% develop chronic postherpetic neuralgia (1).
  • HIV—33 million people infected across the world; ~35% have neuropathic pain.
  • Diabetic neuropathy—affects 0.8% of population (1)

Etiology and Pathophysiology

  • Positive symptoms due to changes in peripheral nerves, loss of inhibitory mechanisms in CNS, and central sensitization
  • Negative symptoms (sensory deficits) reflect neural damage.
  • Associated with numerous conditions, 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) (2)

Risk Factors

  • General risk factors include older age, female gender, physical inactivity, and manual occupation.
  • There is growing evidence of genetic factors.
  • Includes conditions that cause nerve damage or potentiate symptoms from damaged nerves:
    • Diabetes
    • Herpes zoster
    • Trigeminal neuralgia
    • HIV
    • Lyme disease
    • Cancer and chemotherapy
    • Stroke
    • Multiple sclerosis
    • Trauma
    • Surgery
    • Limb amputation
    • Nutritional deficiencies
    • Medications

Commonly Associated Conditions

  • Depression/anxiety
  • Insomnia
  • Substance abuse

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