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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 (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.

Epidemiology

Prevalence
  • 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)

Risk Factors

  • 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:
    • 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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Citation

Stephens, Mark B., et al., editors. "Neuropathic Pain." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116846/all/Neuropathic_Pain.
Neuropathic Pain. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116846/all/Neuropathic_Pain. Accessed April 21, 2019.
Neuropathic Pain. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116846/all/Neuropathic_Pain
Neuropathic Pain [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116846/all/Neuropathic_Pain.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Neuropathic Pain ID - 116846 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116846/all/Neuropathic_Pain PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -