Neuropathic pain is a special type of pain which occurs when there is damage to nerve fibers, which produces tingling or burning type of pain.
It is of two types:

  1. Peripheral Neuropathic pain: It occurs when there is injury to peripheral nerve fibers (A-delta or C-fibers) which carries pain sensation to brain (Thalamus) for interpretation.
  2. Central Neuropathic pain: It occurs due to sensitization of central pain interpreting mechanisms (Thalamus) to falsely feel pain, when peripheral nerve fibers are no longer sending pain impulses to them.


Worldwide estimates of prevalence of neuropathic pain are 7% i.e. 7 persons out of 100 people are suffering from different types of neuropathic pain.

Symptoms:

  • Tingling sensation or feeling of ants crawling under skin
  • Burning sensation
  • Sharp shooting pain or electric current-like sensation
  • Stabbing pain
  • Dull pain with numbness or heaviness


Reasons for neuropathic pain:

  • Diabetes mellitus: Most common cause worldwide due to uncontrolled blood sugar levels, causing damage to nerve fibers.
  • Alcohol consumption/Cigarette smoking: Damage to nerve fibers or damage to blood vessels supplying nerve fibers.
  • Neck pain/Low Back pain/ Glutei pain
  • Vit. B12 deficiency
  • Chemotherapy for cancer patients
  • Post-Herpes virus infection
  • Post-Spine surgery
  • Post-Amputation
  • Diseases like Spinal cord injury, multiple sclerosis, HIV, Lead toxicity, etc.


Special Neuropathies:

  • Carpal tunnel syndrome: Tingling, burning sensation in hand which occurs due to compression of median nerve in wrist area. It occurs in women especially due to pregnancy, hypothyroidism, diabetes, etc. and in men due to improper position of wrist during working on computers.
  • Cervical Radiculopathy: Pain in neck and shoulder region (which increases with neck movements), along with sharp shooting pain radiating from neck to hand occurs in cases of cervical radiculopathy. This is due to compression of cervical nerve root by disc prolapse, facet subluxation, muscle spasm, trauma,etc.
  • Lumbar Radiculopathy: Pain in lower back or glutei region with sharp shooting pain radiating from hip to leg/foot region, occurs in cases of Lumbar radiculopathy or Sciatica. This is due to compression of lumbar nerve root or sciatic nerve by disc prolapse, facet joint, trauma, hypertrophied ligamentum flavum, piriformis syndrome, etc.
  • Meralgia paresthetica: Tingling or burning sensation in front of thigh, occurs due to compression of lateral cutaneous nerve of thigh, near waist region. Usual causes are tight or constrictive clothing at waist region, prolonged sitting, protuberant abdomen, etc.


Prevention:

  • AVOID  Alcohol consumption and cigarette smoking.
  • Maintain ideal body weight / BMI (Body mass index)
  • Life-style changes:
  1. Daily exercises (>30 minutes per day) or brisk walking or swimming.
  2. Avoid prolonged sitting or standing (>30 minutes).
  • Food/Diet should have following components:
  1. Green vegetables e.g. spinach, fenugreek leaves (methi), radish,etc.; Coloured vegetables e.g. Tomato, carrot, Capsicum (green/red), ladies-finger (bhindi).
  2. Milk products e.g.Milk, buttermilk, curd, cheese (paneer)
  3. Protein-rich foods e.g.  Fish, egg, chicken, pulses (daal)
  4. Fiber-rich foods e.g. Bran, oats, Brown-rice
  5. Fruits e.g. Apple, orange, guava, papaya, pomegranate, Berries.
  • Blood sugar control (in diabetics)
  • Care of feet:
  1. Regular inspection of feet (with mirror)
  2. Comfortable, well-fitted shoes
  3. Regular consultation with podiatrist
  4. Treatment of wounds, foot deformities
  • Adequate sleep
  • Warm water bath (increases blood flow to affected area)


Treatment:

  • Neuropathic pain killers e.g. Amitriptyllline, Pregabalin, Gabapentin, capsaicin, Duloxetine, etc.
  • Vit. B12 supplements, Anti-oxidants, multi-vitamins
  • TENS
  • Acupuncture
  • Relaxation, Yoga
  • Neural Prolotherapy

Neuropathic Pain

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