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When the cause of neuropathic pain, which is defined as nervous pain, is found and treated with the right technique, it ceases to be a nightmare. We will try to explain what neuropathy, or neuropathic pain, which has been heard frequently recently, is different from the pain we know. We will seek answers to questions such as: Can neuropathic pain, which also means nerve pain, be dealt with? What are the symptoms and treatments? How are they different from other pain?
Pain that occurs as a result of nerve damage or dysfunction is called neuropathic pain. Neuropathy is a complication of various diseases and is a common condition. Neuropathic pain is a type of chronic pain. The damaged nerve can be in the central nervous system as well as in the peripheral (ends) nervous system. Symptoms vary depending on damage to motor, sensory, or autonomic nerves. Motor nerves control the movements of muscles such as walking, grasping objects, or speaking. Sensory nerves transmit information such as a light touch sensation or a sharp pain. Autonomic nerves control automatically regulated organ activities such as respiration, food digestion, and heart function. Some neuropathies can affect all three types of nerves.
If a single nerve is damaged in the peripheral (end) regions, it is called mononeuropathy. For example, if a region such as cancer or sciatica is affected, such as nerve compression in the wrist, the type in which many nerves are affected by metabolic diseases such as plexopathy and diabetes is called Polyneuropathy. In the condition called central neuropathic pain syndrome, the functioning of the nervous system is impaired. It is a complex and difficult to control type of pain. What pain doctors call Phantom Pain (ghost pain) reflects exactly this situation. In phantom pain, for example, the patient's foot has been amputated from the knee, the patient feels severe pain in his non-existent foot. How do people look at someone who tells those around that their missing fingers are in severe pain? But this is real pain, the patient is telling the truth.
The characteristic of neuropathic pain is the spontaneous perception of burning, pins and needles, tingling, and electric shock in an area without a visible situation. The pain is felt deeply. Another feature is that a painless stimulus such as cold is perceived as pain in these patients. Sadness is reflected as pain in the same way as stress. Even touch turns into an intense and distorted perception of pain. Even the sheet that we cover at night can cause an increase in our complaints. This means that some parts of the body have become hypersensitive. An important feature is that these patients feel a small painful stimulus very intensely. Even if the cause disappears, this intense pain will continue for a long time and may occur again and again. Neuropathic pain is the enemy of sleep. It makes patients more restless at night.
The cause of 30 percent of neuropathies is unknown. It can occur at any age, but is more common in the elderly. The most common type is Peripheral neuropathy. Here are some of the causes of neuropathic pain;
Diabetes (The most common cause)
Vitamin B12 and Folate deficiency
Excessive alcohol consumption
Certain drugs such as chemotherapy drugs
Toxins, poisons e.g. pesticides
Cancer; such as lymphoma, multiple myeloma
Infections; such as shingles, Lyme disease
Chronic liver and kidney diseases
Traumatic injuries
Connective tissue disease; such as rheumatoid arthritis and lupus
Some hereditary diseases; charcot-marie-tooth snd.
Nerve compressions,
Underactive thyroid gland
Fibromyalgia
May Be Of Diabetic Origin
Since it is the most common cause of peripheral neuropathy, we wanted to briefly dwell on it. Neuropathy occurs in 50% of diabetics. High blood sugar erodes the walls of the tiny blood vessels that supply oxygen and nutrients to the nerves, brain and other vital organs, especially at the tips of the hands and feet, impairing their function. The blood flow to the nerves is disturbed, the nerves are damaged.
Nerve damage occurs increasingly in diabetic neuropathy. The first nerve fibers to malfunction are those farthest from the brain and spinal cord. Pain and numbness are usually felt symmetrically, gradually progressing to both feet. Later, fingers, hands, and arms may be affected. The feeling of gloves on the hands and socks on the feet is common. The occasional pins and needles and stabbing pains are very disturbing.
Neuropathic Pain Interventional Treatment Methods
These techniques and methods, which are frequently used by algology experts, are initiatives that require a lot of experience and skill. These are treatments that are generally applied in the operating room environment and accompanied by imaging devices.
Nerve blockades: It can be applied temporarily with local anesthetic agents or permanently with other techniques to prevent excessive burning and pain of sympathetic nerves.
Neurolytic (nerve-killing) techniques: These are based on the destruction of the nerves identified as the source of pain with substances such as alcohol or phenol, they are generally not preferred.
Pain treatment with radiofrequency method: It is an interventional application that is frequently used in neuropathic pain and has effective results. It is a technique that allows patients to relax, especially by disrupting the transmission of pain, sensory and sympathetic nerves for a long time with this method. No drugs are used here. It's the radio waves that do the work.
Insertion of a Pain Pacemaker (Spinal Cord Stimulation): It is an application similar to a pacemaker that ensures that some nerves are stimulated by the electrodes placed on the spinal cord, thereby deceiving the brain. It is an expensive method. It is preferred if the pain continues to cause discomfort despite 2-3 surgeries and the application of other pain relief methods. These are nerve stimulation devices applied to the peripheral nerves of the batteries.
Pain Pumps: It is a permanent application that is placed on or inside the spinal cord. These pumps have a reservoir that can be filled from the outside when necessary, this reservoir is filled with morphine or similar drugs, these automatic pumps themselves constantly give drugs from there. Drugs are injected externally into the chambers of non-automatic ones. It is preferred in cancer pain, which is a type of neuropathic pain.
Cordotomy: Usually accompanied by tomography image, a radiofrequency needle is entered into the spinal cord at neck level and with the necessary stimulation and patient dialogue, the nerve that carries the pain to the brain is found and burned in a 1-minute procedure. It is possible to get rid of 90-95% of pain. It is used for the treatment of pain that no longer responds to any medication or method, such as cancer pain and phantom pain.
You cannot control this different type of pain with drugs such as conventional painkillers and muscle relaxants. The primary approach in the treatment of Neuropathic Pain should be directed towards the disease causing this pain. In patients with diabetes, it is important to control blood sugar well, not to have vitamin B deficiency, and to reduce stress.
Neuropathic Pain Drug Treatments
Anticonvulsants: These are drugs used in epilepsy disease. It is used to prevent painful nerve symptoms, reduce burning, stinging, numbness.
Antidepressants: They are used to reduce pain modulation and central effects, to reduce other distorted pain perceptions felt in neuropathy, to contribute to the erasure of the formed pain memory and to reduce stress.
Morphine-like drugs: Start with mild forms. It makes a serious contribution to the central cessation of such pains. If there is pain, they are not addictive.
Combination with other drugs is important in pain control. Vitamins B12 and folate are important for damaged nerve tissue repair. Vitamin E, local anesthetics, antiarrhythmics, L-carton, Ozone and Ozone oil can also be counted.
