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Neuropathic Pain (Nerve Pain) (cont.)

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How is neuropathic pain diagnosed?

The diagnosis of pain is based upon further assessment of a patient's history. If underlying nerve damage is suspected, then evaluation of the nerves with testing may be warranted. The most common way to evaluate whether a nerve is injured is with electrodiagnostic medicine. This medical subspecialty uses techniques of a nerve conduction studies with electromyelography (NCS/EMG). Clinical evaluation may reveal some evidence of loss of function, and can include assessment of light touch, the ability to distinguish sharp from dull, the ability to discern temperature, and assessment of vibration. Once a thorough clinical examination is performed, the electrodiagnostic study can be planned. These studies are performed by specially trained neurologist and physiatrists.

If neuropathy is suspected, a search for reversible causes should be done. This can include blood work for vitamin deficiencies or thyroid abnormalities, and imaging studies to exclude a structural lesion impacting the spinal cord. Depending on the results of this testing, there may be a way to decrease the severity of the neuropathy and potentially decrease the pain that a patient is experiencing. Unfortunately, in many conditions, even good control of the underlying cause of the neuropathy cannot reverse the neuropathy. This is commonly seen in patients with diabetic neuropathy.

In rare instances, there may be evidence of changes in the skin and hair growth pattern in an affected area. These alterations may be associated with changes in sweating or perspiration as well. When present, these changes can help identify the probable presence of neuropathic pain associated with a condition called complex regional pain syndrome.

What is the treatment for neuropathic pain?

Various medications have been used in an attempt to treat neuropathic pain. The majority of these medications are used off-label, meaning that the medication was approved by the FDA to treat other conditions and was then identified as being beneficial to treat neuropathic pain. Tricyclic antidepressants (amitriptyline, nortriptyline, desipramine) have been prescribed for control of neuropathic pain for many years. Some patients find that these can be quite effective in giving them relief. Other types of antidepressants have also been shown to provide some relief. Selective serotonin reuptake inhibitors (SSRIs like paroxetine and citalopram) and other antidepressants (venlafaxine, bupropion) have been used in some patients.

Another common treatment of neuropathic pain includes antiseizure medications (carbamazepine, phenytoin, gabapentin, lamotrigine, and others). In severe cases of painful neuropathy which don't respond to first-line agents, medications typically used to treat heart arrhythmias may be of some benefit; however, these can lead to significant side effects and must be monitored closely. Medications applied directly to the skin can provide modest to pronounced benefit for some patients. The forms commonly used include lidocaine (in patch or gel form) or capsaicin. Multiple arguments have been made both promoting and vilifying the use of narcotic agents to treat chronic neuropathic pain. No specific recommendations regarding the use of narcotics will be made at this time.

Curing neuropathic pain is dependent on the underlying cause. If the cause is reversible, then the peripheral nerves may regenerate and the pain will abate; however, this reduction in pain may take many months to years.

Medically Reviewed by a Doctor on 9/6/2016


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