Neuro: Neuropathic pain Flashcards
Potential aetiologies of neuropathic pain?
Postherpetic neuralgia from shingles is in the distribution of a dermatome and usually on the trunk
Nerve damage from surgery
Multiple sclerosis
Diabetic neuralgia typically affects the feet
Trigeminal neuralgia
Complex Regional Pain Syndrome (CRPS)
Characteristics of neuropathic pain?
Burning
Tingiling
Pins and needles
Electric shocks
Loss of touch sensation inf affected area
What questionnaire is used to assess neuropathic pain and what score indicates neuropathic pain?
DN4 questionnaire
This is used to assess the characteristics of the pain and examination of the affected area. They are then scored out of 10 for their pain. A score of 4 or more indicates neuropathic pain.
What are the four first line drugs to manage neuropathic pain?
Amitriptyline is a tricyclic antidepressant
Duloxetine is an SNRI antidepressant
Gabapentin is an anticonvulsant
Pregabalin is an anticonvulsant
(exp. trigeminal neuralgia - carbamazepine first line)
What drug can be used as a rescue therapy in neuropathic pain?
Tramadol ONLY as a rescue for short term control of flares
What topical treatment can be used to manage neuropathic pain?
Capsaicin cream (chilli pepper cream) for localised areas of pain
Non-pharmacological management of neuropathic pain?
Physiotherapy to maintain strength
Psychological input to help with understanding and coping
What is complex regional pain syndrome? (CRPS)
This is a condition where areas are affected by abnormal nerve functioning causing neuropathic pain and abnormal sensations. It is usually isolated to one limb. Often it is triggered by an injury to the area.
The area can become very painful and hypersensitive even to simple inputs such as wearing clothing. It can also intermittently swell, change colour, change temperature, flush with blood and have abnormal sweating.
Treatment is often guided by a pain specialist and is similar to other neuropathic pain.
