Neuropathic Pain

Question 1

Neuropathic pain is caused by….

Answer 1

Neuropathic pain is caused by abnormal functioning of the sensory nerves delivering abnormal and painful signals to the brain.

Question 2

Neuropathic pain can affect a wide variety of areas with number of different causes: what are they?

Answer 2

1: Postherpetic neuralgia from shingles is in the distribution of a dermatome and usually on the trunk
2: Nerve damage from surgery
3: Multiple sclerosis
4: Diabetic neuralgia typically affects the feet
5: Trigeminal neuralgia
6: Complex Regional Pain Syndrome (CRPS)

Question 3

give the typical features of neuropathic pain

Answer 3

Burning
Tingling
Pins and needles
Electric shocks
Loss of sensation to touch of the affected area

Question 4

what is the DN4 questionaire

Answer 4

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.

Question 5

what are the 4 first line treatment options for neuropathic pain

Answer 5

Amitriptyline is a tricyclic antidepressant
Duloxetine is an SNRI antidepressant
Gabapentin is an anticonvulsant
Pregabalin is an anticonvulsant
NICE recommend using one of these four medications to control neuropathic pain. If that does not work then stop and start an alternative and repeat this until all four have been tried.

Question 6

give some other options for neuropathic pain

Answer 6

Tramadol ONLY as a rescue for short term control of flares
Capsaicin cream (chilli pepper cream) for localised areas of pain
Physiotherapy to maintain strength
Psychological input to help with understanding and coping

Question 7

what is special about Trigeminal neuralgia

Answer 7

Trigeminal neuralgia is a type of neuropathic pain however NICE recommend carbamazepine as first-line for trigeminal neuralgia and if that does not work to refer to a specialist.

Question 8

describe complex regional pain syndrome

Answer 8

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.