Neuropathic pain

Neuropathic pain is a maladaptive disease process caused by somatosensory nerve cell damage or dysfunction. Any condition that causes abnormal nerve transmission, including: metabolic disease, infection, ischemia, injury, entrapment, connective tissue disease, acquired immunodeficiency, malignancy, drugs, and toxins can result in neuropathic pain.

Neuropathic pain usually has one or more of the following characteristics:

Neuropathic pain may be classified by location:

1. Central neuropathic pain (CNP) results from a lesion or disease process located in the brain or along the spinothalamic tract or the trigeminothalamic tracts. The IASP identifies stroke and spinal cord injury as most common causes of central neuropathic pain. It estimates about 8% of post-stroke victims and about 70% of spinal cord trauma victims experience central neuropathic pain.

A partial list of other causes of central neuropathic pain include:

CNP symptoms are often experienced as a mix of persistant and painful sensations that involve large areas of the body. Painful CPN sensations include: burning, freezing, aching, ballooning, stretching, crushing, spasticity, shocking/electrical type jolts & stabbing. Other symptoms can include: intolerance to temperature change, fatigue, a vague numb sensation, hyperalgesia , allodynia, allachesthesia, visceral pain, bowel and bladder pain and emotional lability.

"The burning and loss of touch sensations are usually most severe on the distant parts of the body, such as the feet or hands." CNP often begins shortly after the causative injury or damage, but may be delayed by months or even years, especially if it is related to post-stroke pain.

CNP treatment often provide some reduction of pain, but not complete relief of pain, for those affected by central pain syndrome. Tricyclic antidepressants such as nortriptyline or anticonvulsants such as neurontin (gabapentin) can be useful. Lowering stress levels appears to reduce pain.

2. Peripheral neuropathic pain occurs due to the spontaneous activation of pain pathways following an injury to a peripheral nerve, plexus or dorsal root ganglion. Common etiologies include: metabolic disease, infection, ischemia, injury, entrapment, connective tissue disease, malignancy, drugs, and toxins.

It is theorized that damaged peripheral neurons respond to injury by:

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Neuropathic pain stops after healing occurs.