Monday - Friday: 9.30 am to 5.30 pm,
Saturday - 9.00 am to 5.30 pm
Unit 3, Wilmington Cl, Watford WD18 0AF

MACS PAIN CLINIC

Tel: 07868118976
Nerve Pain

NERVE PAIN/ NEUROPATHIC PAIN

NERVE PAIN/ NEUROPATHIC PAIN

Nerve pain or neuropathic pain is caused by damage or changes to nerves or the somatosensory system and this results in malfunctioning and pain.  Nearly one in ten people could have neuropathic pain and half of them have severe pain.  Neuropathic pain may result from disorders of the central nervous system (brain and spinal cord) or the peripheral nervous system.  These are difficult pains to manage, but with the right advice, should be able to have control of the symptoms.

Differential Diagnosis-

Neuropathic pain

Post-herpetic Neuralgia

Diabetic Neuropathy

Peripheral Neuropathy

Chemotherapy-induced Neuropathy

Post-mastectomy pain

Cancer pain

Costochondritis

Non-cardiac chest pain

Post hernia pain

Post surgery pain

SIGNS & SYMPTOMS

The symptoms can vary in descriptions like shooting, stabbing, burning, coldness, tingling, or a sensation of pins and needles.   There are associated symptoms of numbness and altered pain sensation (dysaesthesia); other symptoms are itching, hyperalgesia (slightly painful stimulus causing exaggerated pain), allodynia (nonpainful stimulus causing pain and sensitivity).  Central and peripheral sensitisation can result from nerve damage and cause increasing pain syndromes.  All of these can cause a negative impact on a person’s quality of life.

  • CAUSES

Painful Peripheral Neuropathies

  • Nerve injuries
    • Trauma and post-surgical pain
    • Cancer related
    • Radiation injury
  • Poly-neuropathies
    • Diabetes Mellitus
    • Chemotherapy-induced neuropathy
    • Alcohol abuse
    • Toxic causes – heavy metals, certain drugs
    • Vitamin deficiencies
  • Neuralgias
    • Post-herpetic neuralgia
    • Trigeminal Neuralgia
    • Occipital Neuralgia
    • Glossopharyngeal Neuralgia
    • Pudendal Neuralgia
    • Meralgia Paraesthetica
  • Infections
    • Shingles
    • HIV-induced and anti-retro viral treatment
    Central Neuropathic Pain
  • Post-stroke pain
  • Multiple sclerosis
  • Spinal cord injury
  • De-afferentiation pain
  • Phantom-limb pain (mixed)

TREATMENTS

Treatment of neuropathic pains can be difficult and good pain relief is obtained in only half the patients.  The treatment can be medications, localised treatment options, nerve blocks and neuromodulation options.

Pharmacological:

  • Anticonvulsants – Gabapentin, Pregabalin, Carbamazepine
  • Antidepressants
    • Tricyclics: Amitriptyline, Nortriptyline, Desipramine
    • SNRI: Duloxetine, Venlafaxine, Milnacipran
    • Bupropion
    • Mirtazapine
  • Opioids are used as second line medications and due to its side-effect profile has to be used with caution and under medical supervision.
  • Ketamine has been used to treat refractory nerve pain though evidence is lacking
  • Cannabinoids have little evidence for its use in treating neuropathic pain

Topical Agents

  • 5% Lidocaine plasters
  • Capsaicin creams and patches
  • Menthol cream
  • Compounded preparations of Ketamine, Phenytoin, Baclofen, Amitriptyline, Gabapentin

Botulinum toxin type A
Local intradermal injection of Botulinum toxin can help in some cases

Interventions
Nerve blocks can be tried but may not always be effective; but if they are effective it could be followed up with radiofrequency options or neurostimulation for longer term management.

Neuromodulation
Neuromodulation involves stimulating the nerves with electrical impulses and could be done centrally or peripherally.  Intrathecal or intraventricular pumps can infuse drugs like local anaesthetic, clonidine, opioids etc for similar effect.  Implanted systems are expensive and need specialist input.   Spinal cord, stimulation, Dorsal Ganglion Stimulation and Peripheral Nerve Stimulation are common modalities for managing peripheral neuropathic pain; Deep Brain Stimulation and Motor Cortex Stimulation are used for managing Central Neuropathic pain syndrome.  Non-implantable options include PENS Therapy which is discussed elsewhere.

Frequently Asked Questions

Q: What are the side-effects of injections?

A:

Each injection can have different side-effects. Please refer to appropriate injections information leaflet in the section of treatments.

Q: How can injections help in pain management?

A:

In situations where the pain is disabling severe and not allowing you to do the day-to-day chores, medications have proven inadequate to reduce the pain; injections are targeted to be given either under x-ray guidance or ultrasound guidance at the presumed sources of pain. Injections mainly consist of local anaesthetic with or without steroid. This works as anti-inflammatory at the source of pain.

Injections are not a permanent cure. Injections help by reducing the intensity of pain. The aim is to reduce pain and break the cycle of pain, allow you to carry out rigourous physiotherapy and help and healing. We may have to repeat injections in order to achieve the goals.

There are other injections available when nerves can be ablated (burnt) or we can apply what is called a radio-frequency lesioning at lower temperatures. These treatments have intermediate to long-term benefits and also work to reduce inflammation. These can be offered if the initial injection does not last long enough to follow on with strengthening Physiotherapy. These injections are not operations or permanent treatments. They are used to improve your condition of pain in order for you to carry out rehabilitative strengthening physiotherapy and come out of the vicious cycle of pain.

Q: What can I do if I do not want medications for my pain control or medications have not helped, or I get too many side-effects from medications?

A:

We can offer you Non-injection interventions such as acupuncture. We can introduce you to other means of self management of pain such as using a TENS machine . We have a modalities to offer at our clinic for example Medical yoga therapy, deep electrical muscle stimulation, TENS treatment. If the pain is unbearable, not responding to medications, or you do not want to try the non-invasive modalities ; we could offer you injection therapies.

Q: What will happen then ?

A:

You will have a detailed consultation, examination and then be given information and advice about your condition. We may also organise investigations. We may be able to prescribe you medication and give you details about how to manage pain and other interventional options can be discussed.

Q: Who will be seeing me?

A:

You will be reviewed only by MACS clinic senior Pain Consultants for your condition.

Q: If I am unable to get a GP appointment or don’t want to wait for any appointments how can I get in touch with you?

A:

You could phone us On (020) 7078 4378 or 07868118976; from 9 am to 6 pm; to book an appointment. You could also email us on info@macsclinic.co.uk or you could also get in touch with us on our website www.macsclinic.co.uk

Q: I am concerned about my pain. What should I do?

A:

If your pain is very severe, not responding to over-the-counter painkillers you should contact your GP and get an appointment for review. If you are in severe disabling pain, unable to carry out any routine tasks, you could book an emergency appointment with your GP or go to the local A&E for a review.

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