What causes neuropathic pain
Nerve damage has many causes. Among the more common are shingles and the pain that can persist after it, peripheral neuropathy from diabetes or from autoimmune disease, multiple sclerosis, stroke, carpal tunnel syndrome, and direct nerve injury from trauma or surgery. Poor blood supply, vitamin deficiencies and some medicines, including several used in chemotherapy, can also damage nerves.
Nerve pain can be acute or chronic. Where it persists beyond the normal healing period it is also chronic pain, and the two are assessed together.
How neuropathic pain is assessed
Assessment starts with the description. Because the sensations are distinctive, a careful history often does more diagnostic work than any test. A doctor will ask where the pain is, what it feels like, what sets it off, and whether there is numbness or weakness in the same area.
Physical examination looks at muscle strength and coordination, reflexes, and how the affected area responds to touch, temperature and pinprick. Depending on what that suggests, further investigation may include blood tests, nerve conduction studies, CT or MRI imaging, all aimed at finding the underlying cause rather than measuring the pain.
How neuropathic pain is usually managed in Australia
The first step is treating the underlying condition where one can be identified and treated, such as managing blood glucose in diabetic neuropathy or releasing a compressed nerve.
For the pain itself, the medicines used are generally not the ones used for other kinds of pain. Some antidepressant medicines and some epilepsy medicines are used specifically for nerve pain, at doses and for reasons that have nothing to do with their original purpose.
Alongside medicines, management commonly includes physiotherapy, cognitive behavioural therapy, relaxation techniques and pacing, usually in combination rather than one at a time. Surgery is occasionally recommended, though for most people it does not help.
