Neuropathic Pain – Causes, Symptoms, and Modern Treatment

Neuropathic pain is a chronic pain resulting from damage or dysfunction of the nervous system. It differs from inflammatory or traumatic pain – it has a burning, searing, piercing character and is often accompanied by paresthesia and allodynia. Effective treatment requires proper diagnostics and therapy focused on the neuropathic mechanism.

• It arises from damage to the nervous system.
• It often accompanies diabetes and shingles.
• A characteristic symptom is allodynia.
• Treatment includes gabapentin and duloxetine, among others.
• Non-pharmacological methods are also helpful.

See also: Hand tremors – neurological, metabolic, and stress-related causes.

What are neuropathic pains?

Neuropathic pains result from damage to the structures of the peripheral or central nervous system.

The mechanism involves excessive excitability of pain neurons and disturbances in impulse conduction. Unlike nociceptive pain, they are not a direct response to tissue damage but to nerve dysfunction.

Characteristic symptoms include:

• Burning or searing pain.
• Paresthesia (tingling, numbness).
• Allodynia – pain triggered by a stimulus that normally does not hurt.
• Hypersensitivity to touch.

What are the most common causes?

The most common cause is diabetes complications, leading to diabetic polyneuropathy.

Chronic hyperglycemia damages nerve fibers, causing symmetrical discomfort in the feet and hands.

Shingles can lead to postherpetic neuralgia – chronic pain that persists despite the resolution of skin changes.

Other causes include:

• Disc disease and compression of nerve roots.
• Neoplasms infiltrating nerve structures.
• Chemotherapy.
• Lyme disease.

How is diagnosis performed?

Diagnosis is based on history and neurological examination.

A helpful tool is the DN4 questionnaire, which allows for the assessment of the likelihood of neuropathic pain.

Additional tests include:

• EMG (electromyography) to assess nerve conduction.
• Laboratory tests for diabetes or deficiencies.
• Imaging diagnostics in case of suspected nerve compression.

How is neuropathic pain treated?

Treatment differs from inflammatory pain therapy – classic painkillers are often ineffective.

The most commonly used medications include:

• Gabapentin.
• Pregabalin.
• Amitriptyline.
• Duloxetine.

Local therapy uses lidocaine (patches) and capsaicin.

Supportive treatments include:

• TENS (transcutaneous electrical nerve stimulation).
• Physical therapy.
• Patient education.

Can neuropathic pain be completely cured?

In some cases (e.g., with early diabetes treatment), it is possible to halt progression.

In postherpetic neuralgia, pain can persist for months or years, but appropriate treatment significantly improves quality of life.

Q&A

Is neuropathic pain stronger than other types of pain?
They are often more persistent and harder to treat.

Does EMG always detect neuropathy?
No, some small nerve fibers may not be detectable in a standard examination.

Do regular painkillers help?
They are usually less effective than medications that act on the nervous system.

When should one consult a specialist?
When the pain is burning, chronic, and does not respond to standard treatment.

Sources:

1. Treede RD et al. Neuropathic pain: redefinition and grading system. Neurology.
2. Finnerup NB et al. Pharmacotherapy for neuropathic pain in adults. Lancet Neurology.
3. NICE Guidelines. Neuropathic pain management.
4. Tesfaye S et al. Diabetic neuropathy. Diabetes Care.
5. Dworkin RH et al. Treatment of postherpetic neuralgia.