When a person has neuropathic pain, the nerve fibers are often damaged or injured and become dysfunctional. As a result, incorrect signals are sent by those damaged nerve fibers.
Phantom Limb Syndrome is one example of neuropathic pain which is when a person has lost a limb (an arm or a leg) but their brain is still receiving signals for that limb. This is considered a misfire by the nerves and pain is the result.
The first line of pain management for anyone experiencing neuropathic pain is to be prescribed medications. The process of finding a medication or group of medication can be a trial and error period. That period can become frustrating for the patient and their doctor. And once a medication therapy is in place, there are often side effects that can become problematic.
Neuropathic Pain Medications
There are 3 types of medications that are commonly prescribed to a patient for their nerve pain. Those medications are:
• Anticonvulsants: These are also known as neuroleptic medications and can include carbamazepine, clonazepam, felbamate, phenytoin, and valproic acid. There is also a newer drug on the market, gabapentin which is not only effective but better tolerated.
• Antidepressants: The tricyclic antidepressants like Amitriptyline and Nortriptyline are frequently prescribed.
The newer selective serotonin reuptake inhibitors antidepressant medications aren’t considered to be as effective. A combination of anticonvulsants and antidepressants with local anesthetics are prescribed by pain doctors.
• Local Anesthetics: IV application of lidocaine, mexiletine or tocainide can often provide a patient relief.
In addition to these, topical capsaicin can be applied that will provide the patient pain relief. These usually require multiple applications for a few weeks before it becomes effective. For the most part, studies have found that opioid like morphine and NSAIDs like ibuprofen are not effective for alleviating neuropathic pain.
But each patient is different with a different level of tolerance, and as such, different forms of neuropathic pain medications will have different results and different values.
Neuropathic Pain Diagnosis
The doctor will interview a patient and perform a physical exam in order to start the diagnosis of neuropathic pain. The patient will need to answer the questions as completely and honest as possible in describing their pain, when they have the pain and if there is any specific thing that seems to trigger their pain. Blood work and nerve tests will be ordered as well.
There have been studies on the pain of neuropathicy that suggest using non-steroidal anti-inflammatory drugs will ease the pain. Then there are some patients that those types of medications aren’t strong enough and a stronger painkiller is required such as morphine.
Diabetic patients will have neuropathic pain as well. By managing their diabetes better, the pain is eased and helps stop any further damage. A pain specialist may choose to use an implant device to help some patients manage their pain. Some choose to sue electrical stimulation as well as any of the following:
• Massage Therapy
• Physical Therapy
• Relaxation Therapy
Standard pain management treatments aren’t as effective for neuropathic pain. Unfortunately, the pain will actually begin to worsen if standard treatment is used and a patient can end up disabled. Experts have found that by using a multidisciplinary approach is often the most effective way to providing a patient relief from the pain caused by neuropathicy.