Neuropathic pain: post-shingles pain, medication/radiation pain

Neuropathy

If you are experiencing a persistent burning, itching or numbness, a sensation of pins and needles, or a phantom pain that seems difficult to classify or localize, you might be experiencing symptoms that fall under the broad umbrella of Neuropathy, or nerve damage. First and foremost, your doctor must identify the underlying cause before he/she can tailor the correct course of treatment. This is crucial because the sooner treatment is initiated, the less likely the nerve damage will become permanent.

What is Neuropathy?

Simply put, Neuropathy means nerve damage. Although it can affect Central Nervous System (CNS), the Peripheral Nervous System (SNS), or both, we most commonly are talking about peripheral Neuropathy, i.e. damage to the nerves of the peripheral nervous system.

Two examples of Neuropathy you might be already familiar with are:
-Carpal tunnel syndrome (CTS)
-Diabetic peripheral polyneuropathy (DPPN)
Numbness, burning, tingling and weakness are all reported with Neuropathic conditions.

Neuropathy can be caused by a variety of things, ranging from physical injury and infection to inherited genetic disorders and systemic disease.

Neuropathy is usually diagnosed by patient history and a standard neurological examination alone. If you believe you are suffering from these symptoms, Unique Pain Medicine can offer individualized treatment options unavailable anywhere else in New York City.

Symptoms

Symptoms of a body area affected by Neuropathy include:

  • Pain
  • Burning
  • Tingling
  • Itching
  • Crawling
  • Pins and needles
  • Weakness, tiredness or heaviness
  • Muscle cramps, tremor or fasciculation (twitching)
  • Numbness – painful or painless

The Pain Caused by Neuropathy

Neuropathic pain can often be difficult for a patient to describe. Some patients have problems pinpointing where the pain is even located. This is because neuropathic pain is perceived differently than nociceptive pain (pain that is sharp, aching or throbbing) and typically consists of strange or abnormal sensations. There are six classifications of pain associated with Neuropathy:

Paresthesias: Abnormal, non-painful sensations typically described as tingling, or pins-and-needles sensation; can be spontaneous or evoked.[5]

Dysesthesias: Unpleasant or even painful tingling; can be spontaneous or evoked.

Hyperpathia: Normally painful stimulus is abnormally painful; an exaggerated painful response.

Allodynia: A painful response to a normally non-painful stimulus (e.g., light touch is perceived as burning pain).

Hyperalgesia: An exaggerated painful response to a normally noxious stimulus.

Spontaneous Pain: Painful sensation with no apparent external stimulation.

So drawing together all this information (including “read more” above), we can fully diagnose any given Neuropathic condition. For example, the above mentioned diabetic peripheral polyneuropathy (DPPN).

This patient would suffer from:
1. Sensory Neuropathy
2. Polyneuropathy
3. Paresthesias

Am I Suffering from Neuropathy?

If any of these neuropathic symptoms seem familiar to you, it is important you schedule an appointment with Unique Pain Medicine. Your doctor will generally be able to diagnose neuropathy with your medical history and a standard neurologic examination alone.

While it is true there is a great deal of overlap between many of the different types of neuropathy, identifying the area of the body you are experiencing pain, in conjunction with the particular signs and symptoms a patient presents with can be very suggestive of not only what type of neuropathy is present, but the underlying pathological process as well.

As part of your neurologic evaluation, your physician will evaluate:

  • Light touch
  • Pinprick
  • Temperature
  • Reflex
  • Balance
  • Muscle Strength
  • Coordination
  • Proprioception (position sense)

In addition to a thorough physical exam, your physician may elect to order some blood work as well as imaging (i.e. x-ray, CT scan, or MRI). In some cases, when patients do not respond as well to treatment, further examination may be necessary.

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