"Each physician bears the responsibility to evaluate and treat persistent pain as serious medical condition. Principal  treatment physician must approach each patient with respect and urgency and provide appropriate and timely referrals to a Pain Medicine specialist .."

  Topic of the month 

     " Neuropathy, Neuralgia pain"

There are four types of periferal neuropaty:polyneuropathy, mononeuropathy, mononeuritis multiplex and autonomic neuropathy.

The most common form is symetrical periferal polyneuropathy, which mainly affects feet and legs.

 A radiculopathy involves spinal nerve roots, but if periferal nerves are also involved the term radiculoneuropathy is used.

Neuropathy is often associated with weakness, authonomic changes and sensory changes.

Los of muscle bulk or fasciculations, a particular fine twitching of muscle can be seen.

Sensory symptoms encompass loss of sensation and "positive" phenomena including pain

Neuropathic pain also called Neuralgia.

Neuropathic pain may result from disorder of the periferal nervous system or the cental nervous system (brain and spinal cord).Thas , neuropathic pain may be devided into central, peripheral and mixed neuropathic pain.Central neuropatic pain is found in the spinal cord injury, multiple sclerosis, and some strokes.

Fibromyalgia, adisorder of chronic widespread pain, is potentially a central pain disorderand is responsive to medications effective in neuropatic pain.Aside of the Diabetes and other metabolic conditions, the common cause of painfull periferal neuropaties is herpes zostr infection, HIV - related neuropaties, nutritional deficiencies, toxins, remote manifestations of the malignancies, genetic and immune mediated disorders. Neuropathic pain is common in cancers as a direct result of cancer on perferal nerves ( compression by the tumor) as thr side effect of some chemotherapy  drugs and a sa resultof the radiation injury,injury.

  Symptoms

Neuropatic pain may result in numbness, abnormal sensation   called dysthesias and allodynias that occur either spontaneously or in reaction to external stimuli, and a charcteristic form of pain, called neuropathic pain or neuralgia, that is qualitatively different from the ordinary nocioceptive pain one might experience from stubbing a toe. 

Topic of the month- cont.

" Neuropathy , Neuralgia pain"(cont.)

    Neuropathic pain may have continous or/and paroxysmal (episodic)components.

Common qualities of the pain include burning or coldness , "pins and needles"sensations, numbnessand itching.Ordinary pain results from exclusive stimulation of pain fibers, while neuropathic pain often results from the firing of both pain and non-pain (touch,warm,cool) sensory nerve fibers serving the same area. The result is signals that the spinal cord and brain do not normaly receive.

Treatments

Neuropathic pain is very difficult to treat with only 40-60% of patients atchieving partial relief.

For pharmacological therapy favored treatments are using certain antidepressants e.g. tricyclic antidepressants (Elavil) and selective serotonin- norepinephrine re-up take inhibitors (SNRI's), anticonvulasants, especially Lyrica,Neurontin and topical lidocaine.Opioids analgesics and tramadol are useful agents but not recommended as the first and only therapy.Between oipoids, especially methadone  is more effective as its NMDA antagonistic action has been found most effective in treatment of neuralgia type of pain.

Topical agents like local anesthetics have been found useful in neurpopathic pain, especially like in a  post herpetic neuralgias,lidocain patches, repeated topical applications of capsaicin reduce skin sensitivities can provide relief.. Diabethic neuralgia often has been found  benefit from a diatery supplemental tratment in addition to pharmacutical.ALA lipoic acid and benfotiamine, resercheraddition to the regiment therapy. Other modality of therapy, used as adjunctive to the main streem tx provide additional better outcome in pain relief are : massage, cognitive psychotherapy , meditations , accupuncture and prescribed excersises. TENS should be always considered as a valuble adjunct to a treatment of neuropatic pain.