Pain is a feeling of discomfort that is actually a reaction that the human body shows to tissue damage. The feeling of pain is considered vital for the body, so its absence causes irreparable and life-threatening damage to the body during events that occur to the body.
Pain is generally divided into two categories: Nociceptive and Neuropathic :
Nociceptive means pain that occurs in response to stimuli such as cold, heat, shock, etc. In this type of pain, the pain receptor must be stimulated by an environmental factor such as cold, heat, etc. Then this stimulation is transmitted to the brain.
Neuropathic means that following damage to a nerve and nerve receptor (or for any reason a problem arises with that nerve), a stimulus that normally does not have the ability to cause pain stimulates the nerve in such a way that it sends signals to the brain that lead to the feeling of pain, tingling, etc. There are different types of neuropathic pain that are caused by various causes, which are divided into types.
1- Anonymous
2- Hereditary (similar pains occur in members of the same family)
3- Caused by a structural disorder, etc., classifies.
As explained above , nociceptive pain is a useful pain that is caused by a specific stimulus, can be relieved by taking painkillers, and responds well to painkillers. If they are not present, they are incompatible with life. However, neuropathic pain has an abnormal mechanism. There is no specific stimulus for them and they do not respond well to painkillers. Since they are an abnormal process, they are not considered a defense mechanism, so they are not beneficial to the body.
The estimated prevalence of neuropathic pain is about 2-10 % of the normal population. The prevalence of neuropathic pain among diabetics is about 60 % . The most common location for neuropathic pain is in the legs and lower extremities, and in some cases, such as trigeminal neuralgia, pain is felt in the face and neck.
Causes of neuropathic pain: Often there are no specific, real causes for this type of pain, but some known causes include:
1- Damage to the nerve or nerve endings that occurs following surgery.
2- Chemotherapy
3- Pain following amputation
4- Diabetes
5- Herpes virus
6- Some nerve problems such as trigeminal neuralgia
7. HIV infection
8- MS
9- Excessive alcohol consumption
10. Carpal tunnel syndrome
11- Stroke
The most important symptom of neuropathy is pain:
Pain may be a sharp, sudden pain or a deep, dull ache. A person’s pain may begin without any stimulus or be triggered by a stimulus that normally does not cause pain. In addition to pain, there may be tingling and numbness, decreased reflexes, weakness or impaired perception of high and low temperatures, and problems with the limbs that can cause movement disorders. Sometimes neuropathy disrupts sleep at night and causes depression.
Diagnosis of neuropathies :
Often, the doctor will obtain a detailed history from the patient regarding the area of pain, the nature and severity of the pain, how the pain begins and ends, and the triggers that could possibly cause the pain, followed by a thorough physical examination and the necessary paraclinical measures. Some of the risk factors predisposing to neuropathy include:
1- Diabetes is the biggest risk factor for neuropathy. More than 50 % of people with diabetes develop neuropathy during the course of their disease.
2- Vitamin deficiencies such as vitamin B12 deficiency , etc. and other vitamin deficiencies
3- Some hereditary diseases such as Charcot-Marie-Tooth
4- Alcohol abuse leading to vitamin deficiency.
5- Excessive stress and pressure, which often result in circulatory disorders.
6- Some drugs used to treat certain diseases, such as cancer treatment (chemotherapy)
7- Botox injection
8- Nerve damage following accidents or infectious diseases
9- Carpal tunnel syndrome and Guillain-Barré syndrome
10- Chronic renal failure
11- Chronic liver failure
12- Severe thyroid disorders
13- Blood supply disorders that can lead to reduced oxygen delivery to the nerve.
14- Exposure to some harmful chemical agents in the workplace
15. A tumor pressing on a nerve, HIV
16-Amyloidosis, rheumatoid arthritis, lupus, etc.
Treatment:
Neuropathies cannot be treated with just some pain-relieving drugs and usually require a multi-drug and multi-faceted treatment for these people. This makes it very difficult to treat these people, as only 50-60 % of people suffering from a neuropathy experience pain relief after taking a medication program. The multi-faceted treatment for these people includes the following steps:
1- Treat the underlying cause if possible.
2- Medications that reduce pain
3- Physical therapy methods
4- Psychiatric support
5- Finally, if the 4 steps above do not cure and relieve the pain, we should consider surgical methods.
Using OTC medications ( medications that can be obtained without a doctor’s prescription) will not be very effective in treating the pain of these people, and this is one of the aspects that differentiates this pain from nociceptive pain .
The medications used to treat these individuals include a combination of:
1 – NSAIDs: non-steroidal anti-inflammatory drugs such as ibuprofen, diclofenac, piroxicam, etc.
2- Antidepressants such as tricyclics and SNRIS ( selective serotonin-norepinephrine reuptake inhibitors )
3- Antiepileptic and anticonvulsant medications
4 – And finally, opioid painkillers
5- Local treatment with lidocaine (local anesthesia)
6- Intradermal Botox injection
7- Electrical devices that can be implanted under the skin to send electrical impulses to the relevant nerve. Physical therapies for pain relief are considered depending on the nature of the pain and what is causing it.
Some physical therapies include:
1 – Physiotherapy
2- Spinal cord stimulators, which place electrodes on the spinal cord outside the body and on the surface of the skin.
3- Using local anesthesia to block the nerve causing the pain
4 – Nerve stimuli beyond the skin
5- Acupuncture is a surgical treatment method that involves placing electrodes in areas of the brain or spinal cord (without penetrating the meninges) that actually block nerve messages that reach the brain or spinal cord in an inappropriate way and cause pain. In addition to the above treatments, since neuropathies are closely related to stress, depression, and neuropsychiatric problems, psychological and psychiatric treatments play a significant role in their control. Drug treatments, psychological counseling, and participation in psychotherapy and psychological workshops … Meditation, yoga, and massage have also been effective. Supplements such as alpha-lipoic acid have been particularly effective in people with diabetic neuropathy. The vitamin therapy benfotiamine has also been effective in people with diabetic neuropathy.
