Neuropathic Pain

Neuropathic pain results from damage to or dysfunction of the peripheral or central nervous system , triggered by trauma, infections and nervous system disorders. It is often characterized  by pain out of proportion to tissue injury.  Pain can develop after injury to any level of the nervous system, peripheral or central; the sympathetic nervous system may be involved. Specific syndromes include postherpetic neuralgia, root avulsions, painful traumatic mononeuropathy, painful polyneuropathy (particularly due to diabetes), central pain syndromes (potentially caused by any lesion at any level of the nervous system), postsurgical pain syndromes, and complex regional pain syndrome.  In 2007, a study cited in the Journal of Pain estimated that 170 to 270 million people around the world suffer from peripheral neuropathy (e.g., phantom limb syndrome and complex regional pain syndrome) and neuropathic pain.

Neuropathic pain has been described as numbing or burning, plus sensations of tingling, electric shock, crawling, itching, or shooting. Mild pain stimuli are perceived as very painful. Pain on one side of the body is also felt on the other side. The area of pain increases to include larger and larger areas of the body. This type of pain is difficult to treat and often requires a combination of pharmacological therapies, psychological counseling and the use of some form of alternative and complementary medicine.

 

Standard medical treatments:

Antidepressants –

SSRI’s including Prozac or Cymbalta,

Tricyclic Antidepressantss – Elavil

Anticonvulsants

Neurontin or Lyrica

Topical medications, such as capsaicin cream and Lidocaine patches

Opioids –

Oxydodone, Morphine, etc.

Other medications, such as muscle relaxants, anti-anxiety medicines and sleep medicines

Physical therapy

TENS unit treatment

Treatment of underlying metabolic problem

 

Supportive and alternative treatments:

Nutritional –

Fish oil – anti-inflammatory

Capsaicin cream 0.01% – increases circulation

Vitamin B complex, especially B6 – nerve nutrient

Magnesium – muscle relaxant, often low in peripheral neuropathy

Alpha lipoic acid – antioxidant used in diabetic neuropathy

Glutathione – strong antioxidant

Homeopathic –

Hypericum – for nerve pain

Herbal –

Oat seed – nerve calming and tonic

Ginko biloba – increases peripheral circulation

St. Johnswort – increases serotonin and nerve tonic

Hydrotherapy – hot epsom salt soaks, herbal warm packs

Analgesic packs – castor oil, hemp oil, Chinese herbal liniment

Acupuncture

Massage therapy

Biofeedback

 

Neuropathic Pain and Cannabis

Cannabis has been known to be effective for nerve pain since the 1800s. Patients often report that they achieve better control of neuropathic pain with cannabis than with many other medications and can often decrease or eliminate their need for Neurontin or Lyrica. It is also helpful used topically, for conditions like shingles or sciatica. The treatment of pain, particularly neuropathic pain, is one of the therapeutic applications of cannabis that is currently under investigation. Several research studies of the efficacy of cannabis in treating neuropathic pain have recently been published. Sativex, a cannabis based medicine has been approved in Great Britain for use in the treatment of neuropathic pain in Multiple Sclerosis. Cannabis is slowly becoming accepted as a useful option in the treatment of neuropathic pain. In addition to cannabis’s analgesic (pain reduction) properties it also can improve depression that often arises from chronic pain. It may improve appetite, help sleep and eliminate the nausea often caused by opiate analgesics.