HJAR Sep/Oct 2022

58 SEP / OCT 2022 I  HEALTHCARE JOURNAL OF ARKANSAS PAIN MEDICINE COLUMN PAIN MEDICINE RESEARCH shows that based on best esti- mates, the prevalence of neuropathic pain among Americans may be between 6.9- 10%. With chronic pain affecting over 20% of people in the U.S., neuropathic pain is the leading cause of pain. 1 I’m glad to review neuropathic pain be- cause I believe it is a medical topic and di- agnosis that needs to be understood by any medical provider regardless of their spe- cialty. Neuropathic pain frequently pres- ents in the primary care setting and may be unrecognized. 2,3 It is widely accepted as one of the most difficult pain syndromes toman- age, and outcomes often are unsatisfactory. Neuropathic pain is defined as “pain aris- ing as a direct consequence of a lesion or disease affecting the somatosensory sys- tem.” 4 It is a complex entity that requires a multidisciplinary approach to diagnose and treat, and there is evidence of suboptimal drug use in the treatment of neuropathic pain. 5,6,7 Neuropathic pain, or nerve pain, is one of the most intense types of chronic pain, often described as sharp, stinging, or burning. Neuropathic pain can be peripheral or central. The etiologies are many: trauma, ischemia, infection, inflammation, cancer Neuropathic Pain: THE DECEPT I VE SYNDROME One of the most common, and unfortunately poorly understood, diagnoses in chronic painmedicine is neuropathic pain, and it is widespread in the U.S. therapy, compression, etc. Some examples of traumatic causes are phantom limb pain and spinal cord injury. Ischemic examples include post-stroke pain (all of these being central) and diabetic neuropathy (peripheral polyneuropathy being the most common cause with about 30% of the cases of neu- ropathic pain). Infection-caused examples are post-herpetic neuralgia (shingles), HIV (due to the infection itself and/or also due to the antiretroviral therapy), and alcoholism. Chemotherapy in the form of vinca alka- loids (e.g., vinblastine), taxanes (e.g., pacli- taxel), andmonoclonal antibodies can cause neuropathic pain. Other etiologies include radiation therapy, and compression trigemi- nal neuralgia. Multiple sclerosis has lately been very well recognized as a real source of neuropathic pain but without a clear cause. The first step in the diagnostic workup is no different from any other area of medi- cine — a meticulous collection of the medi- cal history, focusing on exploring the onset of pain and the possible association with current diseases, trauma, surgery, etc. All neuropathic pain is perceived within the in- nervation territory of the damaged nerve or pathway due to the somatotopic organiza- tion of the primary somatosensory cortex. Symptoms Some symptoms of neuropathic pain include: • Severe pain, whichmay feel like shoot- ing, throbbing, or burning. • Electrical-like sensations. • Numbness. • A tingling sensation or the feeling of pins and needles. • Reduced use of senses, such as diffi- culty sensing temperatures. • Skin that appears mottled or red. • Itchiness. • Changes in pain associated with the weather. Neuropathic pain can also cause patients to be overly sensitive to touch. For example, people may find that the slightest pressure or friction from clothing or a gentle touch can aggravate nerves and cause pain. This is referred to as allodynia. Neuropathic pain can be present all the time or come in spurts. Likewise, neuro- pathic pain can range in intensity frombeing mild and nagging to severe and disabling. Treatment The goal is to treat the underlying disease. For example, radiation or surgery is used to