Neuropathic

Neuropathic is an adjective related to neuropathy, a disorder of the nerves. In medical usage, neuropathic pain describes pain caused by a lesion or disease of the somatosensory nervous system, including damage to peripheral nerves, nerve roots, or central pathways. It is often contrasted with nociceptive pain, which arises from tissue injury but not from nervous system damage.

Causes and types: Neuropathic pain can follow peripheral nerve injury, diabetes, herpes zoster, autoimmune diseases, alcohol or nutritional deficiencies, chemotherapy or radiotherapy, stroke, or multiple sclerosis. It is peripheral if the peripheral nervous system is involved and central if the central nervous system is affected.

Clinical features: Common symptoms include burning, shooting, electric shock-like sensations, tingling, numbness, and heightened responses to touch (allodynia) or normally painful stimuli (hyperalgesia). Symptoms often follow a dermatomal distribution and may be accompanied by autonomic changes in some conditions.

Diagnosis and assessment: Diagnosis relies on history and examination, supported by tests such as nerve conduction studies and electromyography, quantitative sensory testing, and imaging as needed. Screening tools like the DN4 questionnaire or PainDETECT aid differentiation from nociceptive pain. Diagnosis may require ruling out non-neuropathic causes and identifying an underlying condition.

Treatment and management: Management is usually multimodal and tailored to the individual. First-line pharmacologic therapies commonly include anticonvulsants such as gabapentin or pregabalin and antidepressants such as amitriptyline or duloxetine. Topical agents like lidocaine or capsaicin may help in focal areas. Opioids are considered in select cases. Nonpharmacologic approaches include physical therapy, psychological therapies, neuromodulation, nerve blocks, and addressing the underlying disease.

Prognosis and research: Neuropathic pain can be chronic and difficult to treat. Ongoing research investigates mechanisms of nerve injury and central sensitization and aims to develop more effective, targeted therapies.