neuropathicpain

Neuropathic pain is pain caused by a lesion or disease of the somatosensory nervous system. It is often chronic and can be described as burning, shooting, electric shocks, or tingling, with sensory signs such as allodynia or hyperalgesia in the affected region.

Common causes include diabetic or other metabolic neuropathies, postherpetic neuralgia, traumatic or compressive nerve injury, chemotherapy-induced neuropathy, and central nervous system lesions from stroke or spinal cord injury. Neuropathic pain can occur with various systemic diseases or after nerve damage.

Pathophysiology involves peripheral nerve injury with ectopic nerve activity and abnormal signaling, along with central sensitization in the spinal cord and brain. Changes in ion channel expression, loss of inhibitory control, and inflammatory mediators contribute to persistent pain and altered pain perception.

Diagnosis relies on clinical history and examination. Distinguish neuropathic from nociceptive pain using screening tools such as the DN4 or PainDETECT. Tests like nerve conduction studies or quantitative sensory testing, and evaluation for underlying conditions, help in ambiguous cases. Imaging may exclude other causes.

Treatment is multidisciplinary and individualized. First-line pharmacotherapy commonly includes gabapentinoids, certain antidepressants (tricyclics or SNRIs), and topical agents such as lidocaine patches or capsaicin. Opioids may be considered in select cases. Nonpharmacologic approaches include physical therapy, exercise, psychotherapy, and neuromodulation techniques (such as spinal cord stimulation) for refractory pain.

Prognosis ranges from partial to substantial relief; many patients experience chronic symptoms. Early recognition and comprehensive management can improve function and quality of life. The condition is relatively common and often underdiagnosed.