neuropatik

Neuropatik, or neuropathic, describes conditions caused by damage or disease of the somatosensory nervous system, including neuropathic pain. The term covers both neuropathic processes (nerve disorders) and the pain that results from them. Etymologically, it combines elements meaning nerve and suffering.

Pathophysiology involves injury to peripheral nerves or central somatosensory pathways, leading to abnormal impulse generation and altered pain processing. Mechanisms include peripheral sensitization, ectopic nerve activity, and changes in spinal and supraspinal circuits, which can produce spontaneous pain, paresthesias, allodynia, and hyperalgesia.

Clinical features include burning, shooting, or electric-shock-like pain, often with tingling or numbness in the affected region. Allodynia (pain from normally non-painful stimuli) and heightened sensitivity to touch are common. Common etiologies are diabetes mellitus (diabetic neuropathy), postherpetic neuralgia after shingles, nerve injury or entrapment, chemotherapy-induced peripheral neuropathy, alcohol-related neuropathy, vitamin deficiencies, HIV, and autoimmune diseases.

Diagnosis is clinical, based on history and examination. Screening tools such as DN4 or painDETECT can aid assessment. Supportive tests include nerve conduction studies or quantitative sensory testing; imaging may be used to identify structural causes. The goal is to distinguish neuropathic from nociceptive pain and centralized pain syndromes.

Treatment is multimodal. First-line pharmacotherapy often includes antidepressants (such as duloxetine or amitriptyline) and anticonvulsants (gabapentin, pregabalin). Topical agents (lidocaine, capsaicin), tramadol, and, in selected cases, cautious opioid use may be employed. Nonpharmacologic approaches include physical therapy, exercise, cognitive behavioral therapy, and TENS. Interventional options, such as nerve blocks or spinal cord stimulation, may be considered for refractory cases. Prognosis varies; many cases persist and require long-term management.