Neuropathic pain. What is it in adults, children, causes in the legs, back, abdomen, symptoms, treatment, drugs

Each person may have a situation related to neuropathic pain. This is caused by a fall, shock or overvoltage. In this way, the body signals danger, forcing the person to repair the damage by starting treatment. If the causes of the pain are not clear or difficult to find out, you should undergo an examination.

What is neuropathic pain?

Neuropathic pain is a painful sensation that occurs as a result of problems in the nervous system.

Their symptoms are:

• burning sensation in the affected area;
• tingling sensation;
• sharp lumbago;
• numbness.

These signs can be felt more strongly during rest and subside with exercise, or vice versa. There is often an increase in neuropathic pain at night.

The problem can only be identified after a full examination. Having studied them, the neurosurgeon will see that the structure of the nerve is disturbed, therefore it is not functioning properly.

This pathological condition is manifested by a malfunction of the signals supplied by the nervous system. As a result, there is a slight pain at first, which gradually intensifies. There is a progression of damage to peripheral nerves - a consequence of pinching or malnutrition of the nerve fiber. It, in turn, sends the wrong signals to the brain.

As a result, the person begins to hurt in the wrong place where there is damage, such as injury or burn. Experts observe this condition in pathologies of the nervous and endocrine systems, as well as injuries.

Diagnosis and treatment of neuropathic pain is carried out in 3 stages:

1. Description of pain by the patient and its examination by a doctor.
2. Localization of pain
3. Revealing the nature of pain and prescribing a course of treatment.

Etiology

Neuropathic pains are symptoms that appear under the influence of internal factors. There are also the causes of the painful condition. Among the huge number of diseases and infections, doctors have identified a specific list that most often become the causes of this condition.

Among them:

Disease	Description
Diabetes	Elevated blood sugar provokes nerve damage. There is an unpleasant tingling sensation and burning sensation in the feet. The pain is worse if you wear tight shoes. Also, the discomfort becomes more acute during sleep.
Herpes	Particularly strong pain symptoms with the shingles variant of the disease. In addition to discomfort, the patient feels an increased sensitivity of the skin and sleep disturbance. It usually occurs in older people and lasts about 3 months.
Spinal cord injuries	If the nerves are damaged or ruptured, the pain becomes unbearable. Moreover, specific tingling sensations are felt in all parts of the body.
Stroke	The difficulty is that neuropathic pain after such a disease does not appear immediately, but after several years. As a result of nerve damage, the patient's legs and arms are constantly freezing.
All types of surgical operations	Even when the suture is almost healed, the patient feels a slight tingling sensation and numbness at the incision site.
Dorsal injuries	The pain manifests itself in the form of unexpected lumbago in the lower back and feet.
Elbow joint affection	These pains are considered professional and occur most often in people who have to keep their elbows on weight for a long time.

They also include radiation damage and HIV diagnosis.

Varieties of neuropathic pain

There is an acute and chronic form of neuropathic pain.

Also in medical practice, the following types of pathology are distinguished:

• constant painlocalized in the area of ​​the upper and lower extremities. The unpleasant sensations intensify during rest. Before going to bed, you have to take potent drugs to relieve the condition;
• short-term seizures. The duration of the pain is several seconds, the localization zone is the area of ​​the feet, fingers and lower leg;
• pressing pain, the most difficult to treat. It captures the feet and legs, makes the patient's condition unbearable. You cannot completely get rid of such pain. Strong pain relievers stabilize the patient's condition only for a couple of hours;
• high sensitivity to touch. Even gentle contact with the skin can cause discomfort. The patient has to constantly wear gloves and socks and try not to make sudden movements in a dream.

Symptoms

The main symptoms of neuropathic pain are considered to be burning and numbness, as well as tingling and pain. The method of treating the disease depends on the reasons that caused it.

In adults

Patients have the following pain symptoms:

• decreased muscle strength. If you ignore this, the muscles will become flabby. Physiotherapy exercises will help to restore strength;
• numbness and goosebumps. Often there is a feeling of coldness in the limbs and a sensation of insects crawling over the body;
• periodic manifestation of pain in the body. Each time the repetitive pain is felt with greater intensity;
• discomfort when touching objects or lack of sensitivity, developing into acute pain.

All this can lead to the appearance of accompanying symptoms, such as:

• severe stress;
• chronic insomnia;
• despondency and apathy;
• unreasonable irritability.

The patient himself cannot always understand the complexity of his condition, believing that it is just fatigue or incorrect body position during rest.

In children

In children, the symptoms of neuropathic pain are difficult to notice immediately. The child does not understand the nature of the sensations, but tries to alleviate the condition, remaining in a more comfortable position for himself, even if it does not seem very comfortable from the outside.

In this state, children do not allow touching the diseased area. In addition, they become lethargic, inactive and do not make contact without explaining their condition. In some cases, the child shows aggression, trying to distract himself from severe pain.

Stages of pain

With damage to the nervous system, pain develops slowly. This phenomenon is called tunnel syndrome, when nerves in a narrow place are squeezed by tendons, muscles, organs.

On the neck, leg or arm, this often occurs when a person is in an uncomfortable position for a long time, and also uses too tight shoes and clothes. This disease is considered a problem for office workers and programmers.

Sometimes nerve irritation is provoked by a herniated disc, complicated by aseptic inflammation and edema. At first, the nerve is not compressed too much, but this condition gradually develops into severe pain and discomfort when moving.

At the 2nd stage of the disease, the nerve ceases to perform the functions assigned to it. Numbness occurs in the problem area. As a result, the sensitivity of the skin is impaired.

The last third stage is expressed in a complete loss of sensitivity in the affected area. Muscles become weak and practically stop working.

If you do not take any action, complete muscle atrophy occurs.

Having identified a deficiency of nerve functions in a patient, the doctor develops a set of measures aimed at decompression of the nerve (release from pressure). Prolonged refusal of treatment reduces the chances of possible restoration of the nerve properties, even after decompression and if the procedures are carried out in full.

Why does the state of health deteriorate at night?

Neuropathic pain is a difficult sensation to define.

There are several reasons for this:

• this pain is not related to bone or joint problems. The disorder occurs in glial cells;
• the usual pain reliever does not work for such a problem. It is difficult to find a medicine that will temporarily alleviate the patient's condition. As a result, the person loses faith in the effectiveness of the treatment;
• increased pain at night is due to the fact that the human body is stationary. It is the movement that makes it possible to slightly muffle the pain, because the muscles are tense and reduces the activity of painful impulses coming from the brain;
• during rest, electrical impulses are intensified, and the muscles are relaxed, and the pain becomes more intense, while limbs are affected. Sensitivity to pain also increases into the human body, as if a thousand needles are being stuck.

How to alleviate suffering?

Due to the inability to immediately understand the mechanism of neuropathic pain, drug therapy is not always effective. Usually, doctors prescribe a comprehensive treatment to reduce pain, which includes a strong pain reliever. But the drugs do not relieve pain for long.

There are several additional ways to reduce painful symptoms. Before using them, you need to consult with your doctor. After all, each organism is individual and may respond inadequately to such treatment.

Warmly

For many people, warmth can be an effective way to relieve pain. It fills the body with a pleasant sensation and helps relieve neuropathic pain.

There are several ways to use heat to treat this problem. For example, you can purchase a salt or electric heating pad. It is best to choose an electrical appliance that has a temperature regulator, which means you can set a comfortable temperature.

To create the effect of home spa treatments, you need a salt heating pad. It keeps warm for a long time. However, in order to get the desired result, it is necessary to follow the safety rules, because there is a high probability of burns at too high a temperature.

The simplest way of treatment is associated with the use of ordinary water, heated to no higher than 37 ° C. It is enough to hold the limbs in such a bath for several minutes or wrap them with a towel soaked in water. If you add a few drops of aromatic oil, the sensation will be more pleasant.

It is important to know that diabetes mellitus should not be treated with this method. Dry heat can be used, but only under the constant supervision of a specialist.

Cold

The use of cold also gives relief. Despite the fact that this procedure is less comfortable than heat, it is sometimes more effective. For cold applications, ice packs are applied to the numb area. They relieve swelling and have an anti-inflammatory effect. The compress should be kept for no more than 10 minutes, trying to prevent hypothermia of the tissues.

An alternative cold application can be a contrast bath. It is suitable for patients who cannot stand the cold for a long time, but I feel relief from such procedures. Before using cold applications, you must obtain a doctor's approval.

Exercises

Neuropathic pain can sometimes be relieved by special exercises. They must be selected with care so as not to get the opposite result. Specialized strengthening exercises can help restore muscle activity and reduce pain on movement.

Before starting such therapy, you need to consult a physiotherapist. He understands which movements can stimulate muscle work and which ones will harm.

Is it possible to independently determine the neuropathic nature of pain?

Timely treatment of neuropathic pain will help to avoid serious consequences. Such a diagnosis occurs in every 5th person who consults a neurologist.

It is difficult to diagnose the disease, as well as to cure it. You will not be able to do this on your own, so it is better to start the correct therapy right away. Self-medication exacerbates the problem.

Which doctor should I go to? Diagnostics

For complex, persistent pain, you need to contact a neurologist: the sooner this happens, the better the end result will be. The main thing is to control the disease and strictly follow the doctor's recommendations.

There is no clear set of diagnostic measures to diagnose neuropathic pain. To make a correct diagnosis, the doctor interviews and examines the patient. He then assesses the severity of the symptoms and determines the cause of the pain.

At this stage, it is important to know what diseases the patient has, because they can provoke the development of a pathological condition.

By examining painful areas, the doctor should determine how different they are from healthy skin. It is important to find out the degree of change in pain sensations, as well as the reaction to touch and different temperatures. In addition, the motor function of the limbs is being studied. For a more detailed analysis, questionnaires have been developed to simplify the diagnosis.

Additionally, tests are prescribed to clarify the picture of the disease.

Drug treatment

Pain relievers or anti-inflammatory drugs are usually used to treat pain. However, in most cases, they are ineffective in relieving neuropathic pain.

Antidepressants

Neuropathic pain is pain that is most commonly treated with antidepressants. These funds control the intensity of nerve impulses. The most popular of these is amitriptyline.

A tricyclic antidepressant can bring tangible relief in a few days. Its duration of treatment is calculated for 2-3 weeks. Drowsiness and dryness in the mouth can be a side effect of this treatment.

In diabetic neuropathy, the drug duloxetine has proved to be excellent. This antidepressant can also be prescribed for other types of neuropathic pain.

Anticonvulsants

Anti-epileptic drugs are sometimes used to treat neuropathic pain and prevent seizures. These include gabapentin and pregabalin. The dose of this drug is increased gradually.

Opioid analgesics

For severe pain, opioid analgesics are used. They are more powerful than conventional pain relievers. Substances such as codeine and morphine are drug addicts and are therefore prescribed in small doses.

Tramadol is similar in composition to opiates, but works differently, so it can be freely used for this treatment for a short time.

Combination of medicines

When drugs alone do not give the desired result, a combination of antidepressants in conjunction with anti-epileptics can be prescribed. With different effects, they can complement each other well and help relieve pain.

Capsaicin cream

It is used to relieve pain if the usual medications do not help or their use is impossible due to complications. It blocks the nerves that signal pain. You need to use it within 10 days, applying to the sore skin area 3-4 times a day.

The cream can cause a strong burning sensation in the treated area, but this unpleasant phenomenon goes away after several sessions. However, it should not be applied to open wounds.

Other medicines

Your doctor may prescribe other pain medications if your usual treatments don't work. These can be ketamine injections. As an anesthetic, this drug is quite effective.

Lidocaine gel is also used for neuralgia, but it should not be applied to the skin if it is irritated or scarred, otherwise the pain will not go away, and even more irritation will appear on the skin.

Side effects and dose titration of drugs

Most drugs used to treat neuropathic pain are taken in small doses. If they do not give the desired effect, the dosage is increased. In this case, the likelihood of getting side effects increases. Their number and complexity depends on the type of drug and the dose of drugs taken.

A list of possible side effects is in the instructions for use of the drug. In the case when unpleasant symptoms occur after taking, you need to contact your doctor who will correct the treatment. In this case, another drug may be prescribed or the dosage of a proven agent may be reduced.

Non-drug therapy

In the treatment of neuropathic pain, it is important to use an integrated approach, which includes not only drugs, but also non-drug treatments.

This is:

• revitalizing massage;
• acupuncture;
• medicinal baths;
• psychotherapy;
• physiotherapy;
• cold or hot compresses.

The main focus is on the treatment of the underlying disease. Additional therapy can help reduce pain.

In some cases, the possibility of surgical intervention is considered, which allows you to find the problem area and relieve the patient of pain.

The use of neurostimulants can also be a means of restoring the patient's normal functioning. Neuropathic pain is difficult to treat, so it is best to use different therapies to get a positive result.

Features of the treatment of children

Neuropathic pain diagnosed in children is a difficult problem to treat. A child, especially a young child, is not able to explain how and where it hurts, so the doctor must be attentive to complaints, prescribing additional tests, and controlling the situation.

The methods of therapeutic treatment used to treat children have not been worked out and require further development.

Is complete nerve restoration possible?

The nervous system is a complex structure. The balance inside it is easy to upset, and it takes a long time to restore the broken connections. Sometimes it is impossible to achieve full recovery of the function, especially when the squeezing was too long. When no cure is possible, it remains to control the symptoms in order to alleviate the patient's condition.

As a result, patients will have to take medications throughout their lives to maintain the regulation of neurotransmitters in the brain.

The lesions in neuropathic pain grow rapidly and the main thing is to start treatment on time. Only then can we hope for full or partial restoration of the lost functions. Self-medication, a person condemns himself to increased pain and destruction of connections in the brain.

Neuropathic pain is difficult to identify and difficult to treat. Even the most effective therapy does not guarantee a complete cure. Self-medication can cause disability, it will be impossible to restore broken connections. It is especially important to diagnose this disease in children in time. To alleviate the condition, you need to constantly carry out preventive treatment and follow the doctor's recommendations.

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