FYI: Article---> Neuropathic Pain

Discussion in 'Fibromyalgia Main Forum' started by MemoryLane, May 20, 2003.

  1. MemoryLane

    MemoryLane Member

    Patient Notes

    From the website postgradmed:

    VOL 106 / NO 6 / NOVEMBER 1999 / POSTGRADUATE MEDICINE


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    People usually think of pain as having some physical cause. Get rid of the cause, and the pain goes away. However, nerves themselves can also generate pain, and this pain often doesn't go away easily. It is called neuropathic pain (from the Greek neuro, meaning nerves, and pathy, meaning abnormality). It can be puzzling and frustrating for people who have it and for doctors who treat it.


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    Neuropathic pain often seems to have no cause. It responds poorly to standard pain treatment and may get worse instead of better over time. For some people, it can lead to serious disability.

    The most dramatic and mysterious example of neuropathic pain is called "phantom limb syndrome." This occurs when an arm or a leg has been removed because of illness or injury, but the brain still gets pain messages from the nerves that originally carried impulses from the missing limb. These nerves now seem to misfire and cause troubling pain.


    What causes pain?

    Most pain is felt when special nerve endings, called nociceptors (no-si-SEP-turs), sense something is wrong. We have millions of nociceptors throughout our bodies--probably about 1,300 per square inch of skin. The nociceptors all have different jobs: Some detect burns, others cuts, infection, chemical changes, pressure, and many other sensations. Nociceptors use nerve impulses to send messages to other nerves, which move the messages on to the spinal cord and brain at lightning speed.

    The brain interprets the messages as pain, sometimes through an "emotional screen" that remembers previous painful or frightening experiences. That might be why so many people have stronger pain at the dentist's office than while playing rough-and-tumble sports. Also, cultural patterns affect how you "feel" pain. For example, people who were taught to "grin and bear it" may dismiss painful sensations more readily than others would.


    Why do some pains last longer than others?

    Pain is usually described as acute or chronic. Acute pain is related to the physical sensations caused by an injury. It can last from a few seconds to many weeks, but it usually goes away when normal healing occurs. Chronic pain lasts beyond the typical healing time. With neuropathic pain, the nerve fibers themselves may be damaged or injured. They then send incorrect signals to other pain centers. The pain you feel is real, but the cause is not easy to discover.

    Chronic pain can result from diseases, such as diabetes and shingles (an infection related to chickenpox), or from trauma, surgery, or amputation. It can also occur without any known injury or disease. The nerves are sending pain messages, even though there is no identifiable cause for such messages.


    How is neuropathic pain diagnosed?

    When you have a pain with no known cause, your doctor will probably ask some specific questions:

    Do you have any accompanying conditions, such as diabetes, shingles, multiple sclerosis, or HIV infection?

    How would you describe your pain? (Neuropathic pain is often described as shooting, stabbing, burning, or searing.)

    Is your pain worse at any time of the day or night? (Neuropathic pain is usually worse at night.)
    Does the pain seem to follow a certain physical path or specific sequence?

    Does the pain come from an area that has missing or injured nerves?

    Is the pain triggered by minor irritation, such as rubbing against the sheets at night?

    These questions often help define the type of pain involved. Once your doctor knows what is happening, treatment can begin. Interesting research in the field of pain is offering a wide range of new ideas for treatment, and many people can now be helped. Anticonvulsant and antidepressant drugs and various pain relievers seem to work in some cases. If another condition, such as diabetes, is involved, better management of that disorder may alleviate the neuropathic pain.

    Everyone has pain. We would be in serious trouble if we couldn't feel what is happening in our bodies. But pain that doesn't quit is worrisome. Be sure you see your doctor if you have pain that seems to be coming from nowhere and doesn't go away. Help is available.


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    Common causes of neuropathic pain:

    Alcoholism

    Amputation

    Back, leg, and hip problems (sciatica)

    Cancer chemotherapy

    Diabetes

    Facial nerve problems (trigeminal neuralgia)

    HIV infection or AIDS

    Multiple sclerosis

    Shingles (herpes zoster virus infection)

    Spine surgery

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    This information is not a substitute for medical treatment.
  2. sharie

    sharie New Member

    I actually have an appointment scheduled with a nueropathist in July. I was going to post to see if anyone has ever had experience with this type of dr. or nueropathy's in general.

    Have you or anyone out there been diagnosed with nueropathy's?

    Thanks so much,
    Sharie
  3. MemoryLane

    MemoryLane Member

    That was almost 5 years ago. I had a terrible stabbing pain in my right shoulder that went through to my front chest wall behind my breast. My arm was numb and I could barely lift it. When I had to sit the shear weight of my arm strained my shoulder and would cause the pain to radiate up into my neck and head. It would then continue across my chest to the other side of my neck and head and then down into the left side of my upper body. They ran all kinds of tests, never could find anything and finally called it quits on all the tests and then ignored me.

    The Dx went from Neuropathy to Neuralgia, but no further. I tried to help them with a possibility of Brachial Plexus nerve entrapment, which is like Carpal tunnel. It's common with Gyn & hysterectomy patients, but more common in children. It's usually a symptomatic result for children who are constantly picked up by one arm. No interest there either.

    This was all before I was diagnosed with CFIDS, by a different doctor this last year.

    Lane
  4. sharie

    sharie New Member

    Do you remember what types of testing they did on you?

    I have had numbness and tingling on and off for over a year now. It moves around, sometimes my face, sometimes hands and feet, half of my body etc. My most recent problem is a spot in my ankle. I have been diagnosed with so many different things by now I'm not sure where I stand anymore.

    I'm sorry that you did not have a good experience with this type of dr. Unfortunatly it seems this is how it goes. I am going to keep my fingers crossed that they won't disregard me once they hear of the fm diagnosis.

    Sharie
  5. MemoryLane

    MemoryLane Member

    They did:
    ANA with a Double stranded-double smooth antibody test
    Rheumatoid Factor
    MRI of Head
    MRI of Cervical and Thorasic Spine
    EMG
    Myelogram
    Cat Scan of Cervical Spine
    Culture of spinal fluid

    They did everything EXCEPT my shoulder. My doctor was about to do an X-ray and MRI of my shoulder with more lab testing, when the insurance group said no.
  6. MemoryLane

    MemoryLane Member

    This is from the National Library of Medicine
    Medline Plus website (nlm nih gov)


    Considerations

    Numbness is a complete lack of sensation or lack of response to normally painful. Tingling is an indication of damage or irritation to the nerves. Unlike numbness, tingling suggests that the affected nerve is not completely dead or severed, just injured or experiencing pressure.

    Unless the cause is obvious (for example, when a hand or foot "falls asleep" because of the position it is in), you should discuss any numbness and tingling with your health care provider.


    Common Causes

    Local injury to the nerves under the skin
    Lack of blood supply to the area
    Pressure on the nerves, caused by the following:
    Herniated disk
    Tumor
    Abscesses
    Arthritic bones
    Toxic action on nerves (such as the effects of lead, alcohol, and tobacco)
    Diabetes and other metabolic abnormalities
    Vitamin B12 deficiency
    Hypothyroidism
    Carpal tunnel syndrome
    Drugs
    Chemotherapeutic agents
    Chloroquine
    D-penicillamine
    Isoniazid
    Nitrofurantoin
    Parenteral gold therapy
    Phenytoin
    Long-term radiation
    Transient ischemic attack (TIA)
    Stroke
    Multiple sclerosis (a less common cause of numbness)
    Seizures
    Migraine


    Home Care

    The underlying cause should be treated by your health care provider.

    A numb hand or foot may be more prone to accidental injury. Take care to protect the area from cuts, bumps, bruises, or other injury.


    Call your health care provider if

    Tingling or numbness is not explained by an obvious cause (such as position-related "falling asleep" of a hand or foot).
    Numbness and tingling are accompanied by other symptoms.
    The sensation lasts longer than a few minutes.


    What to expect at your health care provider's office

    Your health care provider will obtain your medical history and will perform a physical examination and an evaluation of your neurologic system.

    Medical history questions documenting numbness and tingling may include the following:

    Location
    Does it affect the main part of the body (trunk)?
    Does it affect the legs or feet?
    Which leg or foot is it on? Both?
    Is it on the inner (medial) thigh or calf?
    Does it affect the arms and hands? Which (right, left, both)?
    Where, specifically is it on the hands or arm (palm, fingers, forearm, etc.)?
    Is it on the thumb, index and middle finger only?
    Does it affect the face?
    Is it around the eye (orbital)?
    Is it around the mouth (perioral)?
    Is it on the cheek?
    Is it on both sides of the face?
    Does it affect the knee?
    Does it feels like the knee is giving way?
    Does it affect many locations and does the location change (multiple and migratory)?
    Do you have numbness over the entire hand or foot (which feels like the presence of a stocking or glove)?
    Is it only in the hand or foot (distal extremities)?
    Quality
    Is it numbness?
    Is it tingling?
    Is it another abnormal sensation?
    Does the affected person ignore everything around them that occurs on the affected side (inattention to environmental stimuli on the affected side)?
    If two areas of skin on the affected side are stimulated at the same time (pinching, poking gently with a pin or with the finger, or similar stimulus) is there a reflexive response (for example, do they pull away, jerk or complain of discomfort)?
    Time pattern
    How long has the numbness lasted?
    When did it develop?
    Aggravating factors
    Is it worse during or after exercise?
    Is it worse after standing?
    What other symptoms are also present?


    Diagnostic tests that may be performed include the following:

    Blood tests (such as CBC or blood differential)
    Imaging studies
    CT scan of the head
    CT scan of the spine
    MRI of the head
    MRI of the spine
    Electromyography
    Myelography
    X-ray affected area
    Lumbar puncture
    Ultrasound of neck vessels
  7. sharie

    sharie New Member

    for all of the info. I am going to check out that site and see if I can come up with anything else.

    Last year they thought I was having tia's and put me on blood thinners but the tingling and numb still continued. then they said it was migraine related. The spot in my ankle is totally numb now. It was tingly but not anymore.

    Who knows, at first everything was supposedly lupus related, now with the fm, it seems that's all they say it is now. I just wish someone would pick something and stick to it already.

    I'll let you know what the results are.
    Sharie