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Nerve Pain https://instituteforchronicpain.org Sun, 29 Jan 2023 15:25:00 +0000 Joomla! - Open Source Content Management en-gb Peripheral Neuropathy https://instituteforchronicpain.org/common-conditions/neuropathy/peripheral https://instituteforchronicpain.org/common-conditions/neuropathy/peripheral

What is peripheral neuropathy?

Neuropathy is damage to nerves that causes pain, numbness and/or tingling. While technically many conditions are a form of neuropathy, most people tend to think of peripheral neuropathy when using the term neuropathy.

Peripheral neuropathy is nerve damage in the peripheral nerves. Peripheral nerves are any nerve in the body, which is not part of the brain or spinal cord. While peripheral neuropathy can start in any nerve of the body outside the brain and spinal cord, it usually starts in the nerves of the hands or feet. Symptoms usually begin as numbness or tingling. Over time, these symptoms can progress to pain. Patients most often describe the pain as a burning type of pain.

The most common cause of peripheral neuropathy in the hands or feet is diabetes. It is then commonly referred to as ‘diabetic neuropathy.’ Other causes can be kidney disease, HIV, or alcohol dependence. It can also occur for unknown reasons. In the latter case, it is called ‘idiopathic peripheral neuropathy.’

Is there a cure for peripheral neuropathy?

When the cause of neuropathy is diabetes, therapy involves aggressive treatment of diabetes. In such cases, treatment consists of medications to control blood sugars, dietary changes, exercise, and, most importantly, weight loss. Conventional wisdom is that if the diabetes is controlled early, the neuropathy can be reversed. However, diabetic neuropathy is often permanent.

When the cause of peripheral neuropathy is some other condition, like kidney disease, HIV or alcoholism, these primary diseases must also be managed.

In any of these cases, the pain of peripheral neuropathy is also a focus of care.

Therapies & procedures for neuropathy

Common symptom management therapies include antidepressant medications, anticonvulsant medications, opioid medications, mild aerobic exercise, cognitive behavioral therapy, and chronic pain rehabilitation programs.

Antidepressant medications

Because some antidepressants are heavily advertised for use in diabetic neuropathy, patients are commonly familiar with them. When considering their use, it is important to understand the types of antidepressants and their relative effectiveness.

Roughly, there are three types of antidepressant medications. Serotonin norepinephrine reuptake inhibitors (SNRI’s) are the newest type of antidepressant medications. SNRI’s are typically the ones that are advertised for use in either diabetic neuropathy or depression. Selective serotonin reuptake inhibitors (SSRI’s) are the second type and are a little older. They were originally developed for use in depression. They are now sometimes also used for diabetic neuropathy. Tricyclic antidepressants are the third type. They are the oldest type of antidepressants. They too were originally developed for use in depression. However, they also have a long history of use for diabetic neuropathy and chronic pain in general.

Surprisingly, the newest type of antidepressant medications, the SNRI’s, are not the most effective.1 The most effective type of antidepressant are the tricyclics. These are the oldest type. They are very likely to reduce pain by at least 50%.

The SSRI’s, the second oldest type of antidepressants, are somewhat likely to reduce pain by at least 50%.

The SNRI’s, the newest type of antidepressants – and the ones that are heavily advertised on television and in magazines -- are the least likely to reduce pain by at least 50%.

Anticonvulsant medications

Anticonvulsant medications are medications that were originally developed for the management of seizures. However, they have also been shown to be helpful in managing neuropathic pain.

Tricyclic antidepressants and anticonvulsants are largely equally effective in reducing pain.2, 3 

Opioid medications

Opioid, or narcotic, pain medications are commonly used in clinical practice. However, there are few research studies that support their use for peripheral neuropathy.

Gimbel, et al.,4 showed that the use of opioid medications was statistically better than placebo, but the actual clinical difference was minimal. Those who were treated with an opioid rated their pain on average at a 4 out of 10 whereas those who were treated with a placebo rated their pain at a 5 out of 10.

In a much smaller trial, Watson, et al.,5 also found a minimally better response.

Mild aerobic exercise

Mild aerobic exercise, such as walking, bicycling, or pool exercises, is an important part of self-managing peripheral neuropathy. Balducci, et al.,6 showed that mild aerobic exercise is able to reduce the likelihood of developing peripheral neuropathy due to diabetes.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a standard and effective treatment for chronic pain syndromes in general.7 While there are no controlled trials of CBT for peripheral neuropathy, it is commonly pursued on the assumption that it is effective, based on its demonstrated effectiveness for other pain conditions.

Chronic pain rehabilitation programs

Chronic pain rehabilitation programs are interdisciplinary programs designed to help patients learn to self-manage chronic pain. Their goals are to reduce pain, reduce secondary stressors associated with living with chronic pain, reduce the use of narcotic medications, and return to work or some other meaningful regular activity. They are effective in achieving these goals, and there is high quality research evidence demonstrating their effectiveness.8 However, there are no clinical trials assessing the effectiveness of chronic pain rehabilitation programs solely for peripheral neuropathy. One observational study of a limited version of a chronic pain rehabilitation program showed promise.9 

References

1. Wong, M., Chung, J. W., & Wong, T. K. (2007). Effects of treatments for symptoms of painful diabetic neuropathy: A systematic review. British Medical Journal, 335, 87. doi: 10.1136/bmj.39213.565972.AE

2. Chou, R., Carson, S., & Chan, B. K. (2009). Gabapentin versus tricyclic antidepressants for diabetic neuropathy and post-herpetic neuralgia: Discrepancies between direct and indirect meta-analyses of randomized controlled trials. Journal of General Internal Medicine, 24, 178-188.

3. Collins, S. L., Moore, R. A., McQuay, H. J., & Wiffen, P. (2000). Antidepressants and anticonvulsants for diabetic neuropathy and post-herpetic neuralgia: A quantitative systematic review. Journal of Pain and Symptom Management, 20, 449-458.

4. Gimbel, J. S., Richards, P., & Portenoy, R. K. (2003). Controlled-release oxycodone for pain in diabetic neuropathy: A randomized controlled trial. Neurology, 60, 927-934.

5. Watson, C. P., Moulin, D., Watt-Watson, J., Gordon, A., & Eisenhoffer, J. (2003). Controlled-release oxycodone relieves neuropathic pain: A randomized controlled trial in painful diabetic neuropathy. Pain, 105, 71-78.

6. Balducci, S., Iacobellis, G., Parisi, L., Di Biase, N., Calandriello, E., Leonetti, F., & Fallucca, F. (2006). Exercise training can modify the natural history of diabetic peripheral neuropathy. Journal of Diabetes and its Complications, 20, 216-223.

7. Morley, S., Eccleston, C., & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy and behavior therapy for chronic pain, excluding headache. Pain, 80, 1-13.

8. Gatchel, R., J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic non-malignant pain. Journal of Pain, 7, 779-793.

9. Norrbrink Budh, C., Kowalski, J., & Lundeberg, T. (2006). A comprehensive pain management programme combining educational, cognitive and behavioural interventions for neuropathic pain following spainl cord injury. Journal of Rehabilitation Medicine, 38(3), 172-180.

Date of publication: April 27, 2012

Date of last modification: May 27, 2017

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joemcallister4@gmail.com (Murray J. McAllister, PsyD) Neuropathy Fri, 27 Apr 2012 13:40:27 +0000
Diabetic Neuropathy https://instituteforchronicpain.org/common-conditions/neuropathy/diabetic https://instituteforchronicpain.org/common-conditions/neuropathy/diabetic

What is diabetic neuropathy?

Neuropathy is damage to nerves that causes pain, numbness and/or tingling. Patients most often describe the pain as a burning type of pain or as if they are persistently walking on a pebble or other sharp item. The most common cause of peripheral neuropathy in the hands or feet is diabetes. 

Diabetes is a disorder of excessively high blood sugar levels in the body. It occurs when the body does not produce enough insulin, which is a hormone that controls blood sugar. Sometimes, the cause is due to the body not responding well enough to the insulin that is produced. Either way, when blood sugars remain high for a long enough period of time, changes to the nerve cells occur and leads to neuropathy.

There are two types of diabetes, which can typically lead to neuropathy. The first type is called Type I. It refers to a kind of diabetes that is typically diagnosed in childhood. Its cause is unknown. The second type of diabetes is usually diagnosed in adulthood. Its cause is chiefly related to obesity. It's called Type II.

Is there a cure for diabetic neuropathy?

Therapy for diabetic neuropathy involves aggressive treatment of diabetes. Treatment consists of medications to control blood sugars, dietary changes, exercise, stress management, and weight loss. Conventional wisdom is that if the diabetes is controlled early, the neuropathy can be reversed. However, diabetic neuropathy is often permanent when treatment for the diabetes is unsuccessful.

For the pain of diabetic neuropathy, goals of treatment are to reduce pain and improve functioning (i.e., the ability to do more life activities, like work).

Therapies & procedures for diabetic neuropathy

Common symptom management therapies include antidepressant medications, anticonvulsant medications, opioid medications, mild aerobic exercise, cognitive behavioral therapy, and chronic pain rehabilitation programs.

Antidepressant medications

Because some antidepressants are heavily advertised for use in diabetic neuropathy, patients are commonly familiar with them. When considering their use, it's important to understand the types of antidepressants and their relative effectiveness.

Roughly, there are three types of antidepressant medications. Serotonin norepinephrine reuptake inhibitors (SNRI’s) are the newest type of antidepressant medications. SNRI’s are typically the ones that are advertised for use in diabetic neuropathy. Selective serotonin reuptake inhibitors (SSRI’s) are the second type and are a little older. They were originally developed for use in depression. They are now sometimes also used for diabetic neuropathy. Tricyclic antidepressants are the third type. They are the oldest type of antidepressants. They too were originally developed for use in depression. However, they also have a long history of use for diabetic neuropathy and other chronic pain disorders.

Surprisingly, the newest type of antidepressant medications, the SNRI’s, are not the most effective.1 The most effective type of antidepressant are the tricyclics. These are the oldest type. They are likely to reduce pain by at least 50%.

The SSRI’s, the second oldest type of antidepressants, are somewhat likely to reduce pain by at least 50%.

The SNRI’s, the newest type of antidepressants – and the ones that are advertised on television and in magazines -- are the least likely to reduce pain by at least 50%.

Anticonvulsant medications

Anticonvulsant medications are medications that were originally developed for the management of seizures. However, they have also been shown to be helpful in managing the pain of diabetic neuropathy.

Tricyclic antidepressants and anticonvulsants are largely equally effective in reducing pain.2, 3 

Opioid medications

Opioid, or narcotic, pain medications are commonly used in clinical practice. However, few research studies support their use for diabetic neuropathy.

Gimbel, et al.,4 showed that the use of opioid medications was statistically better than placebo, but the actual clinical difference was minimal. Those who were treated with an opioid rated their pain on average at a 4 out of 10 whereas those who were treated with a placebo rated their pain at a 5 out of 10. In a small study, Watson, et al.,5 also found a minimally better response.

Opioid medication have significant potential for the development of addiction as well as death.

Mild aerobic exercise

Mild aerobic exercise, such as walking, bicycling, or pool exercises, are an important part of self-managing diabetes. It helps with maintaining blood sugar levels, weight loss, and stress management. It is also helpful in managing the pain of diabetic neuropathy. The American Diabetes Association recommends obtaining at least 150 minutes of aerobic exercise each week.Balducci, et al.,7 showed that mild aerobic exercise is able to reduce the likelihood of developing neuropathy due to diabetes.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a standard and effective treatment for chronic pain syndromes in general.8 A small clinical trial showed that it is effective at reducing pain.9

Chronic pain rehabilitation programs

Chronic pain rehabilitation programs are interdisciplinary programs designed to help patients learn to self-manage chronic pain. Their goals are to reduce pain, reduce secondary problems associated with living with chronic pain, reduce the use of narcotic medications, and return to work or some other meaningful regular activity. They are effective in achieving these goals, and there is high quality research evidence demonstrating their effectiveness.10 However, there are no clinical trials assessing the effectiveness of chronic pain rehabilitation programs solely for neuropathy.

References

1. Wong, M., Chung, J. W., & Wong, T. K. (2007). Effects of treatments for symptoms of painful diabetic neuropathy: A systematic review. British Medical Journal, 335, 87. doi: 10.1136/bmj.39213.565972.AE

2. Chou, R., Carson, S., & Chan, B. K. (2009). Gabapentin versus tricyclic antidepressants for diabetic neuropathy and post-herpetic neuralgia: Discrepancies between direct and indirect meta-analyses of randomized controlled trials. Journal of General Internal Medicine, 24, 178-188.

3. Collins, S. L., Moore, R. A., McQuay, H. J., & Wiffen, P. (2000). Antidepressants and anticonvulsants for diabetic neuropathy and post-herpetic neuralgia: A quantitative systematic review. Journal of Pain and Symptom Management, 20, 449-458.

4. Gimbel, J. S., Richards, P., & Portenoy, R. K. (2003). Controlled-release oxycodone for pain in diabetic neuropathy: A randomized controlled trial. Neurology, 60, 927-934.

5. Watson, C. P., Moulin, D., Watt-Watson, J., Gordon, A., & Eisenhoffer, J. (2003). Controlled-release oxycodone relieves neuropathic pain: A randomized controlled trial in painful diabetic neuropathy. Pain, 105, 71-78.

6. Sigal, R. J., Kenny, G. P., Wasserman, D. H., Castaneda-Sceppa, C., & White, R. D. (2006). Physical activity/exercise and type 2 diabetes. Diabetes Care, 29, 1433-1438.

7. Balducci, S., Iacobellis, G., Parisi, L., Di Biase, N., Calandriello, E., Leonetti, F., & Fallucca, F. (2006). Exercise training can modify the natural history of diabetic peripheral neuropathy. Journal of Diabetes and its Complications, 20, 216-223.

8. Morley, S., Eccleston, C., & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy and behavior therapy for chronic pain, excluding headache. Pain, 80, 1-13.

9. Otis, J. D., Sanderson, K., Hardway, C., Pincus, M., Tun, C., & Soumekh, S. (2013). A randomized controlled pilot study of a cognitive-behavioral therapy approach for painful diabetic neuropathy. Journal of Pain, 14(5), 475-482.

10. Gatchel, R., J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic non-malignant pain. Journal of Pain, 7, 779-793.

Date of publication: April 27, 2012

Date of last modification: October 23, 2015

 

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joemcallister4@gmail.com (Murray J. McAllister, PsyD) Neuropathy Fri, 27 Apr 2012 13:40:14 +0000
Neuropathy https://instituteforchronicpain.org/common-conditions/neuropathy https://instituteforchronicpain.org/common-conditions/neuropathy

What is it?

Neuropathy is a condition of the nerves that causes pain, numbness and/or tingling. While, technically, many conditions are a form of neuropathy, most people tend to think of peripheral neuropathy when using the term neuropathy.

Peripheral neuropathy usually starts in the hands or feet as numbness or tingling. Over time, these symptoms can progress to pain. Patients most often describe the pain as a burning type of pain.

The most common cause of peripheral neuropathy is diabetes. It is then commonly referred to as diabetic neuropathy. Other causes can be kidney disease, HIV, or alcohol dependence. It can also occur for unknown reasons. In the latter case, it is called idiopathic peripheral neuropathy.

Is there a cure?

Conventional wisdom is that, if the primary disease that causes the neuropathy is cured or controlled early, the neuropathy can be reversed. So, if the neuropathy is due to diabetes, kidney disease, HIV, or alcohol dependence, rigorous treatment of these conditions is necessary. However, neuropathy is often permanent.

Once it becomes chronic, treatment is focused on managing the symptoms, rather than attempting to cure it.

Therapies & Procedures

Common symptom management therapies include antidepressant medications, anticonvulsant medications, opioid medications, mild aerobic exercise, cognitive behavioral therapy, and chronic pain rehabilitation programs.

Date of publication: April 27, 2012

Date of last modification: October 23, 2015

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joemcallister4@gmail.com (Murray J. McAllister, PsyD) Neuropathy Fri, 27 Apr 2012 13:40:01 +0000
Nerve Pain https://instituteforchronicpain.org/common-conditions/nerve-pain https://instituteforchronicpain.org/common-conditions/nerve-pain

What is nerve pain?

Nerve pain is a catchall phrase that is used to refer to a loosely associated group of pain disorders. It’s somewhat of a curious use of the phrase because, in a sense, all pain is nerve pain. Pain would not occur without nerves and the nervous system. No matter what the cause of pain, messages related to the cause are nerve impulses that travel along a system of nerves in the body, including the spinal cord and brain. So, again, in a sense, all pain is nerve pain. Nonetheless, the phrase ‘nerve pain’ is used to refer to a group of pain disorders that have some loosely associated features.

While not an exhaustive list, pain disorders that tend to get loosely referred to as nerve pain are the following:

There is no single feature that all these conditions have in common. Instead, they all have some features, which are associated with nerve symptoms. These nerve symptoms are the following:

  • Burning or electrical-like pain
  • Numbness and/or tingling
  • Heightened sensitivities to pain or touch

Sometimes, these symptoms are associated with actual nerve damage, such as in post-surgical pain or neuropathy. Sometimes, though, it is associated with excessively reactive and sensitive nerves, such as in fibromyalgia and complex regional pain syndrome.

Is there a cure for nerve pain?

Typically, there are no cures for nerve pain symptoms and the pain disorders associated with them. Healthcare providers and their patients focus on management of the symptoms. Chronic pain management has two broad goals:

  • Reduce symptoms to the extent possible
  • Reduce the emotional distress and functional impairments that are associated with the symptoms

The first goal involves reducing pain and other symptoms. The second goal is two-fold: to reduce the fear, anger, anxiety, depression or sleep problems that tend to go along with living with chronic pain, and reducing the sense of disability that tends to occur with pain. Overall, these goals amount to assisting the patient to live well, work, and be involved in life, despite having some chronic nerve pain symptoms.

The healthcare system has different ways it pursues chronic pain management. Broadly speaking, there are three different types of pain clinics in our healthcare system:

  • Pain clinics that focus on surgical and/or interventional procedures (surgeries, injections, nerve-burning procedures, and the like)
  • Pain clinics that focus on long-term medication management (such as the long-term use of narcotic pain medications)
  • Pain clinics that focus on chronic pain rehabilitation (such as interdisciplinary chronic pain rehabilitation programs)

All three types of clinics treat nerve pain symptoms and the chronic pain disorders associated with them.

Therapies & procedures for nerve pain

Common symptom management therapies include lidocaine patches, antidepressant medications, anticonvulsant medications, opioid medications, cognitive behavioral therapy, epidural steroid injection, nerve burning procedures called radiofrequency neuroablations, implantable spinal cord stimulators, surgeries, and chronic pain rehabilitation programs.

Most, but not all, of these therapies have been shown in research to be effective in reducing pain. It is important to note, however, that ‘effective’ in this context does not mean ‘curative.’ Rather, it means that many of these therapies are helpful in reducing pain, but some degree of pain will typically remain. Also, it is important to note that these therapies, even the ones with demonstrated effectiveness, are not all equally effective. The research shows that some are more effective than others.

Date of publication: April 27, 2012

Date of last modification: October 23, 2015

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joemcallister4@gmail.com (Murray J. McAllister, PsyD) Common Conditions Fri, 27 Apr 2012 13:38:39 +0000