Neuropathic Pain 

Everyone has experienced irritating, unpleasant, and unwanted sensations, like these:

• an itch

• a scratchy feeling

• a temporary burning feeling

• a temporary numb feeling

• the sensation of a breeze of air on your skin that is unpleasant, rather than pleasant

• tingling

• prickly sensation, like when your hand goes to sleep

• experiencing a pinch or pinching event (example: catching the edge of the skin of your fingertip in a zipper; catching skin between a hard or squeezing object)

• the tingling, crawly-type feeling of air moving the hair on head or skin

• unwanted pressure, like when your sleeping spouse leans a little too hard against part of your body

• a quick burn-sensation when you've touched something hot, or the effects of even a mild sunburn 

• your hands and feet becoming very, very cold on an icy, winter day

• becoming very, very hot when stuck in a glass-mortar office building an hour after the air conditioning system quits and no windows can be opened

Many people have experienced a paper-cut, or bigger kind of cut that burns, pulls, and hurts, and a cut that "hurts" for several days to a week.

Many people have experienced a deeper cut (laceration) when the sensation of burning, pulling, aching and throbbing seems to be "a million times worse" than a minor cut.

Almost everyone has had the unpleasant feeling that comes from bumping a body part so hard that it bruises, and the "ouchiness" of a bad bruise.

This is the everyday life for an estimated 20 to 30 MILLION persons who suffer from a condition called neuropathy (neuro = nerves + pathy=abnormal).   The most commonly known type of neuropathy is when it is associated with diabetes:  Diabetics mostly experience neuropathy in their feet and lower legs.  

But, there are many other causes of neuropathy than only diabetes.  Other causes include:

• uremia

•  AIDs

• nutritional deficiencies

• mechanical pressure such as compression or entrapment

• direct trauma

• penetrating injuries

• contusions (bruises, deep brusises)

• fracture or dislocated bones

• pressure involving the superficial nerves (ulnar, radial, or peroneal) which can result from prolonged use of crutches or staying in one position for too long, or from a tumor

• intraneural hemorrhage

• exposure to cold or radiation 

• rarely, certain medicines or toxic substances

• vascular or collagen disorders such as atherosclerosis, systemic lupus erythematosus, scleroderma, sarcoidosis, rheumatoid arthritis, and polyarteritis nodosa

• Alcohol

• Agent Orange

• Idiopathic - no known cause

• All of the above are "acquired" disorders (e.g. NOT hereditary)

• Inherited disorders - e.g. some genetic disorders

Many neuropathy sufferers may show similar vocal and physical reactions to neuropathic pain, like:

A patient with neuropathy may have rapid changes in mood and personality: depending on the severity of the pain, a patient may quickly go from pleasant or "normal," to irritated, frustrated, or angry.    The abruptness of mood or personality change is VERY OFTEN related to how much or how long the person has tried to ignore or hide the pain that exists at that moment, on that day.  At the point when the patient can no longer ignore or hide the increasing pain, or the constant level of the pain, an abrupt change in mood or personality can occur.

Patients often describe a point at which pain becomes so severe that "they would do anything" to get relief.   Individual patients can sometimes identify a specific activity which PARTLY decreases the pain, OFTEN  involving a RESTING state.  For example, persons with neuropathy in the feet find they MUST remove their shoes and socks and get off their feet; a person with this pain in the upper legs or groin MUST lie down; if pain is in the arms, the person MUST restrict the movement of the arms (pseudo-sling behavior) or lie down.  Persons will try anything to reduce/relieve the pain, including: rubbing the area, not touching the area; avoiding clothes, shoes, and any touch; shaking the area, as to "wake it up"; breathing differently or trying to regulate their breathing; stretching; wiggling; and any lotion, cream or oral medications that seem to reduce the pain.  But, because it is nerve pain, medications are just not very effective or the medicine would need to be taken at such high doses that it could be injurious to the person's body.  

The pain(s) associated with neuropathy does NOT respond well to narcotics.  In fact, patients can take very high doses of narcotics with little improvement of neuropathic pain.  If the patient has other pain conditions, the narcotics CAN be useful for those other conditions though.  But for neuropathy, doctors have been prescribing neuroleptic drugs (neuroleptic means anti-seizure medications).  The most widely used neuroleptic prescribed is Neurontin, which can be taken in relatively high doses.  A second choice is Trileptal, which has less sedation effects than Neurontin.  ALL neuroleptics have side effects and can result in developing seizures if stopped abruptly; they must be tapered in dose if a patient needs to stop one drug or a physician may substitute another neuroleptic drug if one drug needs to be discontinued.  As one can see, these are not medications that should be given or shared with others; these are serious meds!  For information on Neurontin call the manufacturer, Parke-Davis or Pizor , or for Trileptal, call the manufacturer,  Novartis.   Both drugs were formerly known as anti-spasmodics or CNS depressants based on the original intent which for the stoppage or reduction of seizures.

Research is desperately needed to eliminated the suffering of millions of persons who develop neuropathy annually.  The treatment is based on cause; the cause, however, can be difficult to find.  There is debate about how long neuropathy will persist, even if the patient receives the right treatment for the right cause.  In some fortunate cases, neuropathy resolves.  But the longer it takes to find the cause, and the longer neuropathy continues, the more likely that the symptoms will continue throughout the person's life.  Just to think that this pain syndrome cannot be cured is almost too much to contemplate for the majority of neuropathy sufferers!

Read a chart of "Pain Behaviors" that doctors watch for in pain patients.

If you would like to read more about why doctors are afraid to prescribe opioid narcotics, see these web articles:

Who'll Stop The Pain?

Treating Doctors as Drug Dealers: The DEA's War on Prescription Painkillers

Ideas on Liberty

Dr. Hurwitz Convicted on 50 Counts, Faces Life in Prison 

"A Bad Prescription from DEA; The drug agency's misguided campaign against a painkiller" 
by Eric M. Chevlen, published in The Weekly Standard,  June 4, 2001.  Full article online at http://www.cpmission.com/main/misguided.html 

Dr. Chevlen also testified on April 25, 2000 as an expert witness before the Senate Judiciary Committee Concerning "The Pain Relief Promotion Act"  --- see http://commdocs.house.gov/committees/judiciary/hju62489.000/hju62489_0.htm

See also: Assessing Pain in Older Adults (with Dementia)