Neuropathic pain differs from other typesof pains and in order to start talking about neuropathic pain, it’s important to rememberwhat pain actually is. So, nociceptive pain or pain that we sense usually is nerves transmittingan impulse and letting us know that there is a damage or injury to part of our body.Neuropathic pain is an actual pathology of the nerve itself. Nerve consists of its body,which is the axon, which is the part that usually gets injured and when that axon isinjured what happens is abnormal transmission of impulses. It’s important to remember thatit’s not nerves communicating an injury elsewhere, but the process in the nerves themselves.Neuropathic pain itself presents differently
from other types of pain. So, neuropathicpain is likely to be severe. It is usually sharp. It is electric shocklike sensationthat people usually describe. It is lightning or lancinating type of pain that most peopletalk about when they describe neuropathic type of pain. Accompanying that, it can bea deep burning or, at the same time, it can also present as coldness in the limbs or distributionof that nerve. It also comes, at times, with persistent numbness, tingling, or weaknessof the muscles that nerve supplies. Neuropathic pain usually travels along thepath of the nerve itself. Because the nerves have different function some nerves aremotor nerves, some nerves are sensory nerves
if the sensory part of the nerve is affected,it can alter sensation. Now, it can actually decrease sensation in other words, createnumbness or it can heighten sensation where normal stimuli are now painful or altered so something that would usually be a normal muscle sensation, such as light touch, canbecome a painful sensation. There are many causes for neuropathy or neuropathicpain affecting the nerves. Some of those are compression of the nerve. Now, compressionof the nerve can occur anywhere along the path of the nerve. It can be as it exits thespine and travels onward, as in radiculopathy or in other words, pain arising from compressionof the spinal nerve before it exits the spinal
column or it can be peripheral nerve compression.And many of us know what it feels like when we cross our legs and the leg goes numb thatis compression of the peripheral nerve and usually that recovers by itself, but if thatcompression remains for a longer period of time, then that can become not necessarilypermanent, but the recovery from that can take months and sometimes even a whole year.Other sources of the neuropathy can be systemic processes, such as diabetes. Diabetes is amicrovascular process decreasing the supply of nutrients to tissues as well as nervesand that tends to be what’s called a quot;lengthdependant process,quot; in other words, nerves that arelonger tend to be affected first and that’s
why people with diabetic neuropathy tend tofeel their feet being affected first because the nerves are that much longer, so thosenerves tend to be affected first, then the hands follow that because they are the nextlongest nerves in the body. That being said, any process that can damagetissue can also damage nerve tissue. So, what I mean is treatments like chemotherapy thereare different chemotherapy agents that can alter different processes that the nervesdepend on and some are actually neurotoxic in other words, they are damaging the nervesdirectly. Now, chemotherapy affecting the nerves can appear at the time of the treatment,but it can also be a delayed presentation
of that neuropathy. Also, radiation; a processthat radiation causes, in the long run, can come up as postradiation fibrosis. In otherwords, tissues fibrose and contract and can affect the nerves and that can cause neuropathyas well.
Neuropathic Pain After a Spinal Cord Injury
There’s a common type of pain that we calldysesthetic sensation, or you may hear a term neuropathic pain or nerve pain, which, peoplehave compared to, like, phantom sensations in people who have lost their limbs becauseof amputations. While the reasons for them may be different, the underlying mechanismsfor it may in fact have some similarities. There is some belief that the reason for thoseunusual sensations may be because of signals that are generated up in the brain. Now normallythere are unconscious signals, sort of what we can call feedback signals, that go backand forth between different parts of our body and the brain. And there is a belief, a theory,that after a spinal cord injury, because those
signals from that part of the body back tothe brain are now blocked, and after a period of time the brain starts to create signalsof its own to make up for the lack of signals that are coming from the body. The reasonwith think that may be taking place is that many of the medications that are used to helpmanage this neuropathic pain we know work essentially up in the brain, not out in theperiphery or out in the area of the body where the person can’t normally feel. So becauseof that, there’s a belief that these signals are generated in the brain, and why thesemedications are effective in helping minimize these painful sensations.
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