Getting your head around neuropathic pain

Do you have post-herpetic neuralgia? Diabetic neuropathy? Phantom pain?

Neuropathic pain is weird pain – people describe it as tingling, sharp, electric shocks, numbness, burning, hot, cold, random and intermittent pain. There are three major types of neuropathic pain depending on where the problem lies in the nervous system (this is a very, very simplified description of neuropathic pain mechanisms).

  1. Peripheral neuropathies. This is where a peripheral nerve, that’s a nerve that goes from the body towards the spinal cord, is damaged in some way. This changes the information flow, so that less stimulation produces much more information flow along the nerves than normal. This can create times where normally pleasant input, like someone gently touching the skin, can feel incredibly painful, or where usually painful things like stubbing a toe can create far more pain than you would usually expect. Post-herpetic neuralgia or diabetic neuropathy are good examples of this kind of pain.
  2. Injuries along the spinal cord. This is where the information from the body to the spinal cord might be normal, but when it’s conveyed along the spinal cord, somewhere the information flow is altered. Again, it gets altered so that it takes far less input for the information to flow. Sometimes this can happen because information from the body is not being received and descending pathways from the brain allow more information to go upwards. This could be the case in phantom pain. Sometimes it occurs because there is more branching and sprouting of nerve endings in the spinal cord, so they respond to normal information from the body when ordinarily they wouldn’t.
  3. Injuries in the brain. This can occur when a person has a stroke. A part of the brain can be damaged, and nerves around the area can sprout, or they can allow more information to flow. The nerves from your body to the spinal cord are working normally, and even the information going from your spinal cord up to the brain are functioning well, but a part or parts of the brain are not functioning well, and the information gets scrambled.

Now what I haven’t included in this very simplified description of neuropathic pain is that although I’ve described some of the mechanisms involved, I haven’t included some of the most important ones – your personal experiences, emotions, beliefs, expectations, worries and concerns about the future, and even the social context in which you live (such as the kind of job you do, your family life, your access to treatment, your general health and healthy habits). These ALL influence how your brain interprets the information it gets from your nervous system.

Pain isn’t pain until it emerges as an output of your brain. What this means is that pain is the sum of all your biological systems (including your nerves, hormones, muscles, general fitness and general health), all your psychological factors (including your past experiences, emotions, beliefs and hoped-for future), and all the social factors around you (including whether you have someone to rely on for support, your community’s attitudes towards pain, your access to healthcare, your job demands).

The problem with neuropathic pain is that it’s very difficult to treat. There are some medications that help, some creams, sometimes TENS can help, and in some cases, surgical or injection interventions can help – but for many, many people, neuropathic pain is best managed by YOU.

How can you help yourself?

I guess it’s worth asking yourself what you’d be doing if your pain was less of a problem for you. then becoming your own pain expert. This might mean asking some difficult questions of your health providers. Asking things like “What is my main problem?” (you might want to ask yourself this first – what is the main problem that pain poses for you? Is it sleeping? Sitting? Concentrating? Lifting things?)

“What do I need to do?” – to help yourself. It might be taking medications regularly, exercising at a lower level than you’d like, getting out and about even when you don’t really want to. It might be asking for help although you’d rather be independent.

“Why is it important that I do this?” – because if your health professional can’t tell you why you should do something, then maybe they don’t really know and they’re just doing what they learned during their training. Or maybe they’re grasping at straws. But mostly because, if you understand WHY you need to do something, you can decide if the benefits outweigh any drawbacks.

I’ll post more on what you can do to help yourself next week. If you’re keen, you can subscribe to this blog. I post once a week, and I write both from personal experience, and as a pain clinician, researcher and lecturer. If you want to know the source of any thing I write about, please drop me a line.


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