Neuropatía
When the sensory system is affected by disease or injury, the system is unable to transmit pain signals to the brain. This situation will often lead to a lack of sensation or numbness. In some situations, the individual will be experiencing intense pain in the affected areas.
Neuropathic pain will not start suddenly and cannot be resolved fast. It is a chronic condition which is characterized by persistent pain as well as other symptoms.For many patients suffering from neuropathic pain, the intensity of the symptoms experienced will cycle throughout the day.
Albeit neuropathic pain is believed to be associated with problems of the peripheral nervous system, such as neuropathy, caused by spinal stenosis or diabetes. Injury to the spinal cord or brain has also been found to cause chronic neuropathy.
El dolor neuropático puede contrastarse con el dolor nociceptivo, que se experimenta cuando alguien se golpea un dedo del pie al caminar sin zapatos, o cuando se aplasta los dedos con un martillo. Aunque este tipo de dolor es intenso, dura poco y responde bien a los analgésicos comunes y otros medicamentos, a diferencia del dolor neuropático.
Factores de riesgo del dolor neuropático
Any illness, injury or situation that leads to the loss of function of the body’s sensory nervous system is a possible cause of neuropathic pain. With that said, nerve issues resulting from carpal tunnel syndrome, and any other similar condition, is a known trigger for this pain.
There are other conditions which have been found to increase the chances of a patient experiencing neuropathic pain. These conditions include diabetes, cancer, shingles, HIV, multiple sclerosis, stroke, vitamin deficiencies and cancer treatment.
Causas del dolor neuropático
There are many reasons behind the development of neuropathic pain. On a cellular level there are different explanations but one of the main ones is that there is an increase in the release of some neurotransmitters which signal pain and when this is combined with the fact that the nerves cannot regulate the pain signals, it results in the pain sensation experienced in the affected area.
The area which is responsible for the interpretation of pain signals in the spinal cord is disarranged due to the loss of normally functioning cells and the changes in the neurotransmitters. These changes and alterations lead in the perception of pain even when there is no stimulation from the outer part of the region affected.
Lesiones como traumatismos o derrames cerebrales pueden provocar la pérdida de la capacidad de controlar las señales de dolor. Con el tiempo, habrá más daño celular, y esto sólo provocará más dolor. El dolor neuropático se ha asociado a afecciones como la diabetes, algunos tipos de cáncer, infecciones variadas, carencia de vitamina B, consumo crónico de alcohol, enfermedades relacionadas con los nervios, toxinas y algunos tipos de fármacos.
Síntomas del dolor neuropático
Unlike other neurological problems, the identification of neuropathic pain is not an easy task. This is because there are few or no objective signs that can be used to identify the condition. For this reason, examiners use a collection of words that the patient will use when describing the frequency and the intensity of pain they experience.
The most common description of neuropathic pain is dull, sharp, hot, sensitive, cold, itchy, stinging, deep, burning, among others. In addition, some of the patients will experience pain with just a little pressure or light touch on the affected area.
There are different pain scales which are used in determining the intensity and the kind of pain that is experienced by the patients. These scales are not 100% accurate but because of the lack of proper signs and symptoms of neuropathic pain, they are the best options available.
In most cases the pain scales range from 0 (zero) where there is no pain at all to 10 (ten) where the pain is agonizing. Some doctors can use the face pictures depicting different degrees of pain especially when the patient is in no position to describe the intensity of the pain they are experiencing.
Neuropatía Diagnóstico del dolor
The diagnosis of neuropathic pain is based on the assessment of the patient’s medical history. If the physician suspects the damage of underlying nerves, then there might be some tests to evaluate these nerves. The use of electromyogram in nerve conduction study is the most common method used in the evaluation of nerve damage.
Clinical evaluation, which may include the ability to distinguish dull and sharp pain, vibration assessment, the ability to discern temperature and assessment of light touch and pressure, can be used to reveal loss of function.
If neuropathy is suspected, then there might be a search for reversible causes. This includes blood works for thyroid abnormalities and vitamin deficiencies.
An imaging study might be conducted to eliminate the possibility of structural lesion which might be impacting the spinal cord and causing the condition.Depending on the tests and results, there might be different methods of decreasing the neuropathy severity and thus reducing the pain perceived by the patient.
The unfortunate thing is that even with the best methods of controlling the underlying causes; some patients will not experience an improvement in the pain. This is especially experienced by patients that are suffering from diabetic neuropathy.
Tratamiento del dolor neuropático
There are various medications that are used in the attempt of treating neuropathy pain. Most of these medications are used in what is referred to as ‘off label’. This means that the medication was approved for the treatment of other conditions but has been found to help in the management of neuropathic pain.
For the control of neuropathy pain, tricyclic antidepressants such as desipramine, nortriptyline and amitriptyline are prescribed.Some patients have reported getting relief using these drugs. There are other antidepressant types that have also been found to be effective in providing relief.
SSRIs or selective serotonin reuptake inhibitors such as citalopram and paroxetine and other antidepressants such as bupropion and venlafaxine have been found to be beneficial in pain relief for some patients.
"Acabo de empezar a visitar la ubicación de Lombard. Fui enviado allí por mi dentista debido a un dolor del nervio en la mandíbula que mi dentista no tenía experiencia con. Vi el Dr. Xia y entró con un estetoscopio en (me quejé a mi novia que los médicos de hoy en día sólo prescriben medicamentos y ni siquiera donde un estetoscopio). Encontró el problema, me ayudó a aliviarme y me recomendó que fuera a un especialista. Entonces elegí uno y fui al especialista que no me gustó .... sólo me recetó medicamentos. Volví al Dr. Xia para una segunda opinión y me explicó todo completamente para que lo entendiera. Su conocimiento es impecable y realmente escucha lo que tienes que decir. También cree que recetar medicamentos NO es la solución. Quiere solucionar el problema. Mi primera parada será siempre con el Dr. Xia a partir de ahora " . - TONY RODRÍGUEZ
— TONY RODRIGUEZ
Another common treatment used in the management of neuropathic pain is the use of antiseizure medication such as phenytoin, lamotrigine, gabapentin and carbamazepine among others. Severe neuropathy pain cases will not respond to first-line agents and this leads to the use of medications used in the treatment of heart arrhythmias.
These medications have significant side effects which is why they need close monitoring. Some patients can benefit from medication applied on the skin and the results will differ with individuals. The most common forms used in this kind of treatment include capsaicin or lidocaine in patch and gel form
There have been multiple arguments vilifying and promoting the use of narcotics in the treatment of neuropathy pain. The curing of neuropathic pain purely depends on the underlying cause. If the cause of the condition is reversible, then there will be a regeneration of peripheral nerves and this might lead to the disappearance of the pain.
This reduction might take a long time, sometimes a few years. Though neuropathy pain is not dangerous to human life, the chronic pain will affect the quality of life of the patient and this might lead to several conditions such as depression, sleep deprivation, and anxiety and mood disorders.
Es importante que encuentre el mejor programa de tratamiento que aborde la causa subyacente y controle el dolor de la mejor manera posible.En Tratamiento Integrado Del Dolor le ayudaremos a tratar el dolor neuropático y otros tipos de dolor.
