Neuropathic Pain

What is Neuropathic Pain?

Neuropathic or neurogenic pain differs from other types of pain because it is not caused by physical injury. However, nerves themselves can generate pain and this is a pain which doesn’t disappear very easily, if at all.

The term ‘Neuropathic Pain’ is derived from the Greek neuro, meaning nerves, and pathy, meaning abnormality. Pain like this without apparent cause also includes, itching, electrical shock sensations, prickling, tingling, or ‘pins and needles’ and patches or larger areas of skin with heightened sensitivity. It can be puzzling and frustrating and is usually chronic rather than acute which means that it’s a constant feature, although it may fluctuate in degrees depending on factors such as viral activity in the body, heat, stress or physical over-exertion. These are called Paresthesias.

Other neuropathic pains are Dysesthesias; they include a burning feeling, aching or girdling around the body e.g. The MS Hug.

With demyelination, the last sensation to be lost and the first to recover with healing is a dull, poorly localised burning dysesthesia. It is often described as a pain you’d feel after having just touched a hot stove in which there is a kind of ‘flare’ which has poorly defined boundaries, or again a small patch of bad sunburn. All these are often known to be worse at night thus hindering a good night’s sleep.

What causes Neuropathic Pain?

Most pain is felt when nerve endings, called nociceptors get nerve signals confused due to slowing down of nerve impulses caused by demyelination. We have millions of nociceptors throughout our bodies, probably about 1,300 per square inch of skin. Demyelinated axons may cause neural impulses to leak out and spread to other adjacent demyelinated fibres. If the adjacent fibres belong to the sensory pathway, these misdirected neural impulses give rise to pain.

Treatment and Management of Neuropathic Pain

Neuropathic Pain does not respond to conventional painkillers because drugs such as aspirin or paracetamol follow the wrong neural pathways to achieve this function successfully.

It is widely acknowledged that anti-epileptic medications or anti-depressants are more successful at treating this kind of pain therefore these are prescribed for its relief.

These include anti-epileptics drugs such as:

Carbamazepine (Tegretol®)
Phenytoin or Epanutin ( Dilantin®)
Gabapentin (Neurontin®)
Pregabalin (Lyrica®) this being the newer, most effective drug on the market with fewer unpleasant side-effects.

Also included are tricyclic anti-depressants such as:

Amitriptyline
Dothiepin (Prothiaden®) also known as Dosulepin

Other alternatives include medicinal marijuana or cannabis, which can also be obtained as a Sativex spray.

A drug not licensed for MS but which has been proven to be effective is LDN or Low Dose Naltrexone.

In extreme cases of Neuropathic Pain, a surgeon may carry out a nerve block procedure but this can be highly dangerous and therefore used as a last resort when all else has failed.

Personal Experiences

“I've experienced varying degrees of tingling. I had nine years of constant ‘background’ tingling of my legs, feet and hands. It would get worse if I exerted myself, got hot or had too much alcohol. It then would reach epic proportions, felt like a million ants marching over me in hobnail boots - eeeww! Then I started on 4.5mg of LDN and poof! Within two days I realised that the tingling had gone!!! Now it only resurfaces if I really overdo it, and then it is only very mild and short-lived. Thanks LDN!"

"It feels like my flesh has been burned off in places. When I go to bed the bedclothes make it feel even more sore.”"

“I put on cold gel packs for comfort. Also a cool bath to lower my body temperature one degree can help.”

“I found that none of pain meds. work. I have had the most success with the benzodiazepenes or tranquilisers.”

“I wake up some mornings with so much tingling and buzzing that the only thing I can do is to get up, even if it’s at the crack of dawn, and go sit by my PC to amuse myself as a distraction.”

“I eat cannabis chocolate just prior to my going to bed. I keep a supply of this most delicious confectionary by my bed rather than my little pipe because if my legs do get bad during the night smoking in bed is a no-no.”

© Multiple Sclerosis Resource Centre (MSRC)