Neuropathic Pain: Diagnosis, Treatment, and Therapy of Neuropathic Pain According to the German Pain Society

Neuropathic pain often arises as a direct result of damage to or dysfunction of the nervous system. Neuropathic pain is often described as stabbing, shooting, or burning and can become chronic. Causes include diabetes, polyneuropathy, shingles, chemotherapy, and disorders of the central nervous system. Typical symptoms of neuropathic pain include allodynia, neuralgia, or painful reactions to otherwise harmless stimuli.

Diagnosis is made neurologically through examination procedures, MRI, CT, or imaging techniques to detect neuropathic pain. Medications such as gabapentin, pregabalin, amitriptyline, or lidocaine are used to treat neuropathic pain. In addition, physical therapy, nerve stimulation, or medication-assisted treatments can help alleviate severe pain. Early diagnosis of neuropathic pain is particularly important to prevent nerve damage and chronic pain.

Causes of Nerve Pain

Neuropathic pain results from damage to the peripheral or central nervous system. Many factors can contribute to this condition. 

Common causes include:

• Nerve damage caused by injuries (surgery or a herniated disc)
• Infections caused by shingles 
• Poorly controlled diabetes
• Chemotherapy
• Multiple sclerosis
• Stroke

Nerve cells © ktsdesign / Fotolia

What are the characteristic symptoms of nerve pain?

Neuropathic pain is typically accompanied by impaired skin sensitivity. 

Patients suffering from nerve pain may be hypersensitive to external stimuli such as heat, cold, and pressure, or may experience reduced sensitivity (numbness). This is accompanied by burning pain and sudden, intense shooting pain attacks.

Nerve pain  @ vectorfusionart / Fotolia

Diagnosis of nerve pain

The first step is a consultation with the doctor (medical history). During this consultation, the doctor and patient discuss the patient’s medical history and the onset, nature, and characteristics of the pain.

This is followed by a neurological examination, during which the doctor tests skin sensitivity. The doctor can identify nerve damage using diagnostic procedures such as measuring nerve conduction velocity. 

Imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) are also frequently used to visualize nerve damage.

Treatment of Neuropathic Pain

The treatment of neuropathic pain is usually a lengthy and difficult process. Complete freedom from pain is rarely possible. 

The pain specialist should set realistic treatment goals with the patient from the outset. 

The German Pain Society (DGS) defines these as follows:

• Pain reduction of > 30–50%
• Improved sleep quality
• Improved quality of life
• Maintenance of social activities and relationships
• Maintenance of the ability to work

Pharmacological pain management is at the core of treating neuropathic pain. Finding the right medication requires a patient and doctor to work together through a process of trial and error to identify the optimal combination of drugs.

Neuropathic pain varies from patient to patient, so there is no one-size-fits-all treatment.

Alternative methods for pain reduction can be used as adjuncts, such as:

• Nerve blocks
• Infiltrations
• Electrical nerve stimulation
• Physical therapy
• Occupational therapy and 
• Psychotherapy 

The following video demonstrates one treatment option:

Preventing nerve pain from becoming chronic

Modern pain research assumes that any acute pain can develop into chronic pain. 

That is why appropriate pain management should begin as early as possible and be as intensive as necessary. Encouraging patients to “hang in there” does nothing to help them and puts them under additional pressure. 

Doctors should also help patients overcome their fear of having to take unnecessary medication. 

Only when pain management begins early is it possible to prevent pain from becoming chronic.

FAQ

What is neuropathic pain?

Neuropathic pain arises as a direct result of damage to or disease of the somatosensory nervous system. Neuropathic pain affects peripheral or central areas and differs significantly from nociceptive pain. Typical nerve pain is often described as stabbing, burning, or shooting.

What causes neuropathic pain?

Neuropathic pain is often caused by nerve damage resulting from diabetes, polyneuropathy, chemotherapy, shingles, or spinal cord injuries. Tumors, inflammation, or lesions of the central nervous system can also trigger neuropathic pain. Central neuropathic pain, in particular, occurs following damage to the brain or spinal cord.

How is neuropathic pain diagnosed?

Neuropathic pain is diagnosed neurologically using clinical examination methods, MRI, CT, and specialized diagnostic tests. Typical symptoms such as allodynia or neuralgia are important for confirming neuropathic pain. In addition, imaging techniques help visualize changes in the nervous system or spinal cord.

What medications help with neuropathic pain?

Gabapentin and pregabalin are frequently used to treat neuropathic pain. Amitriptyline, antidepressants, carbamazepine, lidocaine patches, or opioids may also be helpful, depending on the specific pain syndrome. According to the German Pain Society, some of these medications are considered first-line treatments for chronic neuropathic pain.

What treatments are available for neuropathic pain?

Treatment for neuropathic pain includes medication-based approaches, physical therapy, and nerve stimulation. Combined approaches aimed at pain relief and improving quality of life are particularly effective for neuropathic pain. For patients with neuropathic pain following amputation or in the area of the missing body part, specialized treatments for chronic pain are used.