Neuropathic Pain

Chronic pain impacts the lives of many Canadians every day. Thousands of people wake up every morning to pain, deal with it throughout the day and don't even escape its clutches as they sleep.

Neuropathic pain is one kind of chronic pain that is very common and poses a challenge for doctors. This particular kind of pain is the result of a primary lesion or dysfunction in the nervous system. In total it is estimated that 2-5 % of the population in Canada are affected by this type of pain.

Normally, pain occurs as a natural product of injury to our bodies. We twist our ankle and it hurts for a few days. Or we break a bone and feel the effects while it heals. Generally, as healing progresses, the pain surrounding the injury becomes less severe until it eventually fades entirely.

Unfortunately, many people will experience ongoing pain where there is no obvious injury or will continue to experience pain at the site of an injury long after it has healed. In these cases of neuropathic pain, the nervous system is not performing its proper function of alerting the individual to an injury, but is malfunctioning and sounding an alarm where none is needed. Thus, the nervous system itself becomes the cause of the pain.

Some of the most common reasons for neuropathic pain include pain associated with diabetes - called peripheral diabetic neuropathy, pain that arises after an episode of shingles (post-herpetic neuralgia), phantom limb pain after amputation and pain that persists after severe trauma or surgery such as mastectomy.

Other types of neuropathic pain can result from infections, metabolic abnormalities, chemotherapy, radiation, neurotoxins, inherited neurodegeneration, nerve compression, inflammation, or tumor infiltration.

While short-term pain related to a specific injury is protective and serves a purpose, neuropathic pain serves no biological purpose and can go on for decades. If it is not dealt with effectively, chronic pain can lead to additional symptoms such as chronic anxiety, depression, fear, sleeplessness and difficulty functioning in many areas of life.

Obviously, treating this kind of pain is important so that individuals can continue enjoyable activities, work and social situations. In fact, early recognition and aggressive treatment of neuropathic pain is crucial in ensuring it does not remain a chronic and severe problem.

This is where the challenge begins. Unfortunately, neuropathic pain does not respond well to common pain relieving medications such as analgesics and non-steroidal anti-inflammatory agents. Taking an aspirin every few hours will not do much to alleviate suffering.

Some medications such as antiepileptic drugs have shown positive results in treating neuropathic pain. In fact, gabapentin and more recently pregabalin have been approved for use on some forms of neuropathic pain.

Some studies have also shown the older antidepressant medications called tricyclic antidepressants have been effective in treating neuropathic pain. Unfortunately, these drugs can have fairly unpleasant side effects for an often minor benefit.

Physical rehabilitation, behaviour therapy and relaxation training can also help, but the magic bullet has not yet been found.

Research continues into new medications. At Okanagan Clinical Trials we are currently beginning a study examining the effectiveness of a pregabalin, a medication that has just been approved in Canada for post-herpetic neuralgia and diabetic peripheral neuropathy.

It is not yet available at your pharmacy but will be soon. We will be looking at its use in these conditions and in all the other neuropathic pain conditions for which it has not yet been approved. It is similar to gabapentin in its mechanism of action but 6 times more potent and appears to have a very favourable side-effect profile.

If you suffer from neuropathic pain for which you have not found adequate treatment, you may be interested in participating in this study.

 

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