Neuropathic Pain

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Neuropathic Pain
University of Calgary Department of Clinical
Neurosciences Dr. Cory Toth May 25, 2006
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Neuropathic Pain
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Neuropathic Pain
Objectives Describe pain Describe neuropathic
pain Describe some conditions that cause
neuropathic pain
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Neuropathic Pain

• Pain
• unpleasant sensory and emotional experience

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Neuropathic Pain

• acute pains are warning signals

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Neuropathic Pain

• chronic pain is unnecessary

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Neuropathic Pain
NOCICEPTIVE
NEUROPATHIC
Visceral
Somatic
Deafferentation
Sympathetic Maintained
Peripheral
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Neuropathic Pain
Somatic Pain

• Aching, often constant
• May be dull or sharp
• Often worse with movement
• Well localized
• Eg/
• Bone soft tissue
• chest wall

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Neuropathic Pain
Visceral Pain

• Constant or crampy
• Aching
• Poorly localized
• Referred
• Eg/
• CA pancreas
• Liver capsule distension
• Bowel obstruction

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Neuropathic Pain
FEATURES OF NEUROPATHIC PAIN
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Pain Which Cannot Be Described
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Neuropathic Pain
1) Neuropathic Pain
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Neuropathic Pain
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Neuropathic Pain
Conditions producing neuropathic pain
Diabetic neuropathy Other neuropathies Post
herpetic neuralgia Cervical and lumbar
radiculopathy Post thoracotomy, post
mastectomy Phantom limb Trigeminal neuralgia
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Neuropathic Pain
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Neuropathic Pain
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Neuropathic Pain
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Neuropathic Pain
Acute pain sensation
Temperature sensation
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Neuropathic Pain

• Sensory nerves transmit the ability to feel
• Pressure
• Light touch
• Vibration
• Joint movement (important in balance)

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Neuropathic Pain
How is neuropathic pain generated?
Overactive nerve cells
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Neuropathic Pain

• Improper nerve wiring after injury

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Neuropathic Pain

• inflammation after nerve injury

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Neuropathic Pain
How can we manage neuropathic pain?

• conservative measures 1st
• aerobic exercise and weight loss can be
  beneficial (30 min times 5/week, and loss of 10
  of body weight)

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Neuropathic Pain
How can we manage neuropathic pain?

• Multidisciplinary pain clinic with a
  kinesiologist, psychologist, pain management
  experts
• Specialized neuropathic pain clinic

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Neuropathic Pain
How can we manage neuropathic pain?

• Pharmacology
• Most patients (75) will need medications to
  control neuropathic pain

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Neuropathic Pain
How can we manage neuropathic pain?

• Medications may control up to 50 of pain,
  making life more tolerable
• However, there is no cure
• Many medications cause side effects ranging from
  sleepiness to slowing of thinking or balance
  problems

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Neuropathic Pain
How can we study neuropathic pain?

• We can use animals in the lab who have nerve
  injuries or diabetes
• Testing allows us to tell if they respond to
  touch or temperature as pain, allowing us to
  measure pain

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Neuropathic Pain
How can we study neuropathic pain?

• We can give substances or medications in
  different manners to test the animals pain
  response

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