WHAT IS NEUROPATHIC PAIN AND SYMPTOMS?

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WHAT IS NEUROPATHIC PAIN? WHAT ARE THE SYMPTOMS OF NEUROPATHIC PAIN?

Stab, electric shock, frostbite, tingling, burning. These are the adjectives that neuropathic pain sufferers use when describing the extent of their pain. So why do these pains appear? Who’s at risk? Is there a cure for neuropathic pain?

Turkey Medicals ask our questions about the subject from Pain Polyclinic Specialist Doctor in Antalya JCI hospital who has answers them…

Neuropathic pain is a type of pain that sometimes has an unknown cause and does not go away with the painkillers that we know. It can be due to shingles and diabetes, as well as be seen as a ‘phantom pain’ that occurs after limb loss. Moreover, in some cases, even just touching this area can cause the patient to feel very serious pain; for example, if there is neuropathic pain in the abdomen, he cannot even wear a T-shirt.

The Pain Clinic that answers our questions is specialist Doctor who gave important information about the severity and neuropathic pain treatment in Turkey:

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THERE ARE 2 TYPES OF PAIN

According to the mechanism of pain, we classify pain into two groups; one is nociceptive and the other is neuropathic pain. Nociceptive pains are pains that we are all familiar with, for example, when we bump our arm somewhere, burn our hand, cut it, accompanied by tissue damage. This tissue damage can also be caused from the outside, it can also be caused internally, such as a mass growing inside. We stop these pains with the usual painkillers we know, paracetamol, which we call anti-inflammatory.

Neuropathic pain, on the other hand, unlike nociceptive pain, is a pain that is characterized by damage or irritation of the nerves themselves. In other words, this pain is a pain directly related to the nerves in the body.

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WHERE DOES NEUROPATHIC PAIN OCCUR?

Neuropathic pain can occur all over the body. For example, diabetic neuropathy is one of the most well-known types of it. High sugar levels here directly damage and damage the nerves. There is also pain due to damage to the nerves.

Diabetic neuropathy, often manifested in the feet.

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PAINS SUCH AS BURNING, ELECTRIC SHOCK

The pain caused by tissue damage, which we call nociceptive pain, is in the form of cuts, stings, pains. Neuropathic pain, on the other hand, has a slightly different shape. There is more pain here, such as burning, electric shock, it gets there. In addition, it is a condition where a stimulus that is not normally painful becomes painful. The patient feels terrible pain, even if only the area with neuropathic pain is touched. For example, if there is pain in the abdomen or back, he cannot even wear a T-shirt, if there is pain in his feet, he is uncomfortable even wearing socks.

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TYPES OF NEUROPATHIC PAIN

Diabetic neuropathy, which is usually observed in people with diabetes, occurs in the feet. This pain is felt on both feet, that is, it is symmetrical, and especially patients talk about burning pains under the knee, starting from the ankles and progressing to the tip of the fingers. But of course, it can also occur in the arms, hands, abdomen, chest, because the nerves in all parts of the body are destroyed due to high sugar. This condition is a little more atypical, but it is possible.

In addition, shingles pain is also a neuropathic pain. This pain is a very typical example of neuropathic pain. Shingles is a disease caused by the chickenpox virus. As a child, you get chickenpox, you get better, but this virus is such that it stays dormant in some nerve areas in the spinal cord. After many years, at some point in your life, it can reappear with the progression of age or with a decrease in body resistance due to cancer, or due to a weakened immune system after a very serious stress; the virus wakes up again. This time, this virus causes a different discomfort than chickenpox and directly causes damage and inflammation to the nerves; we call it shingles.
Shingles,

Shingles is a disease caused by the chickenpox virus.

In shingles, a rash appears on the skin of the area of the body where that nerve transmits its sensation, and with it a very severe neuropathic pain. This pain is felt as burning, itching, tenderness when touched, needle sinking, and can also occur in the chest, back, arms, that is, all over the body. But the most typical feature of shingles pain is that it is one-sided, it does not occur on the double side. Suppose, if it is on the back and abdomen, then it is visible only on the left or only on the right side. It is very rare that it occurs on both sides when it is common, but as I said, this condition is very rare.

In addition, trigeminal neuralgia is also a type of neuropathic pain. There is a nerve called the trigeminal nerve that transmits the sense of the face. This transmits the sensation of the area around the eyes, the upper lip, the lower jaw, the lower lip. Very typically, lighter-style pains occur, such as an electrical leak in that nerve. The reason for many of these is unknown. Sometimes a condition such as a tumor or vascular ball that presses around the trigeminal nerve can cause this pain. But often the reason is not understood.

A type of neuropathic pain is an interesting type that we call Phantom pain. It’s also called phantom pain. These are pains that occur after the loss of a limb. This pain is observed in patients who have had their arm and leg amputated. It feels as if that limb is still there and it hurts. For example, a patient whose right leg has been amputated above the knee may say, “The thumb of my right foot hurts,” even though his foot has been amputated. And this shows us that neuropathic pain is a condition caused by nerves. Because all organs have a projection in the brain. The pain is felt from the pain center in the brain. In phantom pain, the part of the pain center in the brain that codes for that missing limb continues to produce signals, and even if that limb is amputated, it creates a situation as if there is pain there. It is believed that phantom pain occurs only in people who have lost their arm and leg, but this pain can also be seen in the loss of other limbs. For example, in patients whose breasts were removed as a result of a breast tumor, in patients whose rectum was completely removed in rectal cancer, in patients whose uterus was removed in uterine cancer, these pains can occur.

We see neuropathic pains in cancer. In particular, this pain can occur due to the compression of tumor cells on the nerves. These pains can occur when chemotherapy drugs damage the nerves.

Neuropathic pains may also occur with certain vitamin deficiencies.

In addition, there is a pain that we call central pain. For example, in patients with cerebral hemorrhage or Parkinson’s patients, a number of neuropathic pains may occur directly due to sensitization and sometimes damage to the pain centers in the brain.

Fibromyalgia has been decried as one of the neuropathic pains in recent years.

Previously, fibromyalgia was not November as neuropathic pain, it was thought to be caused by muscles. Muscles ache in fibromyalgia November but it has been revealed in recent years that it is a neuropathic pain at its origin. With fibromyalgia, burnout syndrome may occur in the patient; conditions such as constant fatigue and inability to enjoy life are observed. These patients enter into a vicious circle of pain; on the one hand, the pain disrupts the patient’s psychology, then the patient’s quality of life decreases, and this condition increases the pain again.

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IS IT DIFFICULT TO DIAGNOSE?

Diagnosis of neuropathic pain is sometimes easy, sometimes difficult. For example, it is not difficult in shingles and diabetic neuropathy. Neuropathic pain is a chronic pain. It is usually long-term, but it can also be short-term.

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IT EXISTS IN 8-10 PERCENT OF SOCIETY

There is an incidence of these pains in the community of around 8-10 percent. The change according to gender is not very visible. But, for example, fibromyalgia is usually more common in women. But in general, when we look at all neuropathic pain, there is not much of a gender difference. It usually comes across more at an older age. This is due to the fact that diabetes, shingles, brain-related disorders that we call central neuropathic pain occur at an advanced age.

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WHAT IS THE EFFECT OF PSYCHOLOGY ON NEUROPATHIC PAIN?

It is not true to say that neuropathic pain can occur only with a psychological factor. Here, when we give antidepressant treatment to patients, we don’t want to say, “you don’t have a problem, you just have a bad psychology, so you have pain”. But of course, the fact that the person’s psychological state is not balanced is a condition that makes it difficult for all chronic pain.

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HOW IS THE TREATMENT OF NEUROPATHIC PAIN?

These pains do not pass with the help of drugs that we call classic painkillers. These painkillers have almost no place in the treatment of neuropathic pain. There are a number of drugs developed specifically for the treatment of epilepsy in these pains, some of which are now only used for neuropathic pain. These drugs are used in trigeminal neuralgia, cancer-related, diabetes-related neuropathic pain, phantom pain. The other group of drugs that we use in treatment are antidepressants.

In the treatment of neuropathic pain, antidepressants and antiepileptic drugs are used.

At this point, we would like to touch on an issue; we do not give antidepressant medications to patients with neuropathic pain or other types of chronic pain because they have depression. So we’re not treating depression. When patients are given antidepressant drugs for treatment, they think that we say, “your pain is not there, your pain is psychological, use this drug, it will pass,” and they don’t want to use antidepressant drugs. But let’s not forget that, for example, I just said that we also use the drugs used to treat epilepsy for neuropathic pain. Just as we don’t mean that the patient has epilepsy when we give these drugs, we also don’t mean that the patient is depressed when we give the patient antidepressants. Because both antidepressant drugs and drugs that we call antiepileptics have secondary analgesic effects. This means secondary pain relief. So these drugs directly have an important place, especially in the treatment of chronic pain.

In patients who do not respond to drug therapy, we resort to interventional methods of treatment. In our body, we have a nervous system that we call the sympathetic nervous system, and this system has a serious role in transmitting pain to the brain. His name is sympathetic, but his role in neuropathic pain is not very sympathetic. Because in neuropathic pain, this phenomenon of excessive activation of the sympathetic nervous system is observed.

The sympathetic nervous system is a nerve chain in the body that spreads downward along the spinal cord, even behind the nose there is also a sympathetic nerve ganglion, from there it extends to the neck and from the neck to the back, waist, coccyx. Here we are also able to eliminate neuropathic pain by blocking this sympathetic nervous system at certain levels according to the location of the pain in interventional treatment. For example, in diabetic neuropathy, the patient has pain in the feet and does not respond to medication, we can stop the pain by entering the lumbar region and blocking the sympathetic nerves in the waist.

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DOES THE PAIN RECUR AFTER TREATMENT?

When this treatment is completed and the pain subsides, the problem disappears. But when it occurs again, the pain can still be eliminated with the same treatment. There are situations when we can take measures to ensure that this does not happen again. For example, if we are talking about diabetic neuropathy, it is important that the patient’s blood sugar levels are kept within normal limits. If the patient’s blood sugar is not kept within normal limits, it is also difficult to control diabetic neuropathy. So my suggestion that I can give diabetics is that they should take great care of their foot care and stick to their diet whenever possible.

Shingles pain, on the other hand, is a pain due to nerve damage, because the pain can continue even after the shingles has healed. We call it postherpetic neuralgia. In this case, you can stop the pain with a nerve blockade or a number of drug injections that you will make into the spinal canal where the nerves come out.

It should be noted that in shingles, it is very important to suppress the pain at the earliest stage with the right medications. And if the rashes have passed, but the pain persists, it is necessary to switch to interventional treatments necessarily. The longer the pain lasts, the more difficult it becomes to stop the pain afterwards.
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Antidepressant drugs in fibromyalgia have been used for a long time. Recently, antiepileptic drugs have also begun to be used. This is a chronic disease. Both preventive drug therapy should be done, and when the pain is very acute and the patient’s quality of life is very reduced, it is necessary to make a number of injections at the trigger points of the pain. We also often emphasize the benefit of proper and regular exercise in this disease.

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President of Organ Transplant Center at MedicalPark Hospital Antalya

Turkey's world-renowned organ transplant specialist. Dr. Demirbaş has 104 international publications and 102 national publications.

Physician's Resume:

Born on August 7, 1963 in Çorum, Prof. Dr. Alper Demirbaş has been continuing his work as the President of MedicalPark Antalya Hospital Organ Transplantation Center since 2008.

Prof. who performed the first tissue incompatible kidney transplant in Turkey, the first blood type incompatible kidney transplant, the first kidney-pancreas transplant program and the first cadaveric donor and live donor liver transplant in Antalya. Dr. As of August 2016, Alper Demirbaş has performed 4900 kidney transplants, 500 liver transplants and 95 pancreas transplants.

In addition to being the chairman of 6 national congresses, he has also been an invited speaker at 12 international and 65 national scientific congresses. Dr. Alper Demirbaş was married and the father of 1 girl and 1 boy.

Awards:

Eczacibasi Medical Award of 2002, Akdeniz University Service Award of 2005, Izder Medical Man of the Year Award of 2006, BÖHAK Medical Man of the Year Award of 2007, Sabah Mediterranean Newspaper Scientist of the Year Award of 2007, ANTIKAD Scientist of the Year Award of 2009, Social Ethics Association Award of 2010, Işık University Medical Man of the Year Award of 2015, VTV Antalya's Brand Value Award of 2015.

Certificates:

Doctor of Medicine Degree Hacettepe University Faculty of Medicine Ankara, General Surgeon Ministry of Health Turkey EKFMG (0-477-343-8), University of Miami School of Medicine Member of Multiple Organ Transplant, ASTS Multiorgan Transplant Scholarship. Lecturer at Kyoto University. Lecturer at University of Essen, Research assistant at the University of Cambridge .

Professional Members:

American Society of Transplant Surgeons, American Transplantation Society Nominated, Middle East and Southern Africa Council Transplantation Society 2007, International Liver Transplantation Association, Turkish Transplantation Association, Turkish Society of Surgery, Turkish Hepatobiliary Surgery Association.

Disclaimer:

Our website contents consist of articles approved by our Web and Medical Editorial Board with the contributions of our physicians. Our contents are prepared only for informational purposes for public benefit. Be sure to consult your doctor for diagnosis and treatment.
Medically Reviewed by Professor Doctor Alper Demirbaş
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