Neuropathic pain is more likely caused by damage to or dysfunction of the peripheral or central nervous system as through stimulation of pain receptors. The diagnosis is in the neurological examination supported by pain, which is not proportional to tissue damage by dysesthesia (eg. As pain, tingling) and signs of nerve damage. Although neuropathic pain responds to opioids, the treatment (topical drug z. B. antidepressants, anticonvulsants, baclofen) is often carried out with co-analgesics.

Pain can develop after injury at any level of the nervous system, peripheral or central; (Cause and sympathetically maintained pain) the sympathetic nervous system may be involved. Specific syndromes include post-herpetic neuralgia (herpes zoster: post-herpetic neuralgia), root breaks, painful traumatic mononeuropathy, painful polyneuropathy (especially diabetic Polyneuropathie- diabetes mellitus (DM): Diabetic neuropathy), (central pain syndromes can virtually all lesions at each level of the nervous system caused), postsurgical pain syndromes (eg. B. Postmastektomiesyndrom, Postthorakotomiesyndrom, phantom limb pain), and complex regional pain syndromes (reflex sympathetic dystrophy and Kausalgie- complex regional pain syndrome (CRPS)).

Neuropathic pain is more likely caused by damage to or dysfunction of the peripheral or central nervous system as through stimulation of pain receptors. The diagnosis is in the neurological examination supported by pain, which is not proportional to tissue damage by dysesthesia (eg. As pain, tingling) and signs of nerve damage. Although neuropathic pain responds to opioids, the treatment (topical drug z. B. antidepressants, anticonvulsants, baclofen) is often carried out with co-analgesics. Pain can develop after injury at any level of the nervous system, peripheral or central; (Cause and sympathetically maintained pain) the sympathetic nervous system may be involved. Specific syndromes include post-herpetic neuralgia (herpes zoster: post-herpetic neuralgia), root breaks, painful traumatic mononeuropathy, painful polyneuropathy (especially diabetic Polyneuropathie- diabetes mellitus (DM): Diabetic neuropathy), (central pain syndromes can virtually all lesions at each level of the nervous system caused), postsurgical pain syndromes (eg. B. Postmastektomiesyndrom, Postthorakotomiesyndrom, phantom limb pain), and complex regional pain syndromes (reflex sympathetic dystrophy and Kausalgie- complex regional pain syndrome (CRPS)). Etiology The peripheral nerve damage and dysfunction can cause neuropathic pain. Examples are Mononeuropathies (eg, carpal tunnel syndrome, radiculopathy.) Plexopathies (typically caused by nerve compression by neuroma, tumor or herniated disc) and polyneuropathy (usually due to various metabolic neuropathies-see table: Some causes of disorders of the peripheral nervous system). Presumably, the mechanisms differ and may involve an increased number of sodium channels in the regenerated nerves. Central neuropathic pain syndromes seem to reorganize central somatosensory processing in this process; The main categories are the deafferentation pain and sympathetically maintained pain. Both are complex and, although probably related, substantially different. The Deafferentation caused by the partial or complete interruption of peripheral or central afferent neural activity. Examples include post-herpetic neuralgia, central pain (pain following injury in the CNS) and the phantom pain in the extremities (pain wird- felt in the region of an amputated body part complications). The mechanisms are unknown, but are likely to be accompanied by sensitization of central neurons, which lower the activation threshold and cause the expansion of receptive fields. The sympathetic maintained pain depends on a efferent sympathetic activity. Complex regional pain syndromes sometimes go hand in hand with sympathetically maintained pain. Other types of neuropathic pain may have a sympathetic entertaining component. The mechanisms probably include an abnormal sympathetic somatic nervous compound (Ephapsis), local inflammatory changes and changes in the spinal cord. Symptoms and complaints dysesthesia (spontaneous or evoked burning pain, often with a superimposed lancinating component) are typical, but the pain can be deep and boring. Other sensations-z. As hyperesthesia, hyperalgesia, Allodynien (pain from a non-injurious stimulus) and Hyperpathien (sometimes unpleasant, enhanced pain response) -may also occur. The symptoms are persistent, typically after removal of the primary cause (if such existed) persistent because the CNS has been sensitized and rebuilt. Diagnosis Clinical Evaluation A neuropathic pain is suspected when the typical symptoms are present and if nerve damage is known or suspected. The cause (eg. As amputation, diabetes) may be readily apparent. If not, the diagnosis can often be surmised from the description. Pain is relieved by a sympathetic nerve block, a sympathetically maintained pain. has treatment Multimodal therapy (eg. as psychological treatment, physical processes, antidepressants or antiepileptics, sometimes surgery) Excluding the diagnosis, rehabilitation facilities and psychosocial needs treatment only limited prospects of success. In peripheral nerve lesions mobilization is necessary to prevent trophic changes, a disuse atrophy and joint stiffness. Surgical treatment may be necessary to remove a nerve compression. Psychological factors must be taken into account from the start of therapy at the time. Anxiety disorders and depression must be treated appropriately. If a malfunction has occurred, patients can benefit from the holistic concept of a pain clinic. Various classes of drugs show moderate efficacy (see table: Pharmacotherapy for neuropathic pain; s also the EFNS (European Federation of Neurological Societies) guidelines on the pharmacological treatment of neuropathic pain: 2010 revision.), But a complete or nearly complete elimination of pain is unlikely. Antidepressants and anticonvulsants are most commonly used. The demonstration is clearly of some antidepressants and antiepileptic drugs. Opioid analgesics can bring some relief, but they are i. Gen. less effective than in acute nociceptive pain; Side effects may be adequate analgesia in the way. Topical drugs and a lidocaine-containing patch can be effective in peripheral pain syndromes. Other potentially effective treatments include Spinal cord stimulation by an epidural electrode set for certain types of neuropathic pain (eg. As chronic pain in the legs after spinal surgery) electrodes along peripheral nerves and ganglia implanted in certain chronic neuralgia. A sympathetic. which is usually ineffective except in some patients with complex regional pain syndrome. Important points Neuropathic pain can be caused by efferent activity or interruption of afferent activity. Neuropathic pain should be considered when patients have sensory disturbances, or if the pain of proportion to the tissue damage and nerve injury is suspected. Patients should be treated with multiple modalities (eg. As psychological treatment, physical processes, antidepressants or antiepileptics, analgesics, surgery)

Health Life Media Team

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