What Is Neuropathic Pain Exactly?

Today's post from neuropathyjournal.org (see link below) is another well-written and easy to absorb article about neuropathic problems by LtCol Eugene B Richardson, who has probably as much experience as a neuropathy patient than anyone else on the Net at the moment. This article looks at the nature of the pain of neuropathy and explains why it happens, what it is and why the medical authorities often dismiss it through their ignorance and not yours. Many neuropathy patients find it difficult to find information that explains the unique pain that neuropathy can bring - this article helps!

What is Neuropathic Pain?
By LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS

The physical cause of neuropathic pain is damaged peripheral nerves and as one medical expert notes, may also be due to the attempt of damaged nerves to fire across damaged sections of the peripheral nerve. See: References #1 to #3

It is illegal to torture prisoners in our country. So why do neuropathy patients too often live with a torture known as ‘neuropathic pain’ caused by Peripheral Neuropathy while being ignored by too many doctors?

Just recently a neuropathy patient was visiting a neuropathy center in the central part of the United States only to have some of the neurologists in this center of experts diagnose the pain as a “somatization’ disorder! 

Somatization Disorders

Somatization disorder is a long-term (chronic) condition in which a person has physical symptoms that involve more than one part of the body, but no physical cause can be found.

This concept cost me my military career in the 1970’s and 80’s. It sets up the neuropathy patient while they seek help for the horror of neuropathic pain. It is important to understand that the pain and other symptoms of patients with this disorder are real and are not created or faked on purpose (malingering). It is time to stop calling patient’s crazy and ignoring this pain or the other symptoms of a neuropathy.

In 2015 we finally have a growing understanding of neuropathic pain yet with limited medication options and sometimes treatment fails the patient due to lack of adequate clinical training of doctors in the diagnosis and treatment of the neuropathies especially training in the use of what we now do know. 

Testing

Too many doctors use the tests for large fiber damage and if they find no recordable damage, dismiss the patient! These tests measure damage and do not diagnose neuropathy. Patients wish it was that simple once they learn the limits of medicine.

The patient can have symptoms and neuropathic pain for years before damage will show in these tests. Testing for small fiber neuropathy is often not done (skin biopsy) for this is the only test to show small fiber damage.. After I was diagnosed with an immune mediated neuropathy, doctor after doctor, asked, ‘Why did they not do the spinal tap?” 

Severity of pain

Dr. Norman Latov, MD, PhD of Cornell University notes that while for some patients neuropathic pain is a nuisance, but for millions of other patients, they are in fact living with constant torture at one level or another with untreated conditions that do many times lead to severe disabilities at a greater cost to society.

So as a patient, are you experiencing neuropathic pains and sometimes people and medical staff will look at you like you are crazy reporting such strange pains with no obvious visible cause! You are not crazy unless of course you ask your spouse and they may or may not agree!

Neuropathic pain can involve a wide variety of strange sensations, such as violent sudden electric shocks, stabbing, shooting, burning, tingling, pins and needles, severe muscle cramps, bone pain, sense of strange numbness, cement legs, heavy legs, strange feelings of socks on the feet or gloves on the hands, severe skin pain due to touch, no feeling on touch, digestive problems, urinary problems, problems with lack of sweating, and the list goes on, in addition to other known symptoms of neuropathy?

While only a trained doctor can determine the cause of your symptoms, you may have peripheral neuropathy and you are experiencing neuropathic pain from damaged nerves sending inappropriate but real signals to the brain.

Like many types of neurological pain, neuropathic pain does remit and relapse making it sometimes difficult to understand both for the doctor and the patient. I even had a doctor state to me on a visit, ‘well you are not hurting now,” as if this was supposed to mean something to me.

Unfortunately, doctors and patients note that these neuropathic symptoms are often worse at night. Experts theorize that this may be due to the brains relaxed state and the fact the brain is not ‘busy’ processing other data. This is why pain is sometimes perceived to be worse at night, as the brain is not as busy working on other information.

Did you know that research has shown that patients with ‘tightly wrapped” neurons in the brain will experience more intense pain than other patients! Ref: #4

While not completely understood, often how a patient experiences neuropathic pain and symptoms is related to their genetic makeup, physical and emotional resources or inappropriate exercise or physical activity in which damaged nerves are forced to work.

Exercise

Did you know that the wrong type of exercise (click to see article) will force damaged nerves to work and increase the pain!

How should a neuropathy patient exercise? Consider ordering a copy of the brand new DVD from Matt Hansen the expert as his perspective on exercise for neuropathy is perfect and understands what we can and cannot do. Yet Matt makes it possible for us to exercise WITHOUT the increase in neuropathic pain, keeping muscles as strong and flexible as possible. To see article on (click on link) Exercise for Neuropathy DVD: When ordering enter the special code NSN 10 and Matt will give 10% of your purchase price back to support the work of the NSN! 

Slow progress in Medicine

For many years, doctors who did not understand the strange manifestations of neuropathic pain would dismiss the patient, noting that the complaint is subjective and with no observable proof of the cause, it must be ‘all in the patients head’.

Disability lawyers love this statement and use this against the patient to deny help when they need it most.

Thank heavens; we are slowly moving away from such a primitive view of neuropathic pain and because of great doctors who report in books and medical journals, especially Dr. Latov in his book for patients and “The Journal of the Peripheral Nervous System” (Ref #3). Since the decades of the 60’s to the 90’’s, we have made great strides toward understanding and attempts to treat neuropathic pain, but we still have a long way to go.

Even with this progress, the most critical aspect beyond the treatment of neuropathic pain, is the absolute requirement for the patient and physician to establish a partnership in which they work together to find out what may work among the options for each individual patient.

Patient systems are different and each patient must be seen as unique when it comes to discovering what works and what does not work for each patient presenting with neuropathic pain.

Diagnosis

Conversely, it is not enough to treat these symptoms of a neuropathy. The physician must be willing to conduct the testing necessary in attempts to find and perhaps treat the cause and to identify the TYPE of the neuropathy.

If the cause is unknown, the worst possible diagnosis is to leave the patient with is a diagnosis of ‘Idiopathic’ Neuropathy. (click on link to read article)

The other important goal is to identify the TYPE of neuropathy as according to Dr. Latov this often points to s suggested cause!

Too many physicians even in 2015 have the attitude, you have neuropathy, there is nothing that can be done, go home and live with it. This attitude must cease, yesterday.

To see How Neuropathic Pain is treated.

References:

#1 Norman Latov, MD, PhD, FAAN Peripheral Neuropathy: When the Numbness, Weakness and Pain Won’t Stop, ANN Press, 2007

#2 Mims Cushing, You Can Cope With Peripheral Neuropathy (Ideas from neuropathy patients), with Dr. Norman Latov, DEMOS Publishing, 2009

#3 “Journal of the Peripheral Nervous System” published by the Peripheral Nerve Society.

http://neuropathyjournal.org/neuropathic-pain-2/