Neuropathic pain..exactly what is it?

amanda · 02-12-2004, 09:27 PM

I know I have some nueropathic pain and take 300 mg 3 times daily of nuerotin. But, exactly what is it? Is the brain confused? Are signals being bounced back? What the heck is going on in there?Please explain it to me on non-nuero surgeon terms .

"When you get to the end of your rope, tie a knot and hang on."
Franklin D. Roosevelt

metronycguy · 02-15-2004, 01:18 PM

hi Amanda , there are a couple recent post by dr wise in the pain forum that may help answer your question.. this is the research neuropathic forum.
come over there to pain forum , lots of post about our neuropathic in there...
sorry to hear your having it..

Chula · 03-25-2004, 09:25 AM

Hi Amamda. It is a complicated topic. The way I understand it that it "seems" similiar to a wiring system that goes haywire. Say a frayed/cut electrical chord that is plugged in and is "firing" constantly. Some medicatrions do help. But as with some things it amy take time to find which medication offers the most relief. Also (I have RSD) some of us experience body jerks because of this. Mine started in my legs but now take hold of my whole body. Clonopin helps a lot, though I had to drop the dose drastically because it started to knck me out. Now even one pill literally knocks me out. Nothing else works! So I am careful to use it only at night just before I go to bed. Hope this and others input helps some. I wish you painfree days. Hasta luego.

Chula

Wise Young · 03-30-2004, 03:47 PM

Amanda,

Neuropathic pain is abnormal pain sensations that originate from the nervous system rather than from actual pain (noxious) sensations. It often occurs in areas of the body that have little or no sensation, or even in parts of the body that have been amputated. For example, many people who have had their legs amputated feel pain in the leg that is no longer there. It is also sometimes called neurogenic or phantom pain. I prefer the term neuropathic pain because the word implies that the pain has a neural origin and that it is abnormal. The sensation may be quite variable. Some people complain of freezing or burning pain. For others, it may be aching or pressure-like, or vibratory.

In general, injuries that cause loss of sensory input into the spinal cord are often associated with neuropathic pain. For example, amputation cuts peripheral nerves. Diabetic neuropathy (peripheral nerve degeneration associated with diabetes) may be associated with neuropathic pain. People with avulsed brachial plexus or lumbosacral plexus (damage of the spinal roots and peripheral nerves emanating from the cervical and lumbosacral spinal cord) often have neuropathic.

What is neuropathic pain due to? There are several theories. One theory is that neuropathic pain results from abnormal sprouting and connection of axons in the spinal cord. Another theory is that it is a result of loss of inhibitory neurons in the spinal cord. A third theory is that it is a result of abnormal neurotransmitter balance in the spinal cord. In my opinion, probably some aspects of each of these mechanisms probably contribute to neuropathic pain. A fourth theory is that neuropathic pain emanates from neurons in the spinal cord that have been deafferented and express a particular enzyme called PKC (phosphokinase) gamma. Mice that have had their PKC gamma gene knocked out do not develop neuropathic pain. It turns out that these neurons are located in a particular layer of the dorsal gray matter of the spinal cord that receives sensory signals, and these cells fire high-frequency bursts of action potentials that may lead to pain.

Neuropathic pain in spinal cord injury is currently classified into four types. The first and most common type is pain that is localized to areas below the injury level. The second type is pain that radiate down the limbs and is far below the injury site. The third is neuropathic pain that is present above the injury site, often in the form of increased sensitivity to touch (allodynia) or temperature. The fourth is visceral neuropathic pain.

Treatments for neuropathic pain are relatively limited today. Probably the most effective are anti-epileptic drugs that block high-frequency bursting activity in spinal neurons, including gabapentin (neurontin). Because people accomodate fairly rapidly to gabapentin, the drug was initially thought to be ineffective. However, it turns out that if one increases the dose to very high levels, i.e. 4-5 grams per day, the drug may produce stable reduction of neuropathic pain. A second treatment that has been useful for some people in amitryptalline (Elavil) which is an antidepressant drug that increases the levels of some neurotransmitters, particularly catecholamines, in the brain and spinal cord. A third group of therapies are glutamate receptor blockers such as dextromethorphan or ketamine. A fourth therapeutic approach is intrathecal baclofen. As you know, baclofen is used for suppressing spasticity. Fifth, electrical stimulation of the spinal cord may help in some people. Finally, some people use opioid drugs (such as Fentanyl) and oxycodone to reduce neuropathic pain.

By the way, I am sorry about the use of technical terms and please ask questions about what you don't understand so that I can try to explain it better.

Wise.

[This message was edited by Wise Young on 04-02-04 at 05:34 PM.]

amanda · 03-31-2004, 05:04 PM

Thanks Wise....you did a fine job of explaining...I pretty much get the idea now.

"When you get to the end of your rope, tie a knot and hang on."
Franklin D. Roosevelt

Wise Young · 04-02-2004, 02:30 PM

I just edited one part of the explanation to Amanda. In the explanation, I had referred to amytryptaline as an MAO inhibitor. KLD pointed out that amitryptaline is not a monoamine oxidase (MAO) inhibitor. She is correct. It has some effects that are similar to MAO inhibitors (i.e. increase the levels of catecholamines) and therefore should not be used in conjunction with MAO inhibitors, amitryptaline or Elavil is not an MAO inhibitor. Sorry. Wise.

br1863 · 05-13-2010, 05:46 PM

Hi Doctor Wise, I am a T-4 complete paraplegic with the exact Neuropathic pain that you have described above #4. From the tip of my toes to the top of my buttocks, I have a burning, throbbing, tingling sensation that reminds me a whole lot like real bad growing pains throughout my legs. I was injured in April 1990 and have no feeling to the touch from basically the T-4 level. The pain has gradually been getting worse the last 6 years or so to the point that I have been seeing a few doctors to try and achieve some kind of pain management. I have tried a 3 or 4 of the anti-epileptic drugs you have mentioned like neurontin and am currently on the Fentanyl 75 patches and have recently tried the Oxycodone. I am now thinking about heading towards the Spinal stimulation route to see if this will give me some kind of relief at all. I also take 30mg of baclefen 4X a day on top of this to stop the spasms. I am just wondering if you know of any other treatments that are available and also how well the spinal cord stimulator's are getting at treating in on the actual spot that the pain is coming from now. I would be interested in finding out what you have to say about the subject as this link looks to be a good 6-7 years old now. Thank you so much for your help and knowledge on the subject!
Sincerely,
Brian Rietveld
Phoenix, AZ.

David Berg · 05-14-2010, 09:37 PM

Brian, generally speaking narcotics are not effective on neuropathic pain. The front-line meds used for this are Neurontin or Lyrica. Remember, you're not dealing with typical pain signals, you're dealing with haywire signals from the nerves themselves.

br1863 · 05-15-2010, 01:14 AM

Hi David, thanks for your reply. So far I have been trying just about anything that the pain docs have to recommend to me including what you call front line meds like Neurontin, Lyrica, and one or two others that don't come to mind at the moment. Above I described them as anti-epileptic drugs as that is how I have seen them described on other sites. My pain management doctor now is talking about the spinal cord stimulator as a next step in trying to kill the pain in some way. How well does this treatment work for people with my type of pain and also is this pretty common for someone like me that has this kind of injury? I would think that since I don't have any feeling at all that in my legs, that this is the way it should be! Kind of a double whammy if you know what I mean. : ( So is there any other treatment that they are currently trying besides what we have been discussing here so far? I guess it looks like the stimulator better be my last great hope!!!??? Thanks again for all your help!
Brian

br1863 · 05-15-2010, 01:19 AM

Hi again Dave, Was just wondering if this is discussed more in detail some where else in the site that I am not aware of. Any links would be helpful as well! Thanks!

02-12-2004, 09:27 PM	#1
amanda Senior Member Join Date: Sep 2003 Location: Arkansas, USA Posts: 959	Neuropathic pain..exactly what is it? I know I have some nueropathic pain and take 300 mg 3 times daily of nuerotin. But, exactly what is it? Is the brain confused? Are signals being bounced back? What the heck is going on in there?Please explain it to me on non-nuero surgeon terms . "When you get to the end of your rope, tie a knot and hang on." Franklin D. Roosevelt

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02-15-2004, 01:18 PM	#2
metronycguy Senior Member Join Date: Dec 2002 Location: ny Posts: 5,674	hi Amanda , there are a couple recent post by dr wise in the pain forum that may help answer your question.. this is the research neuropathic forum. come over there to pain forum , lots of post about our neuropathic in there... sorry to hear your having it..

03-25-2004, 09:25 AM	#3
Chula Junior Member Join Date: Mar 2004 Location: South Jersey Posts: 2	Hi Amamda. It is a complicated topic. The way I understand it that it "seems" similiar to a wiring system that goes haywire. Say a frayed/cut electrical chord that is plugged in and is "firing" constantly. Some medicatrions do help. But as with some things it amy take time to find which medication offers the most relief. Also (I have RSD) some of us experience body jerks because of this. Mine started in my legs but now take hold of my whole body. Clonopin helps a lot, though I had to drop the dose drastically because it started to knck me out. Now even one pill literally knocks me out. Nothing else works! So I am careful to use it only at night just before I go to bed. Hope this and others input helps some. I wish you painfree days. Hasta luego. Chula

03-30-2004, 03:47 PM	#4
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,972	Amanda, Neuropathic pain is abnormal pain sensations that originate from the nervous system rather than from actual pain (noxious) sensations. It often occurs in areas of the body that have little or no sensation, or even in parts of the body that have been amputated. For example, many people who have had their legs amputated feel pain in the leg that is no longer there. It is also sometimes called neurogenic or phantom pain. I prefer the term neuropathic pain because the word implies that the pain has a neural origin and that it is abnormal. The sensation may be quite variable. Some people complain of freezing or burning pain. For others, it may be aching or pressure-like, or vibratory. In general, injuries that cause loss of sensory input into the spinal cord are often associated with neuropathic pain. For example, amputation cuts peripheral nerves. Diabetic neuropathy (peripheral nerve degeneration associated with diabetes) may be associated with neuropathic pain. People with avulsed brachial plexus or lumbosacral plexus (damage of the spinal roots and peripheral nerves emanating from the cervical and lumbosacral spinal cord) often have neuropathic. What is neuropathic pain due to? There are several theories. One theory is that neuropathic pain results from abnormal sprouting and connection of axons in the spinal cord. Another theory is that it is a result of loss of inhibitory neurons in the spinal cord. A third theory is that it is a result of abnormal neurotransmitter balance in the spinal cord. In my opinion, probably some aspects of each of these mechanisms probably contribute to neuropathic pain. A fourth theory is that neuropathic pain emanates from neurons in the spinal cord that have been deafferented and express a particular enzyme called PKC (phosphokinase) gamma. Mice that have had their PKC gamma gene knocked out do not develop neuropathic pain. It turns out that these neurons are located in a particular layer of the dorsal gray matter of the spinal cord that receives sensory signals, and these cells fire high-frequency bursts of action potentials that may lead to pain. Neuropathic pain in spinal cord injury is currently classified into four types. The first and most common type is pain that is localized to areas below the injury level. The second type is pain that radiate down the limbs and is far below the injury site. The third is neuropathic pain that is present above the injury site, often in the form of increased sensitivity to touch (allodynia) or temperature. The fourth is visceral neuropathic pain. Treatments for neuropathic pain are relatively limited today. Probably the most effective are anti-epileptic drugs that block high-frequency bursting activity in spinal neurons, including gabapentin (neurontin). Because people accomodate fairly rapidly to gabapentin, the drug was initially thought to be ineffective. However, it turns out that if one increases the dose to very high levels, i.e. 4-5 grams per day, the drug may produce stable reduction of neuropathic pain. A second treatment that has been useful for some people in amitryptalline (Elavil) which is an antidepressant drug that increases the levels of some neurotransmitters, particularly catecholamines, in the brain and spinal cord. A third group of therapies are glutamate receptor blockers such as dextromethorphan or ketamine. A fourth therapeutic approach is intrathecal baclofen. As you know, baclofen is used for suppressing spasticity. Fifth, electrical stimulation of the spinal cord may help in some people. Finally, some people use opioid drugs (such as Fentanyl) and oxycodone to reduce neuropathic pain. By the way, I am sorry about the use of technical terms and please ask questions about what you don't understand so that I can try to explain it better. Wise. [This message was edited by Wise Young on 04-02-04 at 05:34 PM.]

03-31-2004, 05:04 PM	#5
amanda Senior Member Join Date: Sep 2003 Location: Arkansas, USA Posts: 959	Thanks Wise....you did a fine job of explaining...I pretty much get the idea now. "When you get to the end of your rope, tie a knot and hang on." Franklin D. Roosevelt

04-02-2004, 02:30 PM	#6
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,972	I just edited one part of the explanation to Amanda. In the explanation, I had referred to amytryptaline as an MAO inhibitor. KLD pointed out that amitryptaline is not a monoamine oxidase (MAO) inhibitor. She is correct. It has some effects that are similar to MAO inhibitors (i.e. increase the levels of catecholamines) and therefore should not be used in conjunction with MAO inhibitors, amitryptaline or Elavil is not an MAO inhibitor. Sorry. Wise.

05-13-2010, 05:46 PM	#7
br1863 Junior Member Join Date: Sep 2003 Location: Phoenix, AZ, USA Posts: 4	Hi Doctor Wise, I am a T-4 complete paraplegic with the exact Neuropathic pain that you have described above #4. From the tip of my toes to the top of my buttocks, I have a burning, throbbing, tingling sensation that reminds me a whole lot like real bad growing pains throughout my legs. I was injured in April 1990 and have no feeling to the touch from basically the T-4 level. The pain has gradually been getting worse the last 6 years or so to the point that I have been seeing a few doctors to try and achieve some kind of pain management. I have tried a 3 or 4 of the anti-epileptic drugs you have mentioned like neurontin and am currently on the Fentanyl 75 patches and have recently tried the Oxycodone. I am now thinking about heading towards the Spinal stimulation route to see if this will give me some kind of relief at all. I also take 30mg of baclefen 4X a day on top of this to stop the spasms. I am just wondering if you know of any other treatments that are available and also how well the spinal cord stimulator's are getting at treating in on the actual spot that the pain is coming from now. I would be interested in finding out what you have to say about the subject as this link looks to be a good 6-7 years old now. Thank you so much for your help and knowledge on the subject! Sincerely, Brian Rietveld Phoenix, AZ.

05-14-2010, 09:37 PM	#8
David Berg Moderator Join Date: Sep 2001 Location: St. Louis, MO Posts: 7,004	Brian, generally speaking narcotics are not effective on neuropathic pain. The front-line meds used for this are Neurontin or Lyrica. Remember, you're not dealing with typical pain signals, you're dealing with haywire signals from the nerves themselves.

05-15-2010, 01:14 AM	#9
br1863 Junior Member Join Date: Sep 2003 Location: Phoenix, AZ, USA Posts: 4	Hi David, thanks for your reply. So far I have been trying just about anything that the pain docs have to recommend to me including what you call front line meds like Neurontin, Lyrica, and one or two others that don't come to mind at the moment. Above I described them as anti-epileptic drugs as that is how I have seen them described on other sites. My pain management doctor now is talking about the spinal cord stimulator as a next step in trying to kill the pain in some way. How well does this treatment work for people with my type of pain and also is this pretty common for someone like me that has this kind of injury? I would think that since I don't have any feeling at all that in my legs, that this is the way it should be! Kind of a double whammy if you know what I mean. : ( So is there any other treatment that they are currently trying besides what we have been discussing here so far? I guess it looks like the stimulator better be my last great hope!!!??? Thanks again for all your help! Brian

05-15-2010, 01:19 AM	#10
br1863 Junior Member Join Date: Sep 2003 Location: Phoenix, AZ, USA Posts: 4	Hi again Dave, Was just wondering if this is discussed more in detail some where else in the site that I am not aware of. Any links would be helpful as well! Thanks!