Neuropathic pain..exactly what is it?

amanda · 02-12-2004, 10:27 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, 02:18 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, 10:25 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, 04:47 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, 06:04 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, 03:30 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.

02-12-2004, 10:27 PM	#1
amanda Senior Member Join Date: Sep 2003 Location: Arkansas, USA Posts: 956	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, 02:18 PM	#2
metronycguy Senior Member Join Date: Dec 2002 Location: ny Posts: 5,118	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, 10:25 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, 04:47 PM	#4
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 34,097	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, 06:04 PM	#5
amanda Senior Member Join Date: Sep 2003 Location: Arkansas, USA Posts: 956	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, 03:30 PM	#6
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 34,097	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.