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June 19, 2013
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Chronic Pain (cont.)

Medical Author:
Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Peripheral Neuropathy (pain arising in the nerves leading from the head, face, trunk, or extremities to the spinal cord)

  • In a sense, all pain comes from nerves because nerves transmit painful impulses to the brain. But some painful impulses do not arise from the nerve endings that normally sense injury or illness. Some painful impulses come from irritation to the nerve along its length instead of at the nerve ending.
  • Sciatica, for example, is caused by pinching of the sciatic nerve, which goes from the leg to the spine. The pinching often takes place near the lower part of the spine, but the pain is perceived as coming from the nerve endings in the leg because the sciatic nerve usually transmits feelings from the leg.
  • Other examples of illnesses that cause peripheral neuropathy or "nerve pain" are ruptured discs in the spine, which pinch nerves, cancers that grow into nerves and cause irritation, or infections, such as shingles, which can cause irritation to nerves.
  • Common diseases that often cause peripheral neuropathy are diabetes and AIDS.
  • Nerve pain can feel like a painful "pins and needles" sensation. This kind of nerve pain can be treated with tricyclic antidepressants. Other, more severe nerve pain can be described as a sharp, stabbing, electric feeling. Anticonvulsants (medicines that treat seizures) can be used used for this kind of nerve pain.
  • Some nerve pain is due to loss of a limb. The arm or leg that has been amputated feels like it's still present, and hurts severely. This kind of nerve pain, called deafferentation, or "phantom limb pain," can be treated with clonidine (Catapres) (a blood pressure medicine that also relieves nerve pain).
  • Herpes zoster (shingles) causes an infection of the nerve endings and of the skin near the nerve endings. Local application of capsaicin (Zostrix), an over-the-counter pain medication in the form of an ointment, is sometimes helpful for this. In addition, opioids may be needed.
  • Pregabalin (Lyrica) is a drug that is used for the treatment of postherpetic neuralgia and diabetic peripheral neuropathy, while duloxetine (Cymbalta) has been approved for use in the treatment of diabetic peripheral neuropathy.

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Chronic Pain - Management

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Chronic Pain - Effective Treatments

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Chronic Pain Syndrome »

Chronic pain syndrome (CPS) is a common problem that presents a major challenge to healthcare providers because of its complex natural history, unclear etiology, and poor response to therapy.

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