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Chronic Pain (cont.)

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 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.

Circulatory Problems

  • Poor circulation is often a cause of chronic pain. Poor circulation is usually caused by tobacco use, diabetes, or various autoimmune diseases (diseases where the body makes antibodies that fight against itself) such as lupus or rheumatoid arthritis.
  • Partial blockage of arteries by fatty deposits called plaques (arteriosclerosis) is also a common cause of poor circulation. The reason for the pain of poor circulation is that the part of the body that does not get good blood circulation becomes short of oxygen and nourishment. The lack of oxygen and nutrition causes damage to that part of the body, and the damage causes pain.
  • Pain from poor circulation may be treated by surgery to bypass the clogged arteries with artificial arteries in order to improve the blood circulation. Sometimes this is not possible, and blood thinners or opioids may be needed to control the pain.
  • Another common cause of poor circulation is reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome (CRPS). This is a problem of both circulation and nerve transmission because painful nerve transmissions cause the blood vessels to become narrower. The narrowing prevents enough oxygen and nourishment from getting to the part of the body that is affected. RSD can sometimes be treated with a surgical sympathectomy, an operation to stop the nerve impulses from causing a narrowing of the blood vessels. Often, non-opioid medication, either with or without surgery, is needed. Sometimes opioids are needed.
Last Reviewed 11/21/2017

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