Pain Information

FAQs




What is pain?

There are two main types of pain: acute and chronic. Acute pain warns you that you’ve been hurt, goes away fairly quickly, and usually has a physical cause, such as skinning your knee, burning your finger, or bumping your head. Chronic pain lasts for a long time, and it may have no real benefit at all.

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What is neuropathic pain?

Neuropathic pain is a type of chronic pain. It is a result of damage to the nervous system after infection, disease, injury, or certain medications. Neuropathic pain does not protect or warn you. Instead, the nervous system breaks down and becomes the cause of the pain. Neuropathic pain can continue for months or years and is often described as "burning," "electric," "tingling," or "shooting."

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What is postherpetic neuralgia?

Many decades after a person has chickenpox, the virus that causes chickenpox can become active again, resulting in shingles (also called herpes zoster). Shingles usually appears as a one-sided belt-shaped rash, but may also occur on the face or scalp. It is very painful and the intense pain can last for months or years after the rash has healed, or it may never fully go away.

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What is painful HIV-associated neuropathy?

People infected with HIV may develop neuropathic pain directly as a result of the virus or because of the medications used to treat HIV. If you have painful HIV-associated neuropathy, you may experience mild or severe symptoms, usually in the feet but sometimes in the hands. The autonomic nervous system may also be affected.

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What is painful diabetic neuropathy?

There are many types of diabetic neuropathies (nerve disorders caused by diabetes). Peripheral diabetic neuropathy causes pain, weakness, and reduced or lost sensation in the feet. Some people may develop tingling, burning, or numbness; others may experience sharp pains, cramps, and extreme sensitivity to touch. Other types of diabetic neuropathy affect other parts of the nervous system and may affect digestion, balance, vision, and many other bodily functions.

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What causes neuropathic pain?

Neuropathic pain can result from viral infections such as shingles, metabolic diseases such as diabetes, trauma, surgery, amputation, or certain medications. The infection or injury may damage nerve cells that help send pain signals to the spinal cord. Studies show that the undamaged nerve cells become overactive, sending too many messages to the spinal cord. The brain interprets these messages as pain even though there is no reason for pain to exist.

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What are the symptoms of neuropathic pain?

Most people suffering from neuropathic pain experience two main symptoms: hyperalgesia and allodynia. Hyperalgesia is an extreme sensitivity to something that is usually only a little painful, such as a pinch on the arm with a small needle. Allodynia is pain produced by something that is normally not painful at all, such as the feeling of fabric brushing against skin. Neurpathic pain can make everyday living terrible and hard to bear.

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How is neuropathic pain diagnosed?

If the pain you are experiencing has no known cause, it is important to see your healthcare professional right away. He or she will note the history of the symptoms, perform a neurological exam, and order laboratory tests to help identify the cause of your pain.

If neuropathic pain is allowed to continue unchecked, it becomes increasingly difficult to manage, making more aggressive treatments necessary. Visiting with a healthcare professional as soon as possible may help improve your treatment outcome.

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What treatments are available for neuropathic pain?

To date, treatments to prevent or cure neuropathic pain are limited. The current goal is to balance pain reduction with the negative side effects of available treatments. Many people receive combinations of drugs that are not specifically designed to treat neuropathic pain, provide only short-term relief, and produce many unwanted side effects. There is, therefore, a need for a therapy that relieves neuropathic pain for long periods of time without significant negative side effects.

Nonmedical Therapies
Treatment strategies such as biofeedback, relaxation therapy, meditation, guided imagery, and physical therapy may help some people. Acupuncture is often used to relieve neuropathic pain, but it typically only provides short-term relief. TENS (transcutaneous electrical nerve stimulation) has also been used with limited success.

Pharmacologic Options
Antidepressants, anticonvulsants, anti-arrhythmics, and topical analgesics continue to be the treatments most commonly used. However, they are inconvenient to take and tend to produce negative side effects such as dizziness, sedation, and gastrointestinal problems. Opiates are also used, but because of their side effects and the possible dependency associated with these medications, these drugs may not be tolerated or appropriate for many patients.

Interventional Approaches
Invasive procedures include epidural steroid injections, sympathetic blocks, spinal cord stimulators, morphine pump systems, and a variety of surgical techniques.

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What is capsaicin and how does it work?

Naturally occurring capsaicin appears to work by activating a receptor called TRPV1. The capsaicin receptor TRPV1 is located on nerve cells that help send pain signals to the spinal cord.

Once the receptor is activated, calcium enters the portion of the nerve cells exposed to capsaicin and the process of sending pain signals begins. If the receptor is activated for a long time or by a large amount of capsaicin, too much calcium enters the nerve cell and it becomes unable to send pain signals to the spinal cord. This is possibly the way capsaicin works to relieve neuropathic pain.

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