What Is Nep?

We all know what toothache or a bad-headache feels like and how glad we are when these painful conditions subside. It’s almost beyond our capability to imagine pain which doesn’t always go away and which might even last for years. Picture someone very close to you, in desperation because of neuropathic pain in the feet, going outside at four o’clock on a winter’s morning and standing on a frozen lawn to lessen the pain and burning sensations. This is a real-life example, by no means extreme, of how this type of pain may affect a person.

In the UK alone such significant suffering is believed to affect at least half a million people today.

Neuropathic pain may be defined as pain arising from a disturbance of function or pathological change in a nerve. The multiple kinds of abnormal pain sensations may suggest that several different changes from the normal healthy state of the nerves has taken place. Some people, for example, may experience severe pain as a result of just light pressure from clothing, air movement, or changes in temperature. Others may even experience spontaneous pain for which no obvious cause can be determined. Such pain may be continuous or may even occur in intermittent bursts.

When tests and examinations are performed on people affected in this way, it is common to also discover different areas of numbness, due to the damaged nerves. There is a growing awareness amongst doctors that our perception of pain is complex and that many different factors are involved. Ideally, how pain is defined and how it is treated should take account of these factors.

Causes of Neuropathic Pain

The term ‘neuropathic pain’ covers a number of different causes and types of pain, examples are:

• Diabetes:
‘Diabetic neuropathy’, at it’s simplest, is most often experienced as pain and/or numbness in the feet and is one of the complications of having diabetes.

• Shingles:
After someone has had chicken pox, the virus (varicella zoster) becomes permanently resident in nerve cells, although this in itself does not cause symptoms. However, in some patients, the virus can become reactivated to cause the acutely painful condition of shingles or herpes zoster. In a small number of patients with shingles the affected nerve can become permanently damaged to give neuropathic pain long after the shingles has resolved. This is known as post herpetic neuralgia.

• Amputation of a limb:
When people have a limb amputated some people may experience ‘phantom limb pain’. They feel pain in the amputated limb, even though the limb is no longer there.

• Cancer:
Neuropathic pain is experienced by some people with cancer as a result of either the tumour or the treatment given.

• Trigeminal neuralgia:
This is a type of neuropathic pain that occurs in the face. It is due to problems with one of the facial nerves.

• HIV infection:
Having the HIV virus can result in HIV related painful peripheral neuropathy. Some treatments for HIV may also cause the condition.

• Multiple Sclerosis:
Pain can be a symptom of multiple sclerosis because the layer of insulation around the nerve becomes damaged (demyelination).

• Stroke:
Some people who have a stroke develop neuropathic pain.

• Surgery and trauma:
Pain can follow surgery or trauma due to accidental damage to a nerve.

• Drugs:
Some drugs can cause a peripheral neuropathy.

• Back problems:
Some people who have back pain also experience sciatica. Sciatica is the term given to a neuropathic pain down the leg. This is caused by irritation of the sciatic nerve which is the main nerve into the leg.

In some instances is it not always possible to discover the underlying cause and these cases are described as ‘idiopathic’ or ‘cryptogenic’.

Please consider joining the community today and, in doing so, help us to bring about a positive change. Please remember that we need your support just as much as you may need ours! For further information, and to find out how you can gain full access to all ares of this web site, please click here.

Pain In The Spotlight

Chief Medical Officer Sir Liam Donaldson, in his Annual Report to Parliament, has drawn attention to the extent to which long-lasting pain blights the daily lives of millions of people.  He has underlined the need to increase education and training in relation to chronic pain amongst health professionals and also given attention to the desire to improve the Health Service’s present treatment provision.

Although the media in the UK seems to have largely ignored this significant part of Sir Liam’s report – focusing instead upon alcohol consumption, obesity and knife crime – the report does figure as a significant advance in the slow but sure movement towards improving the treatment of pain.

Neuropathy Trust Survey

It is worth looking back a few years to the very comprehensive survey that over 600 of our regular readers contributed to, and which we displayed at the Pain Society’s annual meeting that same year.

Those of our readers who took the time to complete our innovative survey might draw some satisfaction from realising that they have contributed, at an early stage, to the now growing calls for changes in the recognition and treatment of pain.  Many other problems which surround people affected by chronic pain, all too familiar with many of our readers, are also highlighted in the report.  Just some of the report’s key points are shown here.

• Each year over 5 million people in the United Kingdom develop chronic pain, but only two-thirds will recover.  Much more needs to be done to improve outcomes for patients.

• Chronic pain has a major impact on people’s lives, causing sleeplessness and depression and interfering with normal physical and social functioning.

• All age groups are affected: a quarter of school-age children reported pain (on average lasting more than three years), while most elderly residents of nursing homes experienced frequent moderate to severe pain.

• The limited number of specialist pain clinics around the country are inundated with referrals, and only 14% of people with pain have seen a pain specialist.  Systems and infrastructure are not adequate to meet need or demand.

• Better coordination of services and services designed around the patient’s needs are essential.

Non-Drug Treatments

“Over the years various drugs have been tried but still the pain is excruciating – especially when sitting or lying down.  I have this unbearable pain in my feet and toes.  It is becoming more than I can bear, because there is no respite night and day.  I must confess, my thoughts are sometimes suicidal – cowardly maybe – but until some help is found for this condition I have to drug myself through my days and nights.  Little is written on non-pharmaceutical interventions for neuropathic pain.  I live in hope that you can help people like myself.”

(N.T. member – Nora (now sadly deceased)

Although by no means extensive, the report does list some non-drug treatments.

”Transcutaneous electrical nerve stimulator (TENS) machines work in a number of ways.  Simply put, they work by using electrical energy to directly alleviate nerves in the spinal cord.  In the same way in which pain is helped by rubbing a painful body part, this competes with the ‘pain signal’ and blocks it, as explained by the ‘Gate theory’ proposed in the 1960s.  However, more complex mechanisms are likely to exist as well.  Whatever the mechanism, TENS treatment can have a significant effect on many types of pain if used properly, often in conjunction with other treatment options.

Acupuncture may work in a number of ways.  It may have a counter-irritant effect as well as encouraging the release of the body’s own painkillers (endorphins).  Many other rationales have been proposed, and there is much controversy about acupuncture.  However, there is no doubt that some patients report significant benefit for some pain problems.

Maintaining or regaining a degree of physical function is widely accepted as crucial to reducing the effects of pain.  Physical therapy and/or appropriate rehabilitation programmes both treat pain directly and give patients the knowledge and skills to maintain their own health and function.  This may also help to maintain psychological well-being.

Many localities now run physical activity and leisure services or equivalent schemes, some of which are targeted at people with complex pain.  These aim to reintroduce and maintain good physical function and health.  Health trainers can improve patients’ confidence in doing things despite their pain.  This also reduces the risks of heart disease and obesity.

Cognitive behavioural therapy* can help patients to break the cycle of pain, fear, immobility and disuse that leads to ever-worsening pain.  This approach also helps to develop self-management and coping strategies, and to improve social and physical functioning, even where the underlying pain cannot be improved significantly.  The newer, third-wave therapies such as mindfulness and acceptance-based therapies have proved to be very useful…”

*Cognitive behavioural therapy is featured in the Trust’s ‘Quality of Life’ booklet, which was written by Dr Clare Daniel.

Integrated Approach

The report recognises the fact that people affected by chronic pain have to also cope with the various aspects of the impact which it has upon other areas of their lives.  It recommends that “…aspects of care are integrated and joined up, rather than instigated sequentially or in isolation.”  Quite significantly, it also says that “Patients report that being listened to and given choices over treatment are just as important as the therapies themselves.”

A number of practical actions have been recommended including:

• Training in chronic pain included in the curricula for all healthcare professionals

• For patients in hospital, a pain score should become part of the vital signs that are monitored routinely

• The feasibility of a national network of rapid access pain clinics providing early assessment and treatment should be explored.

Conclusion

The report should be welcomed by everyone who has an interest in the proper diagnosis and treatment of pain.  For years there has been a frustration amongst people affected by chronic pain and those people called upon to offer treatment.  Now, thanks to the many individuals who have dedicated a greater part of their lives to research and clinical treatment for pain, and contributions from those affected by it, there is a real chance of tangible improvements.  Sir Liam Donaldson, as Chief Medical Officer, is known for his tenacity of purpose.  Although there is still a long way to go before the suggested improvements arrive in place, it is unlikely now that the present momentum for change will in any way lessen.  Whatever the future difficulties, we truly welcome all of the initiatives proposed in the report.