Nerve pain can present in many ways when there is damage or trauma to the spinal cord. In this article, I will identify the most common types of neuropathic pain that is often seen in the clinical setting, and explain their treatment.
Trigeminal Neuralgia
Trigeminal neuralgia is a consequence of the fifth cranial nerve (Trigeminal Nerve) being compressed. It usually occurs on one side of the face but can materialize bilaterally. Patients who have been diagnosed with trigeminal neuralgia tend to experience short episodes of intense, sharp, stabbing pains that can happen without warning. Trigeminal neuralgia tends to affect more women than men. This condition can be observed by ordering an MRI of the brain. The best treatment plan is a referral to a neurologist for treatment. First line medication treatment includes SSRIs for anxiety and depression, which are a byproduct of chronic pain. Antiepileptics should be prescribed to prevent seizures from occurring. Carbamazepine or Oxcarbazepine are effective in managing depression, seizures, and nerve pain.
Multiple Sclerosis (MS)
Multiple Sclerosis is a debilitating condition of the brain and the spinal cord. The disease occurs in people between the ages 20 and 40. MS transpires when the immune system attacks myelin, a protective sheath that covers the nerve fibers, which produces delayed messages between the brain and the rest of the body. Over time, the disease will cause permanent damage to the nerves. Patients with MS experience different symptoms because the severity of the disease is different for each person. Some patients undergo a decline in their ability to walk, suffer from visual disturbances, muscle weakness, numbness, tingling, and memory loss. Other patients may lose their ability to write and speak.
Currently, there is no standardized test or cure for Multiple Sclerosis. It’s very important that patients continue to be as active as possible. Physical therapy and occupational therapy are beneficial.
Traumatic Spinal Cord Injury (Incomplete Spinal Cord Injury)
Traumatic spinal cord injury is damage to any part of the spinal canal or nerves. It’s caused by an acute trauma (fall, motor vehicle accident (MVA), lifting heavy objects improperly, contact sports, etc.) that results in temporary or permanent loss of strength, decline in extremity mobility, increased neuropathic and radicular pain that radiates down the extremities and spine. Treatment depends on the severity of the vertebral, tissue, and ligament damage indicated by the results of the MRI or CT scan of the injured spinal area. Constant follow up with your primary care physician, general practitioner, pain management specialist, and neurosurgeon are important.
Radiculopathy (Pinched Nerves)
Radiculopathy is a condition that accompanies all spinal cord injuries. It can be caused by the narrowing of the foramina (space where the nerves exit the spinal column and innervate the muscles), spinal stenosis, bone spurs, herniated discs, etc. It occurs when one or more nerves are affected or do not work properly. Chronic radicular pain results in muscle weakness, difficulty controlling extremities, and numbness.
Treatment for radiculopathy is to find the underlying cause by following up with your primary care physician or general practitioner to order X-rays and an MRI or CT. Gabapentin or Lyrica will be helpful in managing neuropathic pain. However, if pain is intolerable, a referral to a pain management specialist is necessary for epidural steroid injections (ESIs). If there is severe nerve impingement or compression present, and the patient has a severe decline in neuromuscular function, a neurosurgeon consult is necessary.
Complex Regional Pain Syndrome (CRPS)
Complex Regional Pain Syndrome (CRPS) consist of multiple symptoms of pain that includes allodynia (sensitive to touch), hyperalgesia (increased sensitivity to pain), and possible loss of function. CRPS is very rare and is seen mostly in the lower extremities and occurs in more females than males. The best treatment plan for complex regional pain syndrome is to continue to have improved function. This is accomplished by physical therapy, management of depression and anxiety that may accompany the condition, and the use of Gabapentin, Lyrica, or Amitriptyline for managing neuropathic pain.
Phantom Pain and Amputation
People who have had an extremity amputated (hands, arms, fingers, toes, breasts, legs) will experience phantom pain. Phantom pain is not a mental health issue; however, chronic pain can affect amputees mentally, physically, and socially. Phantom pain is a sensation that amputees feel after having a body part removed. Researchers believe that the underlying cause of phantom pain is the regeneration of new nerves in response to the nerves that were severed during the amputation. New amputees will experience this pain (sharp, stabbing, dull, throbbing, or burning) a few hours after the amputation. The pain may be continuous or intermittent and felt distally to the missing extremity. Strong support groups, physical therapy, pain management, counseling, and education are extremely important.
References
American Chronic Pain Association. (n.d). Neuropathic Pain. Retrieved from https://www.theacpa.org/conditions-treatments/conditions-a-z/neuropathic-pain/
Cliparea. (2019). Spine injury pain in sacral and cervical region concept.