Defined as ‘Pain initiated or caused by a primary lesion or dysfunction of the nervous system’
Signs and symptoms
- Electric shocks
Neuropathic pain assessment tools are available to aid diagnosis e.g. LANSS (via Intranet link to chronic pain service).
Consider possibility of serious underlying pathology and refer for investigation as indicated.
Examples of Neuropathic pain
- Post Herpetic neuralgia (PHN)
- Peripheral neuropathy (e.g. diabetic, viral, alcohol, drug/chemotherapy related)
- Trigeminal neuralgia
- Nerve root pain
- Post surgical
- Phantom limb pain
- It is important to establish a diagnosis and explain implications and chronicity to the patient and the importance of compliance with treatment.
- Effective treatment is considered as 30% reduction in pain score and/or improved function.
- Discuss benefits and possible adverse effect of pharmacological treatments including the importance of titration and review.
- Distinguish analgesic from antidepressant or anti epileptic drug activity.
- Simple analgesics and non steroidal anti-inflammatory drugs (NSAIDS) are usually ineffective.
- Start low and go slow.
- Explain that side effects may improve with time.
- Allow 8 weeks of maximum tolerated dose before effects judged and medication stopped.
- If one drug is ineffective it should be stopped and an alternative option commenced. If however one drug is partially effective consider adding a second drug rather than substituting.
- Medicines can be discontinued immediately if the patient is still having their medication titrated up and a significant side effect occurs.
- Patients should be weaned off medication gradually when discontinuing.
- Carry out regular assessment of effectiveness of treatment during titration period – including assessment of pain control, impact on lifestyle, daily activities and participation, physical and psychological well being ; adverse effects; continued need for treatment.
- There is increased awareness of the abuse potential of anti neuropathic medications and caution and increased supervision should be exercised when initiating in someone with addiction behaviours.
- Encourage self Management and provide education.
- Discuss coping strategies for flare ups.
- Patient may require further support from a chronic pain management specialist.