ARE YOU IN PAIN?

Neuropathic Pain

(Pain, Neuropathic; Nerve Pain; Pain, Nerve)

From the Health Library by Rebecca J. Stahl, MA

Definition

Neuropathic pain is a painful sensation that occurs due to damaged or poorly functioning nerves. The pain may be long-lasting.

Nervous System © 2011 Nucleus Medical Media, Inc.

Causes

This condition is caused by damaged nerve fibers that send pain signals to your brain. This happens even when there is no event to trigger the pain. For example, a person with neuropathic pain may experience a feeling of pins and needles when putting on socks.
Nerve damage may be caused by:

• Physical damage
• Chemicals
• The nerve not getting the vital nutrients needed to function
• Infection
• The body’s immune system attacking the nerves

Sometimes the cause of the nerve pain is unknown.

Risk Factors     

Certain conditions increase your risk of developing neuropathic pain, such as:

• Diabetes ( diabetic neuropathy)
• Shingles ( post-herpetic neuralgia)
• HIV infection (HIV sensory neuropathy)
• Amputation ( phantom limb pain)
• Alcoholism
• Vitamin deficiency
• Spinal cord disorder or injury
• Cancer
• Carpal tunnel syndrome
• Congenital (present at birth) conditions

Other risk factors include:

• Back surgery
• Chemotherapy
• Exposure to toxins or metals
• Certain medicines

Symptoms

Neuropathic pain may cause sensations of:

• Burning
• Stabbing
• Electrical shock
• Pins and needles/tingling
• Numbness

This pain may be constant or occur off and on throughout the day. The condition can interfere with daily activities, as well as sleep. In some cases, even the touch of a bed sheet can cause pain.
If you have any of these symptoms, talk to your doctor.

Diagnosis

Your doctor will:

• Ask about your symptoms and medical history
• Do a physical exam

You may be referred to a neurologist. This is a doctor who specializes in disorders of the nervous system. This doctor will do a neurological exam and other tests.
Depending on your condition, you may also be referred to a pain specialist who can help you manage your pain.

Treatment   

Talk with your doctor about the best treatment plan for you. Treatment options include:

Chiropractic care

Procedures

Your chiropractic doctor may recommend nerve decompression. If pressure on the nerve is causing pain, non surgical decompression can relieve it. This can help decrease the pain or make it go away completely.
If you are not getting relief from other treatments, your chiropractic doctor may recommend referral for:

• An injection of a nerve block—An anesthetic is injected into the painful area to block pain signals.
• Pain pump installation—A pain pump can be implanted into your body to deliver pain medicine.
• Nerve stimulators—This device is attached to the nerve and delivers electrical signals to control pain.
• Surgery can be done to block the damaged nerves from sending signals.

Medications

There are a number of medicines that have limited effectiveness for treating neuropathic pain. Some of these, like antidepressants, were created to treat other conditions. They have also been found to be marginally useful for treating nerve pain.
Examples of medicines used to treat symptoms of peripheral neuropathy include:

• Anticonvulsants
• Antidepressants
• Opioid pain relievers
• Over-the-counter pain relievers (eg, acetaminophen, ibuprofen)
• Topical creams (applied to the skin) or patches (eg, capsaicin cream or a patch with lidocaine)

It may take a while for your doctor to find the right medicine for you. You may need to take a combination of medicines for pain relief.

Other Options

• Ask your doctor to recommend a safe exercise program. Being active will help your overall health.
• Work with your chiropractor or a therapist to help you cope with chronic pain. Joining a support group may also be helpful.
• Talk to your family and friends about your condition. They can offer help and understanding.
• Learn relaxation techniques, like meditation, to reduce stress.
• If you have an underlying condition, like diabetes, be sure to get proper treatment for it.

Prevention

You can reduce your chance of developing neuropathic pain by getting proper treatment for any spine movement problems or chronic conditions, such as diabetes.

RESOURCES:

American Chronic Pain Association
http://www.theacpa.org/default.aspx

National Pain Foundation
http://www.nationalpainfoundation.org/

CANADIAN RESOURCES:

Canadian Diabetes Association
http://www.diabetes.ca/

Canadian Pain Coalition
http://www.canadianpaincoalition.ca/

References:

Botez SA, Herrmann DN. Sensory neuropathies, from symptoms to treatment. Curr Opin Neurol . 2010;23(5):502-508.

Causes. Neuropathic pain. National Pain Foundation website. Available at: http://www.nationalpainfoundation.org/articles/740/causes . Accessed February 3, 2011.

Farrar J. Treating neuropathic pain and the neuropathic pain patient. The Transverse Myelitis Association website. Available at: http://www.myelitis.org/pain.htm . Updated April 18, 2010. Accessed February 3, 2011.

Injections. Neuropathic pain. National Pain Foundation website. Available at: http://www.nationalpainfoundation.org/articles/741/injections . Accessed February 3, 2011.

Medications. Neuropathic pain. National Pain Foundation website. Available at: http://www.nationalpainfoundation.org/articles/742/medications . Accessed February 3, 2011.

Neuropathic pain. American Chronic Pain Association website. Available at: http://www.theacpa.org/conditionDetail.aspx?id=29 . Accessed February 3, 2011.

Neuropathic pain. Merck Manuals Online Medical Library website. Available at: http://www.merckmanuals.com/professional/sec16/ch209/ch209c.html . Updated February 2007. Accessed February 3, 2011.

Types of neuropathic pain. The Neuropathy Association website. Available at: http://www.neuropa... . Accessed February 3, 2011.

Understanding nerve pain. American Chronic Pain Association website. Available at: http://www.theacpa.org/uploads/Final_Brochure.pdf . Published 2004. Accessed February 3, 2011.

Replacing Sweetened Drinks with Noncaloric Drinks May Aid in Weight Loss

From the Health Library

by Pamela Jones, MA

Weight loss is based on a simple equation of using more calories than you take in. And if you eat more calories then you burn, you will gain weight. Replacing a calorie rich drink (such as soda) with a noncalorie drink (such as water or diet soda) seems like a reasonable step toward decreasing the amount of calories you take in and helping with weight loss. However, some believe that noncaloric drinks may increase consumption of others foods either because a person isn't satisfied or they reward themselves for "being good". Weight loss efforts could be hampered if increased consumption of other foods occurred. However, this idea had never been tested in a rigorous study.
Researchers from the United States conducted a trial to help determine if replacing caloric beverages with water or noncaloric sweet drinks led to weight loss in people who were overweight. The trial, published in The American Journal of Clinical Nutrition, found that replacing caloric drinks with noncalorie options led to greater weight loss.

About the Study

The randomized trial included 318 adults who were overweight or obese. All the participants reported drinking at least 280 calories in sweetened drink products per day. This may include sugar sweetened beverages, juice, juice drinks, sweetened coffee, tea or milk, sports drinks or alcohol. The participants were then divided into three groups:

• Treatment group 1 - replace at least two drinks per day (200 calories or more) with noncaloric sweetened drinks
• Treatment group 2 - replace at least two drinks per day (200 calories or more) with water or noncaloric sparkling water
• Control group - offered advice about weight loss and made their own choices about weight control

At six months, 5% weight loss was achieved in:

• 19.5% with noncaloric beverage (group 1 and 2)
• 10.5% in control group

How Does This Affect You?   

Randomized trials are considered a very reliable method of research. These trials attempt to account for other influences that affect weight loss by splitting patients into a control group and a treatment group. This step can help to clarify that the outcomes are in fact related to the treatment. Most studies on benefits from noncaloric beverages are observational. Observational studies do not control for other factors that can affect weight loss or weight gain, which may lead to confusing outcomes.
The basic principal of this study was that replacing a regular beverage with a noncaloric beverage might help create a calorie deficit. The replacements may have lowered daily calorie intake by at least 200 calories with the replacement of a full calorie drink. If you are trying to lose weight, track your drinks for the day. If you have more than two drinks per day that are sweetened or sugary drinks, including fruit juices, consider substituting water or noncaloric drinks to help keep your calorie consumption in check. Small gradual changes like this may make dietary changes easier to swallow.

Resources:

American Dietetic Association
http://www.eatright.org/

The Obesity Society
http://www.obesity.org/

Sources:

Tate DF, Turner-McGrievy G, Lyons E, et al. Replacing caloric beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial. Am J Clin Nutr. 2012 Mar;95(3):555-63.