Chronic neuropathic pain: Features, diagnosis and treatment

The article was professionally consulted with Master, Doctor Bui Ngoc Phuong Hoa - Neurologist - Department of Medical Examination & Internal Medicine - Vinmec Danang International General Hospital.

Chronic neuropathic pain is common in millions of people around the world. Early treatment of chronic neuropathic pain improves symptoms of discomfort and improves the patient's quality of life.

Pain is an unpleasant sensation involving tissues. Pain sensations include acute pain and chronic pain. Acute pain is pain that is intense but lasts for a short time, usually due to trauma, internal disease, pain time is usually less than 4 weeks and will go away when the wound heals. Chronic pain is pain that lasts longer than acute pain, usually up to 3-6 months, can be mild, dull or intense pain, pain from any cause.
Nerve pain characterized by aching and stinging sensations. The patient may experience pain, numbness, tingling, or a tingling sensation in the limbs.

Peripheral neuropathic pain: Mainly due to uncontrolled diabetes complications, vitamin deficiencies, effects of drugs and toxins, human immunodeficiency virus (HIV), paralytic syndrome hereditary cancer and neurological diseases; CNS pain: Pain after stroke, pain due to myelopathy such as trauma, multiple sclerosis, spinal cord diseases and HIV-associated disease.

Acetaminophen (or paracetamol): Used for a short time, can reduce nerve pain. Dosage is 500 - 1,000 mg every 6 hours, taken orally. Do not use the drug with a dose of 4g / day. This drug has few side effects, but if taken too much in high doses can lead to liver failure. Subjects using specific drugs will be recommended by a specialist; Tramadol: Used to relieve moderate to severe pain. The maximum total daily dose is 400mg/day. Tramadol should be used with caution in patients with epilepsy or when combined with selective serotonin reuptake inhibitors because of the potential for seizures (rarely). Other common side effects of Tramadol are nausea, drowsiness, and sweating. Overdosage can lead to respiratory failure; Non-steroidal anti-inflammatory drugs (NSAIDs): used to relieve moderate pain, especially in patients with pain caused by inflammation. Patients can use Celecoxib or Rofecoxib. However, they have little effect on people with neuropathic pain and chronic pain. Patients should be careful not to use NSAIDs for more than 4 weeks. Regarding side effects, NSAIDs can cause allergies, affect digestion, kidney failure, heart failure and high blood pressure; Antidepressants: are the most effective medications for chronic neuropathic pain. Antidepressants that can be used for patients are Amitriptyline, Citalopram, Venlafaxine, Duloxetine and Paroxetine with appropriate doses as prescribed by the doctor. Side effects of these drugs may include drowsiness, nausea, dry mouth, constipation, orthostatic hypotension, urinary retention, and narrow-angle glaucoma. In addition, patients taking the drug may experience arrhythmias, especially those who have recently had a myocardial infarction; Antiepileptic drugs: used to relieve neuropathic pain. Commonly used drugs are Pregabalin, Carbamazepine, and Gabapentin. Some of the less commonly used drugs include Phenytoin, Sodium Valproate, and Lamotrigine. Carbamazepine is used to treat pain in the trigeminal neuralgia, glossopharyngeal nerve, and occipital nerve.
- Gabapentin helps to relieve diabetic peripheral neuropathy and other neuropathic conditions.
- Pregabalin has the effect of reducing neuropathic pain caused by diabetes, shingles, pain due to spinal injury, stroke, fibromyalgia,...
- Lamotrigine relieves trigeminal neuralgia, pain due to column injury live and other types of neuralgia.
Side effects of antiepileptic drugs include: Drowsiness, nausea, double vision, dizziness, rash, hyponatremia, liver or bone marrow toxicity.

If pharmacological treatment of pain is not effective, the patient with chronic neuropathic pain is examined, the cause of the pain is determined, and surgery may be indicated. Surgical procedures performed include: Spinal decompression, stimulation in gray matter, spinal cord and basal ganglia. Nerve exploration and nerve decompression will be performed by experienced surgeons.
Electrical stimulation and the use of low-frequency waves are also used for chronic limb and spinal pain.
In addition, in some cases, injection is also indicated in the spinal canal (intradural). Only morphine is currently approved for this purpose.
Chronic neuropathic pain is a condition that seriously affects a patient's quality of life. Therefore, when there are symptoms of pain, the patient should immediately go to the doctor for timely and effective treatment.

Periodic health check-ups help detect diseases early, thereby planning treatment for optimal results. Currently, Vinmec International General Hospital has general health checkup packages suitable for each age, gender and individual needs of customers with a reasonable price policy, including:
General health checkup package diamond Vip General Health Checkup Package Special General Health Checkup Package Comprehensive General Health Checkup Package Standard General Health Checkup Package Patient's examination results will be returned to your home. After receiving the results of the general health examination, if you detect diseases that require intensive examination and treatment, you can use services from other specialties at the Hospital with quality treatment and services. outstanding customer service.
If you have a need for consultation and examination at the Hospitals of the National Health System, please book an appointment on the website for the best service.