Neuropathic pain
2009
One of the major obstacles in the effective treatment and management of back pain is the difficulty in accurately diagnosing its cause
The problem of back pain is one which affects over 20 million people in the UK each year. One of the major obstacles in the effective treatment and management of back pain is the difficulty in accurately diagnosing its cause. It can either be caused by a mechanical factor such as a muscle injury or by a neuropathic problem. Neuropathic pain is caused by physiological changes in or damage to the nerves of the central and peripheral nervous system. An example of neuropathic back pain is seen with sciatica. This is a series of symptoms, including sharp pain in the lower back, buttocks and legs caused by compression and/or damage of the sciatic and surrounding nerves. These nerves run from the lower back to the lower legs.
The precise number of cases of back pain that can be attributed to a neuropathic cause is currently unknown due to difficulties in diagnosing it. However, estimates suggest that anywhere between 8-16% of those suffering from back pain have pain of neuropathic origin.
Although most neuropathic pain does not appear to respond well to standard treatments such as Non Steroidal Anti Inflammatory Drugs (NSAIDs) or opioids, which provide little or variable relief for some people, there are some medications and treatments that appear to be of more help. The use of anti convulsant drugs which stabilise irritable nerve membranes and nerve blocking injections can offer relief for several weeks. Other treatments including acupuncture and other complementary therapies as well as Transcutaneous Electrical Nerve stimulation (TENs) which uses electrical current to control pain, may also be effective. Furthermore, surgery can also provide relief for some but this option should be sought as a last resort. Sciatica sufferers for example can undergo surgery to decompress the sciatic nerve in the hope of easing the pain. In cases where the neuropathic pain is caused by another disorder such as diabetes, management of the disease becomes most important in controlling the pain. Although all these treatment options offer some relief to some people, most will suffer for long periods of time, going through many unsuccessful treatments before finding the one that may benefit them.
Current diagnostic methods including x-rays and MRI scans may not identify a physiological problem as it may not be observable
This difficulty in treating neuropathic back pain stems from the difficulty in diagnosing it. Current diagnostic methods including x-rays and MRI scans may not identify a physiological problem as it may not be observable. Even if the damage is observable and the problem can be rectified the pain may persist. Often with neuropathic pain, even after the initial nerve damage that caused the pain is resolved, the pain signals to the brain are still sent and the pain remains. The mechanisms and reason behind this is still a topic of much research.
Diagnosis usually involves an interview and an exam with some simple tests to identify components of neuropathic pain such as abnormal sensation (but these in no way offer a comprehensive indicator of neuropathic pain). The pain characteristics of neuropathic pain may offer some diagnostic scope as pain of neuropathic origin is usually described as a sharp, shooting, burning pain with some experiencing tingling and numbness, but again this does not act as a definitive diagnosis.
new diagnostic system known as the Standardised Evaluation of Pain (StEP) method can be done in 10-15 minutes
But there is hope on the horizon for those who suffer from neuropathic pain. A recently published study claims to have developed a new method to accurately differentiate between pain of neuropathic origin and pain caused by other factors. This new diagnostic system known as the Standardised Evaluation of Pain (StEP) method can be done in 10-15 minutes. It used a questionnaire of 16 questions and a series of 10 physical tests to establish patterns common to those suffering from neuropathic pain. These commonalities were then used to differentiate between those suffering from neuropathic pain and those with pain of a different cause. Results were very promising with the StEP method appearing to be better at identifying neuropathic pain than standard screening tools and Magnetic Resonance Imaging (MRI).
The development of such a diagnostic tool could lead to better diagnosis of neuropathic pain and consequently better treatment. If neuropathic pain could be diagnosed sooner, then people affected by it would not have to suffer for a long time before finding a suitable treatment. The treatment options known to be beneficial for neuropathic pain could then be offered immediately and the ineffective options ignored.
NICE are currently developing a clinical guideline on how to treat neuropathic pain
Steps are also being taken to govern the way those with neuropathic pain are treated. The National Institute for Health and Clinical Excellence (NICE) is responsible for governing all treatment options within the NHS. They are currently developing a clinical guideline on how to treat neuropathic pain. One of BackCare’s Helpline volunteers Heather Wallace is a member of the guideline development group representing the views of people with back pain in the development of this guideline.
With these positive steps towards its diagnosis and treatment people suffering from neuropathic pain will find greater relief more quickly and be able to live their lives out from under the shadow of pain.