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Neuropathic Pain

Michael J. Arnold, MD Reviewed 06/2020
 


BASICS

DESCRIPTION

  • Defined as pain caused by direct nerve injury in either peripheral or central nervous system

  • Can exist without ongoing disease

  • Can arise from damage to nerve pathways at any point from...

DIAGNOSIS

Diagnosis is based primarily on history (e.g., underlying disorder and distinct pain qualities) and the findings on physical examination (e.g., pattern of sensory disturbance) (1,2)[C]. 

HISTORY

TREATMENT

GENERAL MEASURES

  • Due to multiple neuropathic pain pathways, all medications have limited efficacy and minority of patients have significant benefit at tolerable doses.

  • Physical and occupationa...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Multidisciplinary team

  • Periodic evaluation to rule out other treatable conditions

Patient Monitoring

  • Pain management requires ongoing evaluation, patient education, ...

REFERENCES

1
Fillingim RB, Loeser JD, Baron R, et al. Assessment of chronic pain: domains, methods, and mechanisms. J Pain.  2016;17(Suppl 9):T10–T20.
2
Gilron I, Baron R, Jensen T. Neuropathic pain...

ADDITIONAL READING

  • Attal N, Bouhassira D. Pharmacotherapy of neuropathic pain: which drugs, which treatment algorithms? Pain.  2015;156(Suppl 1):S104–S114.

  • Orhurhu V, Orhurhu MS, Bhatia A, et al. ...

CODES

ICD10

  • M79.2 Neuralgia and neuritis, unspecified

  • E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unsp

  • E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unsp

  • G54.6 Phantom limb syndr...

CLINICAL PEARLS

  • Neuropathic pain is a common syndrome, affecting up to 10% of the population with major impacts on quality of life.

  • Due to numerous mechanisms in neuropathy, potential benefit from any ...

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