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Neuropathic Pain

Michael J. Arnold, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Defined as pain caused by direct nerve injury

  • An injury to either the peripheral or central nervous system (CNS) can lead to neuropathic pain.

  • Can exist without ongoing disease

  • Can aris...

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) (2),(3)[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
van Hecke O, Austin SK, Khan RA, et al. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain.  2014;155(4):654–662. [View Abstract on OvidM...

ADDITIONAL READING

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

  • Baron R, ...

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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