Nerve pain

Introduction Neuropathic pain: According to the pathological mechanism of pain, chronic pain can be classified into nociceptive or inflammatory pain (appropriate response to painful stimuli) and neuropathic (pathological) pain (inappropriate response induced by damage to the nervous system). The International Association for Pain Research (IASP, 1994) defines neurogenic pain as "pain caused by primary or secondary damage or dysfunction or transient disturbance in the peripheral or central nervous system"; neurological (pathological) The neuropathic pain is deleted from the four words of transitory perturbation; however, there is no significant difference between the two in clinical practice and they can be used interchangeably.

Cause

Neuropathic pain has always been a problem that plagues the medical community: the pathogenesis is unclear, opioids are not effective, and patients are very painful. In recent years, with the development of molecular biology and electrophysiological techniques, people have gradually recognized the complex pathological mechanism of neuropathic pain and provided new ideas and methods for treatment.

an examination

Related inspection

Electromyography F-wave

Characteristics of neuropathic pain:

Symptoms unrelated to stimulation (described by patient)

1. Spontaneous pain (resting especially at night): persistent burning, intermittent tingling, electric shock, and beating pain.

2, feeling abnormal: there is no objective reason for abnormal feeling on the skin.

3, feeling slow: feel pain in the skin numb area.

Related to stimulation (stimulation induced)

1. Allodynia - Pain in normal, painless stimuli.

2, hyperalgesia (Hyperalgesia) - increased pain response or persistent pain.

The above symptoms can be improved during the activity or during cold compresses, and can be aggravated after activities or fatigue; the rest of the symptoms worsens at night.

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Intense radiculopathy: Cervical spondylotic radiculopathy refers to the degenerative changes of the cervical intervertebral disc and the secondary clinical manifestations of the pain caused by the nerve root compression caused by the nerve root compression. In its etiology, the degenerative change of cervical disc is the most important cause of the pathogenesis of cervical spondylosis. On this basis, it causes a series of secondary pathological changes, such as intervertebral disc herniation, posterior margin and lateral margin of adjacent vertebral bodies. The formation of spurs, the hypertrophy of the facet joints and the hook joints, the thickening of the ligamentum flavum and the formation of folds into the spinal canal. These pathological factors and the intervertebral discs are interdependent and mutually influential, and can form pressure on the cervical nerve roots, thereby producing Clinical symptoms. Previous treatment of cervical spondylotic radiculopathy is relatively simple, conservative treatment only physical therapy, drugs and traction, conservative or ineffective patients can only face surgery. The emergence of laser and ozone fills the gap between conservative and surgery, but because of its narrow indications, there are still many patients who cannot get rid of pain. Our hospital treats more than 200 cases of radiculopathy with cervical spondylosis every year. The effect of radiofrequency treatment is remarkable, and the cure rate is over 96%.

2. Trigeminal nerve one or two branches of regional pain: the clinical manifestations of cavernous sinus meningioma may have pain in the first or second branch of the trigeminal nerve. The cavernous sinus is a relatively complex and complex anatomical region of the skull that contains important arteries and cranial nerves. Broadly speaking, all meningiomas that invade the cavernous sinus belong to this category. Such as sphenoid ridge medial meningioma, saddle nodule meningioma, middle cranial meningioma.

3. Intercostal neuralgia: Intercostal neuralgia, also known as intercostal neuritis, is a group of symptoms, refers to the damage of the thoracic nerve root (ie intercostal nerve) for different reasons, such as: thoracic degeneration, thoracic tuberculosis, thoracic spine injury , thoracic dural meningitis, tumor, ankylosing spondylitis and other diseases or ribs, mediastinum, pleural lesions, intercostal nerves are subjected to the above-mentioned diseases, oppression, stimulation, inflammatory reaction, and appear in the chest intercostal or abdomen Symptoms of pain.

Intercostal neuralgia is a recurrent pain that occurs in one or more intercostal areas and is exacerbated. Primary intercostal neuralgia is rare, and secondary infections are associated with viral infections, toxin stimulation, mechanical damage, and foreign body oppression. The pain is mostly stinging or burning and is distributed along the intercostal nerves.

4. Sciatica: Sciatica refers to sciatic neuropathy, a group of painful symptoms that occur along the sciatic nerve pathways, ie, the back of the waist, buttocks, the back of the thigh, the posterior aspect of the lower leg, and the lateral side of the foot. The sciatic nerve is the main nerve trunk that governs the lower extremities. Sciatica refers to pain in the sciatic nerve pathway and its distribution (hip, back of the thigh, posterior aspect of the calf, and lateral aspect of the foot).

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