Lower extremity neuropathic pain

Introduction 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. 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. Neuropathic pain refers to a pain syndrome caused by a primary lesion or dysfunction of the central or peripheral nervous system. It can be caused by injury to the peripheral nerve, the posterior root of the spinal cord, the spinal cord and other parts of the central nervous system caused by trauma or / and disease. According to the etiology, nature and extent of nerve injury, it is divided into two categories: central nervous system pain and peripheral nerve pain caused by peripheral nerve injury. Central nervous system pain is referred to as central pain. It is a primary pain caused by damage or dysfunction of the pain pathway of the central nervous system. It is common in spinal cord trauma or cerebrovascular disease, multiple sclerosis and tumor. Peripheral nerve pain is caused by trauma, ischemia, compression, infection, inflammation, metabolism and other factors, such as phantom limb pain, post-herpetic neuralgia, polyneuritis, and diabetic peripheral neuralgia. 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.

Cause

Possible causes include infections, tumors, metabolic diseases, chemotherapy, surgery, radiation therapy, neurotoxins, hereditary neurodegenerative diseases, nerve compression, inflammation, tumor exudation, and the like.

an examination

Related inspection

Nervous system examination CT examination angiography

Ask about medical history, systematic review, physical examination, neurological examination, appropriate laboratory tests such as blood serum tests, magnetic resonance imaging, and electrophysiological examinations.

Differential diagnosis

Lower limb sensation, muscle strength, and neurological abnormalities: The clinical manifestations of thoracic spinal stenosis are mainly a series of syndromes of blood supply circulation, sensory and motor conduction disorders of the thoracic spinal cord caused by chest insufficiency. The lower limbs feel abnormal, such as numbness, feeling slow, the feeling of cotton on the foot, and the appearance of the feeling plane. Lower extremity muscle strength, such as weakness, difficulty walking; lower extremity muscle tension, muscle tension, folding knife-like sputum; abnormal nerve reflex, such as knee, tendon reflexes active or hyperthyroidism, knee, hernia, Barbinskin sign positive. Symptoms of nerve root stimulation, such as chest and back banding, pain; spinal cord, cauda equina circulatory disorder, neurogenic intermittent claudication; sphincter dysfunction, difficulty in two stools; complete spinal cord compression, paraplegia, and incontinence.

Swelling and fatigue of the lower extremities: one of the symptoms of deep vein thrombosis. Those with the following characteristics can diagnose the Cockett syndrome:

1, more common in young and middle-aged patients.

2, continued swelling and fatigue of the lower limbs.

3, as the symptoms worsen, there will be severe lower extremity superficial varices.

4, Doppler ultrasound is helpful for diagnosis, venography can confirm the diagnosis.

Swelling severe pain occurs when the lower limbs are standing for a long time: it is a symptom of primary inferior venous valve insufficiency.

1. Most of them are long-term standing and strong physical labor, or the symptoms of saphenous vein exfoliation have not improved or short-term recurrence.

2. The affected limb is swollen, and there is swelling and severe pain when standing for a long time. Symptoms and signs of simple varicose veins of the lower extremities.

3. Intravenous pressure measurement, directional Doppler ultrasonography is helpful for diagnosis.

4. Venous angiography

1 antegrade angiography. The trunk of the deep vein expands in a tubular shape, losing the formation of a bamboo joint, and the valve shadow is blurred, often accompanied by superficial vein dilatation.

2 retrograde angiography. Can determine the valve function: Grade I - the valve is functional, calm breathing without contrast agent to the far side; II - mild valve insufficiency, a little contrast agent reflux, no more than the proximal thigh; III, IV - moderate valve function Incomplete, contrast agent reflux, respectively, to the knee and knee, but there is still a considerable contrast agent to return to the Han; V-level - severe valve insufficiency, most or all of the contrast agent countercurrent, straight to the ankle.

Symptoms of lower extremity radiation pain: can be along the lower back, buttocks, the back of the thigh, the front of the calf or the posterior lateral to the heel. The nature of pain is mainly radioactive sting. Radiation pain in the lower extremities can occur before low back pain or after the onset of low back pain. These two conditions vary from person to person.

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