Patient Satisfaction With Neuropathic Pain
Introduction
Neuropathic pain is a complex, chronic pain state, most often accompanied by a tissue injury. According to various studies, neuropathic low back pain affects an estimated 5.6 million people in the US. A burning and shooting pain, along with a feeling of tingling and numbness, typically characterizes the condition.
The most common forms in which neuropathic pain manifests itself include:
- Postherpetic neuralgia
- Reflex sympathetic dystrophy/nerve trauma
- Components of cancer pain
- Phantom limb pain
- Entrapment neuropathy (.e.g. carpal tunnel syndrome)
- Peripheral neuropathy (vast nerve damage)
Treatment Modalities – Patient Satisfaction
In the further sections, we have discussed and analyzed the satisfaction experienced by various patients in context of the treatment modalities followed obtaining relief form neuropathic pain. These treatment options include:
- Anti-convulsant medication, such as carbamazipine, gabapentin, pregabalin
- Tri-cyclic anti-depressants, such as amitriptyline, dothiepin, clomipramine
- Anti-spasmodic, such as baclofen, diazepam
- NSAIDs, such as non-steroidal anti-inflammatory drugs
- Trans Electrical Nerve Stimulation (TENS)
- Opioids, capsicum cream
- Acupuncture, reflexology, aromatherapy, homeotherapy
- Bio-feedback/relaxation
Research and Analysis
Research conducted amongst various patient groups suffering from neuropathic pain indicated towards a high satisfaction level with the use of anticonvulsants. The drugs used amongst this group for the purpose of neuropathic pain primarily include carbamazepein, phenytoin, gabapentin and lamotrigine.
Adding on, for the neuropathic pain associated with conditions like trigeminal neuralgia, surgical procedures like Janetta procedure are also performed, with positive results. This procedure is performed to take the pressure off the trigeminal nerve by placing s mall cushion between it and a blood vessel.
Some patients suffering from neuropathic pain associated with conditions like phantom tooth pain, also report a positive effect of injections of local anesthetics and steroids. Patients suffering from such conditions have also reported a therapeutic effect of especially prepared creams and topical applications.
Another set of studies were also conducted to evaluate the impact of the drug gabapentin in reduction of the neuropathic pain. Results revealed that at least 75% of the patients included in the study reported a drastic reduction in the pain after the use of gabapentin.
Meanwhile, the serotonin specific reuptake inhibitors (SSRIs) have been found to have a lower satisfaction amongst the patients suffering from neuropathic pain. On the other hand, fluoxetine was also found to be effective in decreasing pain secondary to diabetic neuropathy, specifically in depressed patients.
In addition, venlafaxine has also been gaining popularity amongst the patients of neuropathic pain. The main reason for this is the fact that it combines the norepinephrine-reuptake, in the process inhibiting effects of TCAs with the serotonin-reuptake inhibiting effects of the SSRIs, but without the anticholinergic side effects.
Miscellaneous reports also reveal that treatment methods like TENS, diclofenac, sodium valporate and amitriptyline have indicated a low impact on the condition of neuropathic pain. On the other hand, medications like dexamethasone, methadone, ketamine and epidural analgesia have indicated a relatively higher impact level on neuropathic pain.
Complementary methods such as aromatherapy, massage and reflexology have also reported having moderately positive results, especially when combined with other forms of medications.
