Neuropathic pain is a serious chronic condition that adversely affects the quality of life, but can only be relieved without being cured. It is a pain resulting directly from a lesion or disease of the somatosensory system (Jongen, Hans, Benzon, Huygen & Hartrick, 2014). Neuropathic pain denotes alteration or damage of the usual modulating and sensing systems. It results from any injury that occurs in the "descending and ascending nerve pathways from the peripheral nociceptors to the cortical neurons in the central nervous system (CNS" (Blumstein & Barkley Jr, 2015). Neuropathic pain's estimated prevalence is at least 1% to 5% of the general population (Blumstein & Barkley Jr, 2015). Nonetheless, despite the significance of this disease, diagnosis, and treatment is still problematic. While there needs to be more research to comprehend how to diagnose and treat neuropathic pain, it is difficult to diagnose and treat neuropathy because the understanding of what causes this pain needs more research, diagnosing the cause of the pain is not definitive, and understanding the mechanisms of the pain is difficult.
There are several diagnostic tests used to investigate nociceptive and non-nociceptive somatosensory pathways among patients suffering from neuropathic pain. At the moment, mostly used tools include quantitative sensory testing (QST), standard neurophysiological techniques, microneurography, skin biopsy, and laser-evoked potentials (LEPs) and related techniques (La Cesa et al., 2015). However, the most commonly used tools out of those listed above are the standard neurophysiological techniques such as the somatosensory evoked potentials, nerve conduction studies and trigeminal reflexes including the blink reflex. All these tools assess mass non-nociceptive afferent fibers which are commonly used for examining central and peripheral nervous system diseases (La Cesa et al., 2015). However, provided the fact that most experimental and clinical studies showed that neuropathic pain is largely related to nociceptive pathway damage, it can be reasonably argued that the "neurophysiological assessment of large non-nociceptive afferent fibers does not contribute to the diagnosis of neuropathic pain" (La Cesa et al., 2015). This is in part due to the nature of the neuropathic pain occurring "from any injury that occurs in the descending and ascending nerve pathways from the peripheral nociceptors to the cortical neurons in the central nervous system (CNS)" (Blumstein & Barkley Jr, 2015). In other words, the pain can occur anywhere in the nervous system making it difficult for techniques that assess the non-nociceptive afferent fibers to detect the ailment. As such, no gold standard for accurately diagnosing neuropathic disease has been established.
Also, the challenge to the diagnosis of neuropathic pain emerges where the accuracy depends on the cooperation of the patient. According to Jongen et al. (2014), a sensory examination to diagnose neuropathic pain is subjective, meaning that accuracy relies on patient reliability and cooperation. For example, altered sensation on the lateral or anterior side of the right leg of a patient with black pain does not always indicate neuropathic pain (Jongen et al., 2014).
Furthermore, diagnosing the cause of the pain in neuropathic pain is not definitive in the sense that the disease results from "any" injury that occurs in the ascending and descending nerve pathways. The injury can be located anywhere between the peripheral nociceptors to the cortical neurons in the central nervous system (Blumstein & Barkley Jr, 2015). Neuropathic pain can result from various causes of the pain hence not definitive. For instance, neuropathy can result from the toxic effect of glucose on the nerve cells. This is the main cause of neuropathic pain among diabetic patients. At the same time, neuropathic pain can be caused by chemo-radiation for cancer treatment. Neuropathic pain usually occurs when the central and peripheral nerve redevelopment is damaged thus altering the normal nerve functioning. This is because the damaged nerves have increased excitability and fire spontaneously eliciting pain signals (Blumstein & Barkley Jr, 2015). Now, assuming that a patient who is diabetic is subjected to chemo-radiation and neuropathic pain results, it may not be easy to define the cause as there are two potential causes involved in the scenario.
Similarly, the mechanism of pain, although explained as "damage to nerves" is not difficult to apprehend because neuropathic pain is characterized by more than one phenomenon. According to Jongen et al. (2014), neuropathic pain is characterized by two phenomena: abnormal impulse generation and increased sensitivity of neurons. Increased sensitivity of neurons takes place in the neurons of the central nervous system as well as in the primary afferent neurons. In abnormal impulse generation, there is increased sensitivity in the injured region itself. Nonetheless, in recent days, glial cells have been established to play a role in the initiation and maintenance of spinal neuropathic pain mechanisms (Jongen et al., 2014). This new realization casts doubt on the earlier documented pathophysiology of neuropathic pain as well as complicates the actual mechanism of pain.
Diagnosis and treatment of neuropathic pain are not much effective owing to the fact that no single cause is responsible for the pain as well as the fact that the mechanism of pain is not well apprehended. There is no gold standard technique for diagnosing neuropathic pain because the disease can occur in different parts of the CNS where certain techniques cannot work. The fact that the mechanism of the pain is still an area that researchers are yet to explain fully shows the complexity in understanding the causes and pathophysiology of neuropathic pain. As such, more research is still needed to understand the entire process of the disease from definitive causes to diagnosis.
Blumstein, B., & Barkley Jr, T. W. (2015). Neuropathic pain management: a reference for the clinical nurse. Medsurg Nursing, 24(6), 381.
Jongen, J. L., Hans, G., Benzon, H. T., Huygen, F., & Hartrick, C. T. (2014). Neuropathic pain and pharmacological treatment. Pain Practice, 14(3), 283-295.
La Cesa, S., Tamburin, S., Tugnoli, V., Sandrini, G., Paolucci, S., Lacerenza, M., ... & Truini, A. (2015). How to diagnose neuropathic pain? The contribution from clinical examination, pain questionnaires and diagnostic tests. Neurological Sciences, 36(12), 2169-2175.
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