Neuropathic pain

Neuropathic pain is a distinct category of chronic pain that arises from damage to, or dysfunction of, the nervous system itself — rather than from ongoing injury to tissues such as muscles, joints, or skin. The damaged or malfunctioning nerve fibres send abnormal signals to pain-processing centres in the brain, producing pain that persists even in the absence of any ongoing injury.

**What distinguishes neuropathic pain** from other types is its quality and associated features. It is characteristically described as burning, shooting, stabbing, or electric-shock-like. Two hallmark phenomena are particularly characteristic: - **Allodynia:** pain produced by stimuli that do not normally cause pain, such as the light touch of clothing or a gentle breeze - **Hyperalgesia:** an exaggerated, disproportionate pain response to stimuli that are ordinarily only mildly painful

**Common causes:** - Diabetic peripheral neuropathy (most common worldwide) - Postherpetic neuralgia (pain persisting after shingles) - Trigeminal neuralgia - Complex regional pain syndrome (CRPS) - Nerve compression: herniated disc, spinal stenosis, carpal tunnel syndrome - Multiple sclerosis - Spinal cord injury or stroke (central neuropathic pain) - Post-surgical or post-traumatic nerve damage - Chemotherapy-induced neuropathy - HIV-associated neuropathy

**Symptoms** depend on which nerves are affected and whether the damage is peripheral or central:

*Peripheral neuropathic pain:* - Gradual onset of numbness, tingling, or prickling in the feet or hands, spreading upward - Burning, jabbing, or shooting pain - Extreme sensitivity to touch (allodynia) - Muscle weakness or loss of coordination - Feeling of wearing gloves or socks that aren't there

*Autonomic involvement (if autonomic nerves are affected):* - Heat intolerance and abnormal sweating - Bowel, bladder, or digestive problems - Blood pressure fluctuations causing dizziness

**Phantom limb pain** — pain perceived in an amputated limb — is a form of neuropathic pain in which the brain continues receiving and misinterpreting signals from the severed nerve ends.

**Management** of neuropathic pain requires treating both the underlying condition (where possible) and the abnormal pain signalling itself. Standard pharmacological options include anticonvulsants (gabapentin, pregabalin), tricyclic antidepressants, and topical agents (lidocaine, capsaicin). When these prove inadequate, interventional approaches — spinal cord stimulation, pulsed radiofrequency, and neuromodulation — offer effective alternatives or complements.