Abstract
Neuropathic pain is defined as a painful condition caused by neurological lesions or diseases. Sometimes, neurological disorders may also be associated with neuropathic pain, which can be challenging to manage. For example, multiple sclerosis (MS) may cause chronic centralized painful symptoms due to nerve damage. Other chronic neuropathic pain syndromes may occur in the form of post-stroke pain, spinal cord injury pain, and other central pain syndromes. Chronic neuropathic pain is associated with dysfunction, disability, depression, disturbed sleep, and reduced quality of life. Early diagnosis may help improve outcomes, and pain control can be an important factor in restoring function. There are more than 100 different types of peripheral neuropathy and those involving sensory neurons can provoke painful symptoms. Accurate diagnosis of peripheral neuropathy is essential for pain control. Further examples are represented by gluten neuropathy, which is an extraintestinal manifestation of gluten sensitivity and presents as a form of peripheral neuropathy; in these unusual cases, neuropathy may be managed with diet. Neuropathic pain has been linked to CoronaVirus Disease (COVID) infection both during acute infection and as a post-viral syndrome known as long COVID. In this last case, neuropathic pain relates to the host’s response to the virus. However, neuropathic pain may occur after any critical illness and has been observed as part of a syndrome following intensive care unit hospitalization.
Highlights
BackgroundNeuropathic pain affects about 3-17% of the general population [1] and is characterized by positive and negative aspects [2]
Neuropathic pain has been defined as a consequence of certain endocrine dysfunctions, viral infections, trauma, and as a treatment-emergent effect, among others
Neuropathic pain has been associated with cancer or neurologic disorders [e.g., multiple sclerosis (MS), stroke, centralized pain syndromes]
Summary
Neuropathic pain affects about 3-17% of the general population [1] and is characterized by positive (extra sensation perceived by the patient, such as pain, paresthesia, numbness, and tingling) and negative aspects (loss of functions such as sensory, motor, and cognitive deficits) [2]. Analgesic regimens for peripheral neuropathy are similar to those used for other types of neuropathic pain: multimodal analgesic therapy involving anticonvulsants, antidepressants, opioids, and NSAIDs. Nonpharmacological treatments may be helpful for some patients as well and may be combined with pharmacologic regimens [47]. Many patients with chronic neuropathy are already taking medications for comorbidities, so combination therapy must be viewed cautiously [94] In this connection, it is important to avoid prescribing two or more drugs with similar adverse events, such as central nervous system depression [92]. In addition to neuropathic symptoms that may occur during acute or postviral COVID, the treatments to which patients are subjected may further contribute to certain neuropathic pain syndromes.
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