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NEUROPATHIES
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Neuropathy is a disease or disorder especially a degenerative one, that effects the nervous system. It is usually short for peripheral Neuropathy. Peripheral Neuropathy is defined as deranged function and structure of peripheral motor, sensory, and autonomic neurons, involving either the entire neuron or selected levels.
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Neuropathy Pain Conditions
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- 7 Categories of Neuropathy pain
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Neuropathy and Neuropathic pain are Symptoms of a hundred different diseases that have injurious effects on normal neurological functioning. These conditions are typically treated by many types of medical professionals; neurologist, pain management, anesthesiologist, Rheumatologist, physical therapist and more. Each professional focuses on one or a few aspects of the contributory development like cancer or diabetes or peripheral Neuropathy. Pain specialists must eventually deal with the common presentations of permanent neurological damage. Once the cellular damage occurs, reversing the disease state becomes almost impossible.
At the stage of Neuropathic pain diagnosis, analgesic treatment is often the only option. As the bio-mechanical make up of these conditions are found and documented new treatment modalities will improve the chances of eliminating of the pain and possibly the condition causing the pain. At this time effective treatment modalities are rare, but some patients are finding successes such as lower pain levels or even remission. The goal of treatments should be to understand the physiological system of the condition and then working to prevent permanent painful Neurological transformations.
7 Major Categories of Neuropathy Pain include:
Toxic
Toxic Neuropathy is typically the result of Chemo-radiation in the treatment of cancer. Other causes are found in tuberculosis patients who receive Isoniazid, a colorless crystalline compound, and thallium, a soft highly toxic white metallic element. Toxic exposure is generally a results in an abnormal and often inherited improper protein processing when a person is exposed to harmful chemicals. Whether it be from a purposeful exposure like Chemo or environmental exposures such as arsenic or lead.
Metabolic
Metabolic Dysfunction Neuropathy pain is typically seen in Diabetes patients. Other causes are Nutritional deficiencies. This can be low Vitamin B1 typically seen with alcohol induced Neuropathy in the case of diabetes and inhibiting of axonal, sodium, potassium and atpase (an enzyme that aids in the breakdown of ATP into ADP with a release of energy) axonal transport producing nerve cell degeneration .
Trauma
Trauma can result in phantom limb syndromes and/or Reflex Sympathetic Dystrophy Syndrome (RSD/CRPS). Amputee pain is thought to be a result of abrupt loss of sensory input from the limb to the brain. The pain is felt at discharges stemming from the nerve endings at the sight of the amputation that continue to send pain signals to the brain, making the brain think the limb is still there. Trauma or insults to the body, be it big or small, that do not heal correctly have been suggested as the cause of RSD , including dysfunctional processing throughout the entire nervous system involving peripheral, central and autonomic nerve systems.
Compressive/Entrapment
Carpal tunnel syndrome and compartment syndromes are common entrapment injuries. The excessive external pressure on nerve axon (transmits impulses outward from the cell body) can cause an inadequate supply of blood to the part of the body or stretching changes. Prolonged injury results not only in pain but we see a resultant muscle atrophy in patients with this type of injury.
Autoimmune
Autoimmune Neuropathic pain conditions include Polyneuropathy (the loss of the fatty covering myelin of the nerve fibers) and Vasculitic Neuropathy (relating to blood vessels). A patient may have an autoimmune antibodies involved in the disturbance of function that a disease causes in an organ, as distinct from any changes in structure that might be caused. These are usually modifiable with immune therapy (IVIG).
Infectious
Viral conditions are known to result in long-standing Neuropathic pain. Conditions in this category are Post-Herpetic Neuralgia, Lyme Disease, Leprosy, HIV and Post-infectious patients.
Congenital/Hereditary
Inherited genetic diseases such as Fabry’s Disease and Charcot-Marie-Tooth Disease are good examples of peripheral Neuropathic pain associated with congenital abnormalities.
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- Peripheral Neuropathy
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Peripheral Neuropathy
The name of the condition tells you a bit about what it is:
Peripheral: Beyond (in this case, beyond the brain and the spinal cord.)
Neuro-: Related to the nerves
-pathy: Disease
Put these concepts together and this is what peripheral Neuropathy means: It refers to the conditions that result when nerves that connect to the brain and spinal cord from the rest of the body are damaged or diseased.
The peripheral nerves make up an intricate network that connects the brain & spinal cord to the muscles, skin, and internal organs. Peripheral nerves come out of the spinal cord and are arranged along lines in the body called Dermatomes. Typically, damage to a nerve will affect one or more Dermatomes, which can be tracked to specific areas of the body. Damage to these nerves interrupts communication between the brain and other parts of the body and can impair muscle movement, prevent normal sensation in the arms and legs, and cause pain.
Peripheral Neuropathy describes damage to the peripheral nervous system, the vast communications network that transmits information from the brain and spinal cord (the central nervous system) to every other part of the body. Peripheral nerves also send sensory information back to the brain and spinal cord, such as a message that the feet are cold or a finger is burned. Damage to the peripheral nervous system interferes with these vital connections. Like static on a telephone line, peripheral Neuropathy distorts and sometimes interrupts messages between the brain and the rest of the body. Because every peripheral nerve has a highly specialized function in a specific part of the body, a wide array of symptoms can occur when nerves are damaged. Some people may experience temporary numbness, tingling, and pricking sensations (Paresthesia), sensitivity to touch, or muscle weakness. Others may suffer more extreme symptoms, including burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction.
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- Autonomic Neuropathy
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Autonomic Neuropathy is a group of symptoms caused by damage to nerves that regulate blood pressure, heart rate, bowel and bladder emptying, digestion, and other body functions.
Autonomic Neuropathy is a form of peripheral Neuropathy. Autonomic Neuropathy is a group of symptoms, not a specific disease.
Autonomic Neuropathy involves damage to the nerves that run through a part of the peripheral nervous system. The peripheral nervous system includes the nerves used for communication to and from the brain and spinal cord (central nervous system) and all other parts of the body, including the internal organs, muscles, skin, and blood vessels.
Damage to the autonomic nerves causes abnormal or decreased function of the areas connected to the problem nerve. For example, damage to the nerves of the gastrointestinal tract makes it harder to move food during digestion (decreased gastric motility). Damage to the nerves supplying blood vessels causes problems with blood pressure and body temperature.
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- Causalgia
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Causalgia is intense burning pain and sensitivity to the slightest vibration or touch, usually in the hand or foot, at a site some distance removed from a wound that has healed. This phenomenon was first described in 1872 by the American neurologist Silas Weir Mitchell. Now this is typically know as Reflex Sympathetic Dystrophy Syndrome or Complex Regional Pain Syndrome.
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- Diabetic Neuropathy
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Diabetic Neuropathy is a disorder associated with diabetes mellitus. These conditions are thought to result from diabetic micro vascular injury involving small blood vessels that supply nerves. Relatively common conditions which may be associated with diabetic Neuropathy include third nerve palsy; Mononeuropathy; Mononeuropathy multiplex; Diabetic Amyotrophy; a painful Polyneuropathy; Autonomic Neuropathy; and Thoracoabdominal Neuropathy. Diabetes is the leading known, cause of Neuropathy in developed countries, and Neuropathy is the most common complication and greatest source of morbidity and mortality in diabetes patients. It is estimated that the prevalence of Neuropathy in diabetes patients is approximately 20%. Diabetic Neuropathy is implicated in 50-75% of non-traumatic amputations.
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- Mononeuropathy
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Mononeuropathy is damage to a single nerve or nerve group, which results in loss of movement or sensation.
Mononeuropathy is most often caused by injury, although systemic (body wide) disorders may cause isolated nerve damage. For example, Mononeutitis multiplex. Prolonged pressure on the nerve due to swelling or injury can result in Mononeuropathy. The covering of the nerve ( Myelin Sheath) or part of the nerve cell (the axon) is destroyed. This damage slows or prevents signaling through the nerves.
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- Neuralgia
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Neuralgia is pain that follows the path of a specific nerve.
The causes of neuralgia vary. Chemical irritation, inflammation, trauma (including surgery), compression of nerves by nearby structures (for instance, tumors), and infections may all lead to neuralgia. In many cases, however, the cause is unknown.
Neuralgia is most common in elderly persons, but it may occur at any age.
Diabetes is another common cause of neuralgia. Diabetes damages the tiny arteries that supply circulation to the nerves, resulting in nerve fiber malfunction and sometimes nerve loss. Diabetes can produce almost any neuralgia nearly anywhere in the body, including Trigeminal Neuralgia.
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- Polyneuropathy
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Polyneuropathy accounts for the greatest number of Peripheral Neuropathy cases. It occurs when many peripheral nerves throughout the body malfunction at the same time. Polyneuropathy can have a wide variety of causes, including exposure to certain toxins, poor nutrition (particularly vitamin B deficiency), and complications from diseases such as cancer or kidney failure.
One of the most common forms of chronic Polyneuropathy is diabetic Neuropathy, a condition that occurs in people with diabetes. It is the result of poorly controlled blood sugar levels. Though less common, diabetes can also cause Mononeuropathy, often characterized by weakness of the eye or of the thigh muscles.
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- Post Surgical Pain
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Post Surgical Pain is a complex response to tissue trauma during surgery that stimulates hypersensitivity of the central nervous system. The result is pain in areas not directly affected by the surgical procedure. Postoperative pain may be experienced by an inpatient or outpatient. It can be felt after any surgical procedure, whether it is minor dental surgery or a triple-bypass heart operation.
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- Shoulder Hand Syndrome
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Shoulder Hand Syndrome is a syndrome characterized by severe constant intractable pain in the shoulder and arm, limited joint motion, diffuse swelling of the distal part of the upper extremity, fibrosis and atrophy of muscles, and decalcification of underlying bones; the cause is not well understood; it is similar to, or may be a form of, Causalgia. Also known as hand-shoulder syndrome.
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- SIP/ Sympathetically Independant Pain
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SIP/ Sympathetically Independent Pain
Some patients will present with the classic symptoms of RSD; however, sympathetic blockade does not take away their pain. This may be due in part to a disease process that we don't understand, or it may be that these patients have progressed so far along in their disease that the disease has become centrally maintained only (there are now changes in the nerve cells in the spinal cord), and sympathetic blocks have little or no effect on it whatsoever. Often SIP is seen later in the development or progression of RSD patients.
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- SMP/ Sympathetically Mediated Pain
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 SMP/ Sympathetically Maintained Pain
One of the factors common to RSD and Causalgia is that almost all patients will respond to sympathetic blockade (blockage of the sympathetic nerves supplying the area with local anesthetics), which will take away their pain for a variable length of time. However, many patients do not present with the full-blown syndrome that includes all the signs listed above, but do respond to a sympathetic blockade. For example, a patient may come to a doctor with pain only. There may not be Allodynia, there may not be swelling, there may not be muscle spasms or any of the other factors relevant to the diagnosis of RSD. However, a sympathetic blockade takes away their pain. In fact, patients can present with any of the symptoms of RSD on their own. They can present with just swelling, just Allodynia, just burning pain, muscle spasm, etc., and if these people respond to sympathetic blocks, they are then defined as having sympathetically maintained pain or sympathetically maintained pain syndrome sympathetically maintained pain.
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- RSD/ Reflex Sympathetic Dystrphy aka CRPS
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RSD/ Reflex Sympathetic Dystrophy Syndrome aka CRPS/ Complex Regional Pain Syndrome
This syndrome has changed names over 20 times through out history and is projected to again change names as more bio-mechanical information is discovered. Other names include: Post Sympathectomy Pain, Hyperpathic Pain, and Mimocausalgia, among many others.
This condition is a progressive neurological condition that can affect one extremity or all 4, and can go full body. It also can affect the immune system, skin, muscles, joints, and bones. The pain start in one area but spread to other areas of the body. The syndrome usually develops after a minor insult to the body, such as whiplash, sprain, broken bone, or following surgery and in a few cases, no precipitating insult can be identified. RSD/CRPS is characterized by constant burning pain at various levels by always present. Patients may also see excessive sweating, swelling, and sensitivity to touch. RSD can go into remission for a period of time and then reappear with a new injury. This most commonly occurs when it is treated within the first 9 months with appropriate care.
RSD has been categorized with two types, although both share the same signs and symptoms.
Type 1 - without nerve injury
Type 2 (formerly called Causalgia) - with nerve injury
Millions of people in the United States suffer from RSD. It affects woman 3 to 1 over men and it can occur at any age. According to Dr. Schwartzman, a leading doctor in the field of RSD treatment, RSD appears to involve a complex interaction among the sensory, motor, and autonomic nervous systems, and the immune system. The brain and spinal cord (central nervous system) which as control over these various processes is somehow changed as a result of an injury.
Early treatment is the key, Leading experts now believe that any invasive procedure or injury can cause the RSD to worsen or spread. Treatments such as spinal cord stimulators, pain pumps and sympathectomies are now considered contraindicated. As well application of ice to the affected areas is also not recommended.
Ketamine Infusions are believed to be the future standard treatment for RSD by top doctors in the field and have been very successful to date. There are not many doctors performing this procedure and wait lists are extremely long for the doctors who are successful with it. The protocol makes a difference, be sure to check with your doctor(s) prior to any treatments or medical intervention. Other treatment modalities include nerve blocks, massage, traction for upper extremity, proper posture, medications At this time, there is no cure, but the bio-mechanical mechanisms are now known and progress for a cure is underway. At this time the closest thing to a cure is Ketamine Infusions and hope.
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Dieases That Can Cause Neuropathy Pain
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