Initially, patients develop numbness and/or weakness in the hands or feet.  Early on, this involves the fingers and toes, but can work its way up the limbs.  Patients experience burning pain in the extremities – most commonly involving the feet.

Treatment is centered on the underlying disease.  Pain therapy involves medication management centered on neuropathic pain medications. In some cases, Spinal Cord Stimulation can be an effective long-term therapy.

The treatment of neuropathic pain can be very difficult.  It is often necessary to conduct trials of multiple medications before finding the best regimen.  It is important to be patient as effective medications for one individual may be different than others.   These medications include:

Anti-epileptic (anti-seizure) medication – gabapentin, pregabalin, carbamazapine, etc.

Antidepressant medication  - tricyclics (e.g. amitriptyline), SSRIs (e.g. duloxetine)

Topicals – Local anesthetic preparations (creams, gels, patches), other compounded creams

Opiates

Medication Management – anti-inflammatories, neuropathic pain medication, muscle relaxants, opiates

Physical Therapy

Injection Therapy

Surgery

Implantable Devices – Spinal Cord Stimulation, Intrathecal Drug Delivery

Psychological therapy – Biofeedback, Cognitive Behavioral Therapy, treatment of depression and anxiety

Causes of low back pain include lumbar degenerative disc disease, spinal stenosis, lumbar radiculopathy, discogenic pain, facet joint arthropathy, sacroiliac joint arthropathy / dysfunction, and myofascial pain.

Causes of chronic neck pain include cervical degenerative disc disease, spinal stenosis, cervical radiculopathy, discogenic pain, facet joint arthropathy, occipital neuralgia, and myofascial pain.

Neuropathic Pain (nerve – generated pain)

Reflex Sympathetic Dystrophy (RSD) a.k.a. Complex Regional Pain Syndrome (CRPS)

Lumbar, Thoracic, or Cervical Radiculopathy

Post-Herpetic Neuralgia (Shingles Pain)

Occipital Neuralgia

Trigeminal Neuralgia

Post-Stroke Pain (Central Pain)

Phantom Limb Pain

Multiple Sclerosis

Peripheral Neuropathy (e.g. Diabetic)

Mononeuropathies (after damage to a single nerve)

Arthritis Pain (Joint Pain)

Rheumatoid Arthritis

Osteoarthritis

Cancer Pain