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Chronic neuropathic pain

Dolor neuropathicus chronicus · Chronická neuropatická bolest

What it is

Pain generated by the nervous system itself rather than by injury.

Symptoms & signs

  • Burning
  • electric shocks
  • allodynia (touch hurts)
  • worse at night

🚩 Get help if…

  • call 112 / 911 now New weakness or loss of bladder or bowel control
  • see a doctor soon Pain spreading fast or with a new rash along one side
  • see a doctor soon Burning pain with a wound on a numb foot
  • see a doctor soon Thoughts of suicide because of the pain

Where it strikes

Medical treatment

  • Duloxetine — about 1 person in 7 gets half their pain gone mixed evidence
  • Pregabalin and gabapentin — similar odds, plus sedation, weight gain and a street market mixed evidence
  • Topical lidocaine mixed evidence
  • Capsaicin 8% patch mixed evidence
  • Spinal cord stimulator — trials against a sham device are unconvincing early / small studies

Natural & lifestyle

  • Graded motor imagery
  • mirror therapy
  • CBT and acceptance therapy
  • exercise
  • sleep repair
  • mindfulness

Emerging & experimental

  • Nav1.7/1.8 blockers (suzetrigine)
  • closed-loop spinal stimulation
  • virtual-reality analgesia
  • ketamine infusions

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Cannabis (nabiximols) — trials show a small benefit mixed evidence
  • Acupuncture — trials disagree mixed evidence
  • Palmitoylethanolamide (PEA) — small trials early / small studies
  • Low-dose naltrexone — small trials early / small studies
  • Magnet therapy — trials found no effect not confirmed in trials

ICD codes