What Is Neuropathic Pain?
Neuropathic pain arises from damage to or dysfunction of the somatosensory nervous system — peripheral nerves, nerve roots, the spinal cord, or the brain itself. Unlike nociceptive pain (caused by tissue damage), neuropathic pain persists because the nervous system itself has been altered. It is characterized by spontaneous pain occurring without any stimulus, allodynia (pain from stimuli that are not normally painful), and hyperalgesia (exaggerated pain from stimuli that are normally mildly painful).
The burning, shooting, electric, or stabbing quality of neuropathic pain is distinctive and often described by patients as fundamentally different from musculoskeletal pain. It can be profoundly disabling, affecting sleep, mood, and daily function.
Common Causes and Syndromes
- Peripheral neuropathy — diabetic neuropathy is the most common, affecting up to 50% of people with diabetes
- Radiculopathy — nerve root compression from disc herniation or spinal stenosis causing radiating limb pain
- Post-herpetic neuralgia — persistent burning pain following herpes zoster (shingles)
- Carpal tunnel syndrome — median nerve compression at the wrist
- Complex regional pain syndrome (CRPS) — severe neuropathic pain after injury, often disproportionate to the tissue damage
- Chemotherapy-induced peripheral neuropathy
- Post-surgical neuropathy — nerve injury from surgical trauma or compression
Diagnosis: The Role of EMG and Nerve Conduction Studies
Accurate diagnosis of neuropathic pain requires more than a clinical history. Electromyography (EMG) and nerve conduction studies (NCS) performed by Dr. Lichtblau identify the specific nerves affected, localize the site of injury (root vs. plexus vs. peripheral nerve), quantify the severity of nerve damage, and distinguish axonal from demyelinating pathology. This precision guides treatment selection and helps predict recovery.
Treatment Approach
Neuropathic pain management at CHLMD is mechanism-specific. Pharmacological options — including gabapentinoids, tricyclic antidepressants, SNRIs, and topical agents — are selected based on the type and severity of nerve dysfunction. Therapeutic exercise addresses secondary deconditioning and preserves motor function. Physical rehabilitation restores mobility and improves safety for patients with sensory loss or balance impairment. For appropriate candidates, injection-based interventions (nerve blocks, epidural injections) may be coordinated as part of a comprehensive plan.
