Guest guest Posted August 7, 2001 Report Share Posted August 7, 2001 There is more to this article, to read all of it go to:http://www.hosppract.com/issues/1998/10/bennett.htm Neuropathic Pain: New Insights, New Interventions GARY J. BENNETT Allegheny University of the Health Sciences The past decade has seen great progress in understanding its causes and in finding new drugs that promise great benefit. An early outcome of the research has been the observation that the new drugs do not blunt normal pain sensation--a pattern beginning to find explanation through the realization that neural pain circuits rewire themselves, both anatomically and biochemically, after nerve injury. -------------------------------------------------------------------------------- Dr. is Professor of Neurology and Director of Pain Research, Allegheny University of the Health Sciences, Philadelphia. -------------------------------------------------------------------------------- Damage to a somatic sensory nerve can be expected to cause a somatic sensory loss. In many patients, however, negative symptoms such as numbness are joined by positive sensations, involving in almost all cases some sort of false sensation of pain. The experience can range from mild dysesthesia to excruciating torture. Indeed, some patients are unable to work, or walk, or sleep; some can hardly wear clothes, whose contact with the skin is experienced as an unbearable burning. The pain is termed neuropathic, in that it is taken to represent neurologic dysfunction. It is extremely difficult to manage. Usually it is chronic and fails to respond to standard analgesic interventions. Morphine may give a degree of relief, but only at doses impractical for what may be a lifelong regime. Unfortunately, too, the disorder is remarkably common. It becomes possible whenever nerves are damaged, by trauma, by diseases such as diabetes, herpes zoster, or late-stage cancer, or by chemical injury (e.g., as an untoward consequence of agents including the false-nucleoside anti-HIV drugs). It may also develop after amputation (including mastectomy). In view of all the possible causes, the prevalence of neuropathic pain can be conservatively estimated at 0.6% of the U. S. population. To the extent that low-back pain is sometimes neuropathic, the actual figure may be far greater. Even if it includes only one back-pain patient in 10, the figure increases by almost three million. By this calculation, neuropathic pain affects 1.5% of the population. Quote Link to comment Share on other sites More sharing options...
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