Neuropathic back pain

Neuropathic back pain is pain that occurs as a direct consequence of injury or disease affecting the somatosensory system.

Neurogenic pain syndromes occur when peripheral or central nociceptive structures are involved in the pathological process. When the peripheral nervous system is affected, pain is called peripheral, when the central nervous system is affected, it is called central.

The clinical picture of neurogenic pain syndromes is polymorphic. Pain can be permanent or paroxysmal. Most often, permanent pain occurs with complete neural damage. Neurogenic pain is often accompanied by the presence of concomitant phenomena, such as paresthesia, dysesthesia, allodynia, hyperpathy, hyperesthesia and hypesthesia. It is very important that the picture of neurogenic pain can reveal local vegetative disorders in the form of tissue swelling, changes in dermographism, skin color and temperature, as well as trophic changes in the skin, subcutaneous tissue, hair and nails. The intensity of pain can depend on internal and external influences. Pain can be provoked by noise, light, changes in air temperature, emotional experiences and various visceral influences. Clinically important in the context of the problem under consideration is the fact that, unlike somatogenic pain syndromes, pain due to damage to the structures of the nociceptive system can be delayed and occur with a delay of up to 2-3 years.

Diagnosis of neuropathic pain involves taking a detailed history and assessing the descriptor words the patient uses to describe the pain. Neuropathic pain is characterized by such terms as burning, shooting, stabbing, like a blow from a gok, scalding, freezing, piercing.

In clinical evaluation of neuropathic pain symptoms, positive and negative symptoms are distinguished. The term positive, of course, is not entirely appropriate in this case. However, positive symptoms are understood as the presence of spontaneous or evoked algic phenomena. Spontaneous symptoms include those signs that arise without external influences and are based on spontaneous generation of impulses by nociceptors or nociceptive fibers: paroxysmal pain, dysesthesia, paresthesia. Evoked symptoms include algic phenomena that arise as a response to external influences and are based on peripheral or central sensitization. Evoked symptoms: allodynia (mechanical, thermal or chemical), hyperalgesia to touch and needle prick, sympathetically maintained pain. Negative symptoms include objectively detectable signs of sensory function loss: decreased tactile (sensitivity to touch), pain (needle prick), temperature and vibration sensitivity.

To diagnose neuropathic pain, one can use short questionnaires that allow one to diagnose with high reliability the presence of neuropathic pain in a patient.

Diseases most often accompanied by the development of neuropathic pain

Etiology	Clinical variants
Metabolic	Diabetic polyneuropathy Alcoholic polyneuropathy Uremic polyneuropathy Alimentary polyneuropathies with deficiency of vitamins B1, B6, B12, pantothenic acid Porphyritic polyneuropathy
Compression	Tunnel neuropathies Compression neuropathies Trigeminal neuralgia due to microvascular compression Compression of a spinal nerve by a herniated disc or hypertrophied ligamentum flavum Nerve compression by a tumor Compressive myelopathy
Ischemic	Central post-stroke pain syndrome
Toxic	Drug-induced polyneuropathies (metronidazole, nitrofurans, suramin, taxol, thalidomide, nucleosides) Toxic polyneuropathies (arsenic, thallium)
Immune	Multiple sclerosis Guillain-Barre syndrome Paraneoplastic polyneuropathy Polyneuropathy (multiple mononeuropathy) with vasculitis Chronic inflammatory demyelinating polyneuropathy
Infectious	HIV-associated polyneuropathy Polyneuropathy (meningoradiculoneuropathy) in tick-borne borreliosis (Lyme disease) Leprosy Postherpetic neuralgia
Traumatic	Phantom pain syndrome Complex regional pain syndrome Postoperative neuropathic pain Deafferentation pain syndrome in brachial plexus avulsion Myelopathy pain
Genetic	Amyloid polyneuropathy Hereditary sensory-vegetative neuropathies
Other	Idiopathic polyneuropathies Polyneuropathy in sarcoidosis Parkinson's disease Syringomyelia

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