Neuropathic back pain

Neuropathic back pain is pain that occurs as a direct consequence of a damage or illness 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 damaged, the pain is called peripheral, when the central nervous system is affected.

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 hypoesthesia. It is very important that in the picture of neurogenic pain, local vegetative disorders can be detected 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 the temperature of the air, emotional experiences and various visceral effects. Clinically important in the context of the problem under consideration is the fact that, in contrast to somatogenic pain syndromes, pain in 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 consists in the detailed collection of anamnesis and evaluation of words-descriptors, by which the patient describes pain. For neuropathic pain, such terms as burning, shooting, stabbing, like a blow by the gob, burning, chilling, piercing are characteristic.

In the clinical evaluation of the symptoms of neuropathic pain, positive and negative symptoms are identified. The term positive, of course, is not entirely appropriate in this case. Nevertheless, positive symptoms are understood to mean the presence of spontaneous or evoked algic phenomena. Spontaneous symptoms include those that occur without external influences, and which are based on spontaneous generation of impulses with nociceptors or nociceptive fibers: paroxysmal pain, dysesthesia. Paresthesia. Symptoms caused include algic phenomena that arise as a response to external influences, which are based on peripheral or central sensitization. The evoked symptoms are: allodynia (mechanical, temperature or chemical), hyperalgesia for touch and needle pricking, sympathetically sustained pain. Negative symptoms include objectively detectable signs of loss of sensory functions: decreased tactile (sensitivity to touch), pain (needle prick), temperature and vibration sensitivity.

For the diagnosis of neuropathic pain, short questionnaires can be used to diagnose the presence of precisely neuropathic pain in a patient with great certainty.

Diseases most often accompanied by the development of neuropathic pain

Etiology	Clinical Options
Metabolic	Diabetic polyneuropathy Alcoholic polyneuropathy Uremic polyneuropathy Alimentary polyneuropathies with a deficiency of vitamins Bl, B6, B12, pantothenic acid Porphyria polyneuropathy
Compression	Tunneling neuropathies Compression Neuropathies Trigeminal neuralgia due to microvascular compression Compression of the spinal nerve of a herniated disc or hypertrophied yellow ligament Nerve compression by tumor Compression Myelopathy
Ischemic	Central post-stroke pain syndrome
Toxic	Medicinal polyneuropathies (metronidazole, nitrofurans, suramin, taxol, thalidomide, nucleosides) Toxic polyneuropathies (arsenic, thallium)
Immune	Multiple sclerosis Guillain-Barre Syndrome Paraneoplastic polyneuropathy Polyneuropathy (multiple mononeuropathy) in vasculitis Chronic inflammatory demyelinating polyneuropathy
Infectious	Polyneuropathy associated with HIV infection Polyneuropathy (menningoradiculoneuropathy) in tick-borne borreliosis (Lyme disease) Leprosy Postherpetic neuralgia
Traumatic	Phantom pain syndrome Complex regional pain syndrome Postoperative non-uropathic pain Deafferentative pain syndrome in case of brachial plexus avulsion Pain with myelopathy
Genetic	Amyloid polyneuropathy Hereditary sensory-vegetative neuropathies
Other	Idiopathic polyneuropathies Polineuropathy in sarcoidosis Parkinson's disease Syringomyelia

[1], [2]