neuropathic pain

1. NEUROPATHIC PAIN
Babak Ashrafnejad

2. CNS or PNS pain
Autonomic nervous system pain
Or a complex pain
chronic pain , central pain , neuropathic
pain

3. Neuropathic pain history
PQRST
P: provocative
Q: quality
R: region , radiation , refferal
S: severity
T: timing

4. Physical examination
Regional sensory and motor
dysfunction
Hypoesthesia , hyperesthesia ,
hyperalgesia , allodynia

5. Laboratory findings
Hematologic , chemical , genetic tests ,
biopsy
Radiology
CT scan , MRI
electrodiagnostic
EMG , NCV

6. Polyneuropaty : DM , alcoholism , HIV ,
Hypothyroidism , RF , Chemotherapy ,
Anti HIV drugs , B12 and folic acid
deficiency
Mononeuropathy : Entrapment synd. ,
traumatic , DM ,Vasculitis
Plexopathy : DM , Avultion , Tumor
Radiculopathy : Compression ,
inflammation , DM
PHN

7. Trigeminal neuralgia
Phantom pain
RSD , Causalgia , CRPS

8. Neuropathic pain ethiology :
Toxic , metabolic
Post traumatic
Compressive
Autoimmune
Infectious
Hereditary

9. Neuropathic pain treatment approach :
Interventional or pharmacologic
multidisciplinary and inter disciplinary
approach
Ablative procedures
TENS
Spinal cord stimulation

10. Neuropathic pain :
Stimulus-Evoked
Stimulus-Independent
Decreased inhibitory mechanisms
Central sensitization

11. Central post stroke pain
thalamic pain (spinothalamocortical
lesion)
hemiplegia , hemiataxia , superficial and
deep sensation disorders ,
choreaathetoid
persistant , paroxysmal , intolerable
pain

12. NEUROPATHIC PAIN TREATMENT
ANTICONVULSANTS
Sodium channel blockade :
Carbamazepine
Phenytoin
Valproic acid
Calcium channel binding :
Gabapentine

13. BENZODIAZEPINES
Clonazepam
ANTIDEPRESSANTS
Amitriptyline
Nortriptyline
Imipramine
Desipramine
Fluxetine
Paroxetine
Venlafaxine

14. ANTIARRHYTHMICS
Lidocaine
Mexiletine
EMLA
CORTICOSTEROIDS
BACLOFEN
CAPSAICIN