Neuropathic pain is defined as “pain that arises as a direct consequence of a lesion or diseases affecting the somatosensory system’.Neuropathic pain can arise from many chronic conditions like Diabetes, peripheral neuropathy, lumbar, cervical spondylosis, CRPS, nerve injury, failed back surgery syndrome, herpes zoster infection like post herpetic neuralgia, trigeminal neuralgia, brachial plexopathy, cancer related neuropathic pain, chemotherapy induced neuropathic pain and spinal cord compression. The assessment of neuropathic pain requires a detailed pain history and physical examination. Several scales used to diagnose neuropathic pain include the Leeds Assessment of Neuropathic Pain, the Pain Neurotoxicity Questionnaire, and painDETECT.
Neuropathic pain is difficult to treat and medications like gabapentin, pregabalin, duloxetine, milnacipran, velnafexine, carbamazepine, ketamine, tapentadol, topical lignocaine and valproate have been tried successfully. Opioids, Capsaicin cream, Lignocaine patch is also useful. Massage, acupuncture, hypnosis, mirror therapy, and cognitive restructuring behavior therapy have been used as adjuvants. If pain persists or does not respond to these agents, following Interventional techniques are used by Releaf Pain Centers to treat neuropathic pain.
1.Sympathetic blocks like Stellate, Thoracic T2, T3 Sympathetic block, lumbar Sympathectomy
2.Radio frequency ablation (Conventional or pulse) Radiofrequency ablation is latest treatment option for neuropathic pain and gives excellent long term results for pain relief.
3.Spinal cord stimulator
4.USG or C Arm guided Nerve root injection
5.Dorsal root Ganglion RFA
6.Gasserian ganglion RFA
7.Peripheral nerve filed stimulator
8.Phenol/ Alcohol neurolysis