What Cause Neuropathic Pain?

If you have neuropathic pain, it is because your pain is coming directly from your nerves. When this happens, even light pressure can cause terrible pain. The pain can feel like an electric shock, or it can be like a burn, there all the time. At times you can get pins and needles sensations, or numbness or itching.
Common causes include shingles, diabetic neuropathy, from long-standing high blood sugars, HIV, thyroid problems, vitamin B12 deficiency or too much vitamin B6, certain medications, some autoimmune diseases, but the commonest cause is nerve injury, as occurs when a nerve swells and becomes too big for the small hole in the fibrous covering of the body it has to cross to get to the skin. Larger nerves, like the sciatic nerve can also be injured often as they cross the neural foramina (the holes in the spinal column they have to go through) to the time they reach their destination.
These nerves communicate their discomfort with their neighbors. Sometimes the pain signals starts in one small area and spreads, until it involves a large part of your body.

Until now, neuropathic pain has been very difficult to treat with only some 40-60% of patients achieving even partial relief. Because of this, there are a multitude of treatments offered, always an indication that not one treatment is best. The three safest are dietary supplements, QR cream, and perineural injections.

Neuropathic Pain Treatment

QR Cream contains a sugar derivative, which normalizes the function of the painful skin nerves in a matter of minutes. It is painless to apply, and has no side effects, unless you are allergic to one of its components, which is highly unlikely. In Dr. Bertrand’s practice, this cream has provided a great deal of relief for people with painful neuropathies.

Dr. Bertrand has just completed a study which proves that QR cream is effective in relieving the pain of postherpetic neuralgia, the burning pain people get after shingles. She is about to start a research project using this cream to treat the burning feet diabetics can develop, called diabetic peripheral neuropathy. Those who will participate in the study will be given at least a three-month supply of the cream and, if it helps them, they will be given more. If you are diabetic and are suffering from burning or feeling pins and needles or other painful sensations in your feet, look at WWW.QRcream.com to see if you want to take part in this study. QR cream is now licensed for sale by Health Canada, and will be on the market by November 2016.

Neuropathic pain treatment with perieural injection therapy (nerve blocks): this treatment is able to relieve neuropathic pain in seconds. Unfortunately, it requires many tiny injections along the course of the painful nerves, as it consists in bathing the nerves in a sugar derived solution. After the first treatment, you are likely to be pain free for anywhere between two hours and four days. You are likely to need between four and 16 weekly treatments before your pain is entirely gone. With each treatment, you need fewer injections and you remain pain-free for longer and longer periods.
Neuropathic pain treatment with Topical agents: if your neuropathy came after a bout of shingles, you may find relief with a local anesthetic, lidocaine patch. Dr. Bertrand just finished a pilot project testing QR cream on postherpetic neuralgia. She showed that those who have this condition were significantly relieved of their pain and the accompanying depression and disability they had after using QR cream. Some neuralgia creams contain capsaicin, which will force the skin nerves to release all their neurotransmitters, so they can no longer send pain signals. Unfortunately, applying these creams can be very painful, as the neurotransmitters these nerves release generate pain signals. A Prolonged use of topical capsaicin eventually kills the nerves it acts on. QR cream also works on the capsaicin receptor, but instead of activating it, it shuts it down: it stops the pain signal from being generated and transmitted.

Neuropathic pain treatment with dietary supplements: if you are diabetic, Alpha lipoic acid and benfothamine have been shown to be effective in relieving the symptoms of neuropathy.

Medications taken by mouth to relieve neuropathic pain

Neuropathic pain treatment with antidepressants that increase the amounts of certain neurotransmitters such as serotonin and norepinephrine help to block the pain signal so it cannot travel up the spinal cord to reach the brain. Only certain antidepressants work, such as duloxetine, venlafaxine, Bupropion, and tricyclic antidepressants such as amitriptyline, nortriptyline, and desipramine. If you click on these, you will find they have a multitude of side effects.
Neuropathic pain treatment with Anticonvulsants are another way of blocking pain nerve transmission. People with diabetic neuropathy, use Pregabalin (Lyrica) and gabapentin. People with trigeminal neuralgia mostly use carbamazepine (Tegretol) and oxcarbazepine (Trileptal)

Lamotrigine helps those who have post stroke pain and HIV/AIDS-related neuropathy. Again, if you click on those, you will see many side effects.
Neuropathic pain treatment with Narcotics, like methadone work in neuropathic pain by blocking a specific receptor on the nerve cells called NMDA. Other narcotics that block the NMDA receptor are dextromethorphan, which can’t really be used because it has a very short half life, memantine which is very weak, and ketamine which has many side effects. Unfortunately, they are also addictive.

Neuropathic pain treatment with marijuana derivatives: Marijuana‘s active ingredients are called cannabinoids. Nabilone can help the HIV neuropathy, and Sativex, can help with neuropathy associated with multiple sclerosis and strokes. Unfortunately, they also have many side effects.
Neuropathic pain treatment with Botox: the only way Botox works for neuropathic pain is if it is injected inside the skin. When it is injected in the muscles, the muscles shrink and, therefore, the tiny holes in the fascia, the fibrous membrane which covers the muscles, get even smaller. The nerves that have to cross these holes to get to the skin are even more likely to be injured. If you are suffering from neck pain, and you get injected in your neck muscles, your pain can get much worse, and this severe pain will last about three months, as long as the muscles are affected by the Botox. Botox is also very expensive.

The next neuropathic pain treatments are all surgical

Reducing sympathetic nervous stimulation: sympathetic nerves increase pain signals, and some operations are carried out to destroy the sympathetic ganglia, in order to reduce the pain signals.

Neuromodulators: stimulators are implanted beside painful nerves to change the pain signal into a pins and needles signal, which takes away about half the pain.

Spinal cord stimulators and implanted spinal pumps: these electrodes, implanted just outside the spinal cord, have a very high complication rate. Some people get infusion pumps, which pump narcotics, local anesthetics or clonidine into the epidural space. Here again, the complication rate is very high, and the pain relief is not that great.

Motor cortex stimulation: Stimulation of the surface of the brain, which controls movement (but not enough to cause movement), through electrodes placed within the skull has been used to treat pain.

Deep brain stimulation: where electrodes are placed deep in the brain does help reduce the pain signal, but it has a high complication rate, which increases over time.

Reference on Mannitol's Effect on the Capsaicin Receptor

Bertrand, H., Kyriazis, M., Reeves, K. D., Lyftogt, J., & Rabago, D. (2015). Topical mannitol reduces capsaicin-induced pain: results of a pilot-level, double-blind, randomized controlled trial. Arch Phys Med Rehabil, 7(1), 1111-1117.