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Neuralgia - what is it?

Neuralgia = pain at the nerve endings, usually induced by a disturbed "food" supply of a nerve.

What is Pain all about?

1. Development of Pain

How Does Pain Begin?

Pain can develop from outside influences - heat, cold or pressure - and through illness processes in the body itself. For exapmle: if you injure your ankle, chemical irritants are produced right there. This is alerting/irritating sensory cells at the end of the nerves. These 'damage feelers' send the pain information in form of  electrical impulses to the spinal cord.

The Spinal Cord - The First 'Switch Over Center"

The pain signals are being changed in the spinal marrow into chemical messengers. These then carry the pain impulses to the pathway of the central nervous system; this pathway  starts in the marrow to end in the brain.

The Brain - The Second 'Switch Over Center"

Only then, when the pain impulses have reached the brain, you are able to feel the pain in the certain area of your body, in our case the ankle und you will react in your typical way. 


Body own opioids lower the pain experience.

In extreme situations the body can produce substances, endogenous opioids, which lower the pain and maybe even 'turn it off' for a short period of time. One of these is called endorphin , which is being produced in higher quantities after an accident or by high physical exercise. The result: you will notice stronger and 'true'/actual pain, when your body is at resting stage and therefore less endorphins are being produced. 
The process explained in another way : Even as our bodies respond to the sensation of pain and our brains integrate that sensation with our knowledge of the environment in which it occurs, the brain produces chemicals - the endogenous opiods - that lessen our perception of painful nerve signals, protecting us from fully feeling them. The way the chemicals produce this effect is similar to the action of some pain medications.

Opioids also play a role in feelings of pleasure and reward, and in responses to stressful situations, and may even be involved in the "runner's high" felt during strenuous exercise.

More recently, specific endogenous opioids such as the so-called endorphins and enkephalins have been found and studied, as have the various kinds of opioid receptors that dot the surface of brain neurons. Studies have even pieced together the chemical cascade within a neuron that results from the binding of an opioid molecule to its receptor and triggers the neuron to stop sending a pain message - an effect known as antinociception.

The mu opioid receptor in particular has been found to be a major target for both the body's own painkillers and for drugs from outside the body, such as heroin, morphine, methadone, synthetic pain medications and anesthetics. All are capable of numbing pain, and, in the case of drugs of abuse, produce pleasurable sensations during use.


The brain is controlling the controls in the spinal marrow.

From the brain nerves are reaching into the spinal marrow. This way the brain can control the actions in the "1st switch-over central station", with connections that carry signals from the brain back to the spinal cord.

By constant fear, constant stress and depression the 'central station' in the spinal marrow is being opened. Then the "pain guard" is not active - and you will feel more intense pain. 
You won't feel the pain, when the 'central station' is closed. The "pain guard" is active and suppresses the pain impulse from the nerves -
for example: in competition, by acute stress, by strong sudden fears, when you are distracted or completely relaxed. 


Even without the interaction of the brain.

From the  'central station' in the spinal marrow reflexes are controlled, which the brain can't manipulate. Such reflexes one can observe in form of  muscle spasm. But as a result of pain blood vessels can contract - with that the surrounding tissue receives less nourishments, next to a number of other 'substances' being send to the area in question, like protein, and voila`, a new pain rises.

Experience of pain

"Burned child shies the fire", a true idiom. Who has hurt himself in a controllable situation, is going to be more careful the next time. Predestined you are already, for example when someone in your family is suffering from headaches or back pain. The you are going to perceive and judge your own pain in this regard totally different than a person who never had any pain like this before or who's family is not predisposed. 

There are many factors that change the way we actually perceive pain and can make pain more intense or less intense depending on the situation. This is also true for other symptoms. This connection between your central nervous system and your brain communicates with your peripheral nervous system so nerves coming from organs, arms and legs, and all symptoms that you may be feeling can be altered by your nervous system either increased or decreased. That's true of nausea or difficulty breathing or any symptom you might be feeling. In fact, it's true of all of your senses. Your sense of hearing, smell, taste, vision are also all interpreted perceptions. Different factors that can alter your perception specifically when it comes to pain include how much attention you pay to the symptom, what the meaning of the symptom is. For some people, pain is a good thing such as when you've been working out and you're waiting to feel that burn and the burn has a good context, as opposed to if you pull a muscle, you may have exactly the same amount of tissue damage but the way you perceive the pain is very different. Memory can affect perception of pain. When we are awake, it takes much less stimulus to cause pain than when we are asleep. If we were in a coma, it would take even more, possibly we don't even experience pain.

2. Acute, Chronic and Neuropathic Pain

Acute pain
One common type of pain is acute pain, currently defined as pain lasting less than 3 to 6 months, or pain that is directly related to tissue damage. This is the kind of pain that is experienced from a paper cut or needle prick. Other examples of acute pain include:

  • Touching a hot stove or iron. This pain will cause a fast, immediate, intense pain with an almost simultaneous withdrawal of the body part that is being burned. More of an aching pain might be experience a few seconds after the initial pain and withdrawal.

  • Smashing one’s finger with a hammer. This pain is similar to that of touching a hot stove in that there is immediate pain, withdrawal and then “slower” aching pain.

  • Labor pains. The pain during childbirth is acute and the cause is certainly identifiable.

The longer pain goes on the more susceptible it is to other influences and developing into a chronic pain problem. These influences include such things as the ongoing pain signal input to the nervous system even without tissue damage, lack of exercise (physical deconditioning), a person’s thoughts about the pain, as well as emotional states such as depression and anxiety.

Chronic pain [more in-depth information]
There are at least two different types of chronic pain problems - chronic pain due to an identifiable pain generator (e.g. an injury), and chronic pain with no identifiable pain generator (e.g. the injury has healed).

Chronic pain due to an identifiable pain generator
This type of chronic pain is due to a clearly identifiable cause. Certain structural spine conditions (for example, degenerative disc disease, spinal stenosis and spondylolisthesis) can cause ongoing pain until successfully treated. These conditions are due to a diagnosable anatomical problem.

Chronic pain with no identifiable pain generator
This type of pain continues beyond the point of tissue healing and there is no clearly identifiable pain generator that explains the pain. It is often termed “chronic benign pain”.

It appears that pain can set up a pathway in the nervous system and, in some cases, this becomes the problem in and of itself. In chronic pain the nervous system may be sending a pain signal even though there is no ongoing tissue damage. The nervous system itself misfires and creates the pain. In such cases, the pain is the disease rather than a symptom of an injury.

The term “chronic pain” is generally used to describe pain that lasts more than three to six months, or beyond the point of tissue healing. Chronic pain is usually less directly related to identifiable tissue damage and structural problems. Examples of chronic pain are: chronic back pain without a clearly determined cause and fibromyalgia.

Chronic pain is influenced by many factors, such as ongoing pain signal input to the nervous system even without tissue damage, physical de-conditioning due to lack of exercise, a person’s thoughts about the pain, as well as emotional states such as depression and anxiety. Chronic pain is much less well understood than acute pain.

Neuropathic pain
Neuropathic pain has only been investigated relatively recently. In most types of neuropathic pain, all signs of the original injury are usually gone and the pain that one feels is unrelated to an observable injury or condition. With this type of pain, certain nerves continue to send pain messages to the brain even though there is no ongoing tissue damage.

Neuropathic pain (also called nerve pain or neuropathy) is very different from pain caused by an underlying injury. While it is not completely understood, it is thought that injury to the sensory or motor nerves in the peripheral nervous system can potentially cause neuropathy. Neuropathic pain could be placed in the chronic pain category but it has a different feel then chronic pain of a musculoskeletal nature.

Neuropathic pain feels different than musculoskeletal pain and is often described with the following terms: severe, sharp, lancinating, lightning-like, stabbing, burning, cold, and/or ongoing numbness, tingling or weakness. It may be felt traveling along the nerve path from the spine down to the arms/hands or legs/feet. It’s important to understand neuropathic pain because it has very different treatment options from other types of pain. For example, opioids (such as morphine) and NSAID’s (such as ibuprofen, COX-2 inhibitors) are usually not effective in relieving neuropathic pain. Treatments for neuropathic pain include certain medications, nerve “block” injections, and a variety of interventions generally used for chronic pain.

Examples of neuropathic pain include: monoradiculopathies, trigeminal neuralgia, postherpetic neuralgia, phantom limb pain, complex regional pain syndromes and the various peripheral neuropathies. 

For further reading please go here

3. What might cause neuropathic pain?

Uncountable damaging outer influences to the nerves, spinal marrow and brain, can cause pain. These are often accompanied by other dysfunctions, like palsy. Instead of a detailed and complete list and explanation, which would lead way to far, I'm going to present a  simplified OVERVIEW of CAUSES.

Mechanical, physical
Injuries like cuts, strains or bruises (f.ex. through bone fractures) can lead to direct injury of the nerves structure. Loss of  extremities often causes a phantom pain. More specific environmental influences with nerve damaging results are  heat, old and x-rays (tumor treatment). Pressure through a herniated vertebral disc (slipped disc) or chronic pressure damage on joints ("carpal tunnel syndrome") often are the foundation to neuropathic pain.

Inflamed
Infectious diseases like Borreliose (Lyme disease), Herpes Zoster ("Shingles"), or the by us on the European and American Continents rare Leprosy, are known causes for neuropathic pain.
By inflammation in the brain or spinal marrow, as they happen during the stages of  Multiple Sclerosis, unbearable neuropathic pain is experienced.

Metabolism Dysfunction
Diabetes mellitus is the main cause for polyneuropathy (illness of peripheral nerves) and therefore reason to neuropathic pain. Polyneuropathie is also a result of  "internal disease", like kidney diseases, thyroid dysfunction and vitamin deficiency (Vitamin B1 or B12). Chemical - toxic influences through medical drugs, especially in the tumor treatment, alcohol and drug abuse, can lead o metabolism dysfunctions, which attack the nerve substance.

Tumors
The growing of tumors, or its metastases can lead to pressure on the nerve structure, or can attack the nerve directly. Also some changes of the immune system lead to reactions on the peripheral and/or central nervous system.

Circulatory Disturbance
After cerebral infarcts severe neuropathic pain is common. Disturbed blood flow by arterioscleroses can lead to damages on the peripheral nerves.

What exactly is happening with the nerves and its cells during chronic and neuropathic pain attacks? Next page

prior page

References:
Physiobiolgie des Schmerzes, 1998 Urban & Vogel;
Biologische Physiology, 2002 Springer Berlin; 
Schmerzmessung und Schmerzdiagnostik, Oskar B. Scholz, 1997, Karger, Freiburg i.B.

 

 

 

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