What causes peripheral neuropathic pain?

From the Guidelines

Peripheral Neuropathic Pain Causes

Peripheral neuropathic pain is primarily caused by diabetes, as well as other factors such as vitamin deficiencies and certain medications like statins and fluoroquinolones 1. Conditions including multiple sclerosis, rheumatoid arthritis, and hypothyroidism can also contribute to its development 1.

Key Factors

• Diabetes is a major cause, with up to 50% of diabetic patients experiencing peripheral neuropathic pain 1.
• Vitamin deficiencies and certain medications can also trigger peripheral neuropathic pain 1.
• Other conditions like multiple sclerosis, rheumatoid arthritis, and hypothyroidism may contribute to its development 1.

Management and Treatment

In managing peripheral neuropathic pain, medications such as gabapentin (at a dose of 300-3600 mg per day for 2-12 weeks) or pregabalin (at a dose of 150-600 mg per day for 2-12 weeks) may be used to alleviate symptoms 1. However, addressing the underlying cause of the pain is crucial for optimal treatment outcomes 1.

Considerations

• A multi-disciplinary approach is recommended for the assessment and treatment of painful diabetic peripheral neuropathy, considering its varied and multi-dimensional impact 1.
• Good blood glucose control is generally advised as the first step in managing diabetic neuropathy, although its direct effect on neuropathic pain symptomatology is not conclusively proven by randomized controlled trials 1.

From the Research

Causes of Peripheral Neuropathic Pain

Peripheral neuropathic pain is a complex condition with various causes, including:

• Neurological lesions or diseases, such as multiple sclerosis, post-stroke pain, and spinal cord injury pain 2
• Peripheral neuropathies, which can be caused by diabetes, brachial plexus injury, and other traumatic nerve injuries 3
• Drug-induced neuropathy, which can occur as a result of certain medications, such as vincristine, cisplatin, and bortezomib 4
• Infections, such as CoronaVirus Disease (COVID) infection, which can cause neuropathic pain both during acute infection and as a post-viral syndrome known as long COVID 2
• Other conditions, such as gluten neuropathy, which is an extraintestinal manifestation of gluten sensitivity 2

Mechanisms of Peripheral Neuropathic Pain

The mechanisms of peripheral neuropathic pain involve:

• Damage to the peripheral nerve system, which can lead to sensory impairments and paresthesia 4
• Activation of Toll-like receptors (TLRs) involved in Wallerian degeneration and generation of neuropathic pain 5
• Stimulation of astrocytes and microglia, which can cause induction of proinflammatory mediators and cytokines in the spinal cord, leading to the generation and maintenance of neuropathic pain 5

Clinical Characteristics of Peripheral Neuropathic Pain

The clinical characteristics of peripheral neuropathic pain include:

• Ongoing pain, described as burning or pressing, which is the most frequent type of neuropathic pain 3
• Paroxysmal pain, described as electric shock-like sensations 3
• Allodynia, which is pain evoked by brushing and pressure 3
• Sensory deficits in the painful area 3