What is the cure for ulnar neuropathy

neuropathic pain in numbers

In Germany around 6 percent of the population suffer from neuropathic pain, which corresponds to almost 5 million people. About 20 percent of all patients who visit a special pain therapy facility suffer from inadequately treated neuropathic pain. In the course of their symptoms, patients with neuropathic pain visit an average of eight different doctors within ten years and are hospitalized for 72 days during this time. A US survey found that only 30 percent of neurologists were able to diagnose neuropathic pain with certainty. Only 20 percent knew an adequate therapy.

Studies show that around a fifth of all patients who have been operated on have long-term, sometimes lifelong, nerve pain. This pain can turn into a chronic form after a "light" procedure as well as after a "severe" one.

Nerve pain, along with back pain and headaches, is one of the common causes of chronic pain.

background

Neuropathic pain, commonly known as nerve pain, is caused by damage to or disease of nerve structures. This can affect the peripheral or central nervous system (brain and spinal cord). The causes are varied, for example nerve pain can arise from injuries during operations or develop in the context of diseases such as diabetes or shingles. Central neuropathic pain can be the result of a stroke or multiple sclerosis, for example. As a result of the nerve injury, the nervous system changes biochemically and structurally. These so-called plastic changes in the nervous system can become irreversible over time, i.e. they no longer regress. Neuropathic pain tends to turn into a chronic form.

typical underlying diseases

Nerve pain occurs with:

  • 8 percent of stroke patients
  • 20 percent of diabetics (diabetic polyneuropathy),
  • 28 percent of patients with multiple sclerosis,
  • approx. 33 percent of patients with tumor pain,
  • 37 percent of patients with back pain and
  • 67 percent of patients with spinal cord injury.
  • Sixty percent of all people who have had a limb amputated suffer from another form of nerve pain called phantom pain.

Other examples are neuropathic pain caused by shingles (postherpetic neuralgia), chemotherapy or alcohol abuse.

typical signs: altered skin sensitivity

Patients who suffer from neuropathic pain have a characteristically altered skin sensitivity. They typically react over-sensitive or less sensitive to certain stimuli such as warmth, cold, pressure or touch or mixed, i.e. over-sensitive to some stimuli and less sensitive to others.

Burning spontaneous pain, shooting attacks and hypersensitivity of the skin to stimuli that are normally not painful or not very painful (allodynia or hyperalgesia) often occur. For example, patients who develop chronic pain after shingles (postherpetic neuralgia) often perceive putting on clothes in the affected skin area as extremely uncomfortable or even painful.

However, sensitive deficits such as reduced skin sensitivity (hypesthesia) to stimuli such as cold, heat or pressure and a reduced perception of pain (hypalgesia) characterize the clinical picture. These symptoms are mostly uncomfortable but not painful.

variable symptoms

What makes the diagnosis of nerve pain more difficult is that there is no uniform symptom pattern. In principle, any symptom can appear in any combination with others, regardless of the underlying disease. One diabetic may suffer from constantly burning feet, while another may suffer from numb legs that are less sensitive to touch and other stimuli. On the other hand, there are also patients who have completely different underlying diseases and still show the same pain picture.

diagnosis

The diagnosis of neuropathic pain is usually based on:

  • the patient's medical history (anamnesis),
  • the characteristic changes in skin sensitivity, which is determined, among other things, in a neurological examination, and
  • the objective proof of nerve damage or disease, which can be done, for example, with imaging methods or the measurement of the nerve conduction velocity.

In order to capture the symptoms of a patient with nerve pain as precisely as possible, the individual symptoms must be precisely analyzed. This is possible with the help of quantitative sensory testing (QST) according to the DFNS standard. During the procedure, several tests are carried out directly on the affected skin area. It is checked whether the patient is overly sensitive or less sensitive to heat, cold, pressure, vibration, fine touches and blunt needle stimuli. The QST thus provides an individual sensitivity profile for each patient. This in turn allows conclusions to be drawn about the nerve damage, e.g. whether it is rather fine or thicker nerve fibers that are affected or whether the nerve damage is in the central or peripheral nervous system. This information can also be important for the most targeted therapy possible.

It is important to distinguish it from other forms of pain in which the nerves are intact (nociceptive pain). In addition to the methods mentioned above, questionnaires such as painDETECTwhich can be completed by the patient in just five minutes and provides information on the presence of nerve pain.

therapy

The therapy currently being applied includes:

  • the treatment of the underlying cause, e.g. optimal control of diabetes,
  • the achievement of freedom from pain, ideally a complete or at least partial, through drug and non-drug methods and
  • improving pain management through additional psychological procedures.

prophylaxis

In principle, effective pain therapy should be initiated as early and as intensively as possible. Effective pain relief in the acute phase can prevent the pain from becoming chronic in the first place.

Nerve pain medication

The drug treatment of pain syndromes is fundamentally similar, even if the underlying cause of the disease is different. Many doctors still prescribe common pain relievers such as ibuprofen, diclofenac or paracetamol, but these are hardly effective for nerve pain. On the other hand, opioids and pain relieving drugs that are otherwise used for epilepsy (anticonvulsants or antiepileptic drugs) and depression (antidepressants) are promising. Local treatments with e.g. local anesthetics or capsaicin, the active ingredient in chili peppers, can also relieve nerve pain.

Usually a combination of drugs makes sense, as different "places" where pain occurs, e.g. special receptors, are attacked. The effectiveness and the side effects are so different from patient to patient that an optimal pain therapy has to be found individually for each patient. This requires a lot of patience from both the doctor and the patient.

Realistic goals of drug therapy are pain relief of more than 30 to 50 percent, an improvement in the quality of sleep, the maintenance of social activities and relationships, and the ability to work. Complete freedom from pain can almost never be achieved. With all drug options, around 20 to 40 percent of patients respond insufficiently to the therapy or they suffer from intolerable side effects. The therapy goals must also be discussed with the patient in order to avoid overly high expectations and thus disappointments.

Non-drug procedures

In addition, non-drug methods can be useful, e.g. transcutaneous electrical nerve stimulation (TENS), interventional procedures, physiotherapy and occupational therapy as well as psychotherapy.

Long-term therapy monitoring is important in order to document the effect of the treatment measures. This should record the pain-relieving success of the therapy, e.g. with a pain diary, as well as document possible effects of the therapy on all areas of life, e.g. mood and sleep.

multimodal treatment concept

Optimally, the treatment follows a multimodal concept that is usually found in specialized pain centers. Here, interdisciplinary teams offer not only medical and medicinal measures, but also psychological and behavioral therapy procedures and exercise therapy. Often, chronic pain cannot be completely cured. This is why it is so important to learn how to deal with pain properly. Ultimately, one goal is in the foreground: to significantly improve the quality of life of patients suffering from chronic pain.