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What Is Neuropathic Pain?

What Is Neuropathic Pain?. Allan Gordon MD Wasser Pain Management Centre University of Toronto Centre for the Study of Pain. Definition of neuropathic pain Symptoms and signs Conditions producing neuropathic pain Treatments Cost of NeP. Definition of Neuropathic Pain.

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What Is Neuropathic Pain?

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  1. What Is Neuropathic Pain? Allan Gordon MD Wasser Pain Management Centre University of Toronto Centre for the Study of Pain

  2. Definition of neuropathic pain • Symptoms and signs • Conditions producing neuropathic pain • Treatments • Cost of NeP

  3. Definition of Neuropathic Pain • Pain resulting from or thought to be resulting from a disturbance of the central or peripheral nervous system • Acute vs Chronic (six months) • Non Cancer vs Cancer

  4. How common is it? • UK 1% point prevalence • But likely more common than that

  5. Symptoms and Signs • Spontaneous vs stimulus evoked • Burning, constant, throbbing vs jabbing, stabbing • Mild, moderate, severe • Distribution may not along classical neuroanatomical lines • Associated with analgesia hyperalgesia allodynia

  6. Fellow travelers • Sleep • Mood • Recreation • Anxiety • Sex • Work • “QOL and function”

  7. Conditions producing neuropathic pain • Diabetic neuropathy • Post herpetic neuralgia • Cervical and lumbar radiculopathy • Post thoracotomy, post mastectomy • Multiple sclerosis • Post-stroke • Phantom limb

  8. Most likely neuropathic pain • Vulvar pain • Interstitial cystitis • Atypical facial neuralgia • Fibromyalgia

  9. Neuropathic pain a component • Post-inguinal hernia • Osteoarthritis of knee • Post TMJ replacement

  10. Management • Pharmacotherapy Oral: Tricyclic antidepressant Antiepileptic Opiate Methadone Topical: Lidocaine Capsacin Intrathecal: Opiate Clonidine

  11. Other therapies • Rehabilitation therapy • Behavioural therapy • Psychotherapy • CBT; Meditation; Hypnotherapy • Alternative: Acupuncture • Neurostimulation • Neuroblock • Injections including Botox • Surgery

  12. Cost of neuropathic pain • Mild pain: $2619 • Moderate pain: $3972 • Severe pain: $8360 • Average $4614

  13. Average cost $4614/3 months • Direct costs $1068 • Indirect costs $3546

  14. Conclusions • Neuropathic pain is being more commonly recognized • Pain can be mild to severe • Characteristic symptoms • Seen in many common conditions • Multimodal treatment • Expensive in human and economic terms

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