Traditional Culture Encyclopedia - Photography major - Several symptoms of neuropathic pain

Several symptoms of neuropathic pain

According to the pathological mechanism of pain, chronic pain can be divided into nociceptive or inflammatory pain (appropriate response to pain stimulus) and neuropathic pain (inappropriate response caused by nervous system injury). The International Association for Pain Research (IASP, 1994) defines neuropathic pain as "pain caused by primary or secondary damage or dysfunction or temporary disorder of the peripheral or central nervous system"; For neuropathic pain, delete the word transient disorder; However, there is no obvious difference between them in clinic, and they can be used together. Neuropathic pain has always been a difficult problem in the medical field: the pathogenesis is unclear, the treatment effect of opioid drugs is not good, and patients are very painful. In recent years, with the development of molecular biology and electrophysiological technology, people gradually realize the complex pathological mechanism of neuropathic pain, which provides new ideas and methods for treatment. Almost everyone has some experience of neuralgia, and most mild neuralgia will disappear by itself within a few days; However, some severe neuralgia can last for a long time and become annoying diseases. The feeling of unintentional "electric shock" is unpleasant and often affects daily work and life, such as trigeminal neuralgia affecting half of the face; Especially in the dead of night, it is even more uncomfortable to suddenly wake up in pain; What's more, some patients may have numbness in their limbs for 24 hours, just like "electricity leakage". The main symptoms of neuralgia include the following situations: 1. "Wear socks and gloves" has local pain or numbness at the ends of limbs. Second, the affected part may feel abnormal. Third, the pain may be sharp or burning, like an electric shock. Fourth, the general function of most nerve pain areas is not affected and the function does not change. Fifth, the nerve pain area can be accompanied by muscle tendons. There is no specific test method for neuralgia. The main purpose of inspection is to exclude other possibilities; General inspection includes: 1. Nervous system examination: in order to determine whether there is a specific pain area and determine the nerve distribution that causes pain, and then establish the diagnosis and possible causes. Second, dental examination: whether there is an abscess near the nerve. Third, blood test: whether there is infection. X-ray or imaging examination: is there the possibility of nerve compression? Neuralgia can be treated by internal medicine and physical therapy, and surgery will be considered for some stubborn neuralgia. The treatment direction is as follows: 1. Causes of treating neuralgia: using antibiotics and dentistry to treat tooth abscess; Or surgically remove the bone that compresses the nerve. Second, the treatment of pain: such as painkillers. Treatment with anticonvulsants or antiepileptic drugs: These drugs are used to treat pain and tendons caused by trigeminal neuralgia. Fourth, the use of antidepressants: it can relieve some patients' pain. 5. Operation: Use nerve block to relieve pain. Other methods: including acupuncture and hypnosis. There are many reasons for painful peripheral neuropathy, including neuroinflammation, compression or injury. But most neuralgia is unknown. Neuroinflammation (neuritis) causes neuralgia under the following circumstances: 1. Herpes zoster: it is a neuroinflammation caused by herpes virus infection. This common neuralgia often lasts until herpes zoster is cured, so it is also called post-herpetic neuralgia. 2. Any infection: Neuralgia caused by any infection around the nerve, such as tooth abscess. Third, syphilis infection: in the late stage of syphilis infection, in addition to neuralgia, it will also affect neurological function. In addition, god is oppressed or injured: neuralgia caused by fracture, disc herniation (sciatica) or tumor compression. Postherpetic neuralgia is a complication of herpes simplex or skin snake, which is caused by varicella-herpesvirus. After the early infection of varicella virus, some viruses will be hidden in nerve cells of ganglion. After several years, these varicella-herpes viruses hidden in the ganglion may be activated due to factors such as age, disease, stress or drugs, or even unknown reasons. These viruses can cause pain along nerve fibers, and when they reach the skin, they will produce rashes and chickenpox on the skin. It takes about one month from the whole course of disease to the recovery of the rash. However, some patients still have pain after the rash has healed, which is called post-herpetic neuralgia. Occipital neuralgia is caused by stimulating the nerve in the occipital part of the skull. This kind of pain is confined to the back of the head, which is a deep pain or maybe a paroxysmal "electric shock" feeling. Some of the pain will extend to the forehead. It may be caused by the tension of the muscles and tendons in the back neck or occipital region, or by infection, inflammation or injury of the neck. Trigeminal neuralgia is a very common neuralgia. Because this kind of pain is quite intense, some patients don't think about tea and rice, and some patients mistakenly think it is toothache and have a lot of dental treatment; But there is still no improvement. The main branches of trigeminal nerve, the sensation of cheek and jaw. It is a sudden pain that only affects half of the face, such as the feeling of "electric shock"; Actions in daily life, such as brushing your teeth, shaving, and even the wind blowing on your face, may cause bouts of neuralgia, and when the pain is severe, it will cause facial muscle twitching; Very few people's trigeminal neuralgia will affect both faces. There are many reasons, including multiple sclerosis or tumor compressing nerves. This is very common among women over 50. First of all, let's learn about the anatomical position of trigeminal nerve. Trigeminal nerve is one of twelve pairs of cranial nerves, which covers the left and right sides of the head of each branch of a pair of cranial nerves. They are sensations that control head and neck movements, touch, pain, temperature and pressure. The trigeminal nerve is the largest cranial nerve. A person has two trigeminal nerves, one for the right brain and the other for the left brain. These twelve pairs of cranial nerves are represented by Roman numerals from one to twelve. The trigeminal nerve is the fifth cranial nerve, so it is represented by the Roman numeral "V". Gu Ming thinks that trigeminal nerve is divided into three branches, and each branch is named V 1, V2 and V3 respectively. The following table describes the distribution, name and function of trigeminal nerve. Trigeminal nerve-fifth cranial nerve branch name distribution function V 1 eye branch and forehead sense V2 maxillary branch lower eyelid, ipsilateral nose, upper teeth, gums, lips and ipsilateral cheeks. Feel the teeth, gums, lips and ipsilateral mandible of V3 mandibular branch. Sensory sense of movement: transmit the feelings of pain, pressure, touch and temperature to the brain. Motion: the control of motion. Most patients with trigeminal neuralgia can't find the cause after many examinations, that is, it is caused by unknown reasons; The remaining reasons can be found as follows: 1. The trigeminal nerve root is compressed by blood vessels. According to statistics, this is the most common cause of trigeminal neuralgia, and the trigeminal nerve root is compressed by curved blood vessels. There are many important blood vessels near our brain stem, which may become distorted and straight because of personal differences or with age; Even bent into a circle, pressing the nearby trigeminal nerve. 2. Less than 3% of cases are caused by demyelination; For example, trigeminal neuralgia may be one of the symptoms of multiple sclerosis in severe cases, but it is rarely the first symptom in the early stage. Multiple sclerosis is a disease in which myelin sheath is destroyed. Third, very few cases are caused by tumor compression of trigeminal nerve. Four, facial trauma, facial infection, facial surgery or dental treatment caused by trigeminal nerve injury, can also cause trigeminal neuralgia. 5. The cause is unknown, because the cause cannot be found in all cases. There are even special cases of genetic constitution. The symptom of trigeminal neuralgia is a sharp tingling sensation similar to electric shock or electric shock in a short few seconds, but it can happen many times a day; Generally, it only affects one side, and there are a few cases that affect two sides. Trigeminal neuralgia is usually triggered by unique triggers, such as touching the face, talking, eating or shaving. These triggers vary from person to person. Trigeminal neuralgia may last for days, weeks or months, and then disappear for months or years. The pain area of trigeminal neuralgia includes the distribution area of any trigeminal nerve, and sometimes it may involve two trigeminal nerves at the same time, so the pain area is: 1. V 1 (ophthalmic branch): The first branch mainly affects the eyes, forehead and nose. V2 (maxillary branch): The second branch mainly involves the lower eyelid, ipsilateral nose, upper teeth, gums, lips and ipsilateral cheeks. V3 (mandibular branch): The third branch mainly involves the lower teeth, gums, lips and the ipsilateral mandible. Trigeminal neuralgia can be divided into typical trigeminal neuralgia and atypical trigeminal neuralgia. Typical trigeminal neuralgia is a sharp tingling sensation similar to electric shock or electric shock, without any numbness or weakness in the face; Typical trigeminal neuralgia will be completely painless for a period of time; It also includes drugs for the treatment of epilepsy, such as tegretol. Atypical trigeminal neuralgia in addition to the above-mentioned typical pain, some patients will also feel swelling pain, burning sensation, pulsating or squeezing pain; In some patients, the pain is persistent and will not go away by itself. Atypical trigeminal neuralgia is difficult to treat and has poor response to drugs. In addition to general medical examination and medical history inquiry, it is best to increase imaging examination including magnetic resonance photography to diagnose trigeminal neuralgia and whether trigeminal nerve is compressed by vein or artery; Or can't find any reason, most patients can't find any reason. If the cause cannot be found, the diagnosis can be established in addition to the clinical pain conforming to trigeminal neuralgia and the clinical curative effect on epilepsy. For typical trigeminal neuralgia, it is not difficult to diagnose clinically; Atypical trigeminal neuralgia is difficult to diagnose. Carbamazepine is the first choice for the treatment of trigeminal neuralgia. Other drugs include Befon, clonazepam, and gabapentin, which can be used alone or in combination. The recently produced Sanlepu has the same effect as epilepsy, but has fewer side effects. When drugs can't control the pain, patients who don't respond well to drugs can consider surgical treatment. Treatment methods include decompression surgery and blocking trigeminal nerve conduction. The advantages and disadvantages of these operations must be discussed with neurosurgeons in order to have a correct understanding. The causes of "neuropathic pain" are very complicated. In addition to the above-mentioned common trigeminal neuralgia, postherpetic neuralgia and posterior occipital neuralgia, there are sciatica, neuralgia caused by cervical nerve root compression, neuralgia caused by multiple peripheral neuropathy, complex local pain syndrome, multiple sclerosis neuralgia and cancer-related neuralgia. These long-term and chronic neuropathic pains not only have pain symptoms, but also have insomnia, anxiety, depression and other symptoms, which affect work performance, cause the deterioration of patients' social function and quality of life, and even have suicidal tendencies; Apart from personal illness, it is a heavy burden to the family and society. Often patients don't know how to seek medical treatment, so they have to find ways to relieve pain in hospitals and departments. It is suggested that patients with neuropathic pain should seek a neurologist who specializes in neuropathic pain in order to get appropriate treatment and advice. And remember the following important features about neuralgia: 1. Neuralgia will be painful along the nerve direction; Second, generally speaking, neuralgia is not a disease, but one of the symptoms of injury or pathological changes; Third, many cases belong to pain that cannot be found; Fourth, this kind of pain can be treated by drugs, physical therapy or surgery, rather than the so-called "terminal disease".