Neuropathic Pain in Older People - Causes, Symptoms, and Treatment

Introduction

Neuropathic pain due to disease or lesions of the somatosensory system mainly affects elderly individuals with several comorbidities. Elderly individuals are often hospitalized, poly-medicated, and treated in nursing homes with an increased risk of recurrent hospitalization and drug interaction. Due to consistent pain, individuals with neuropathic pain often report mood disorders and sleep disturbances. Depression is a common consequence, mainly if the pain is associated with social isolation, poor sleep, increased risk of falls, and functional deterioration.

What Is Neuropathic Pain?

Pain happens if an individual's nervous system is damaged and not working efficiently. The pain can be felt at various levels of the nervous system - the spinal cord, peripheral nerves, and brain levels. The spinal cord and the brain are known as the central nervous system. The peripheral nerves are spread throughout the rest of the body, like arms, legs, toes, and fingers.

The nerve damage can change the nerve function, and wrong signals can be sent to the pain centers and the central nervous system. Disturbances of function and changes in one or several nerves lead to neuropathy. Around 30 percent of neuropathy cases are due to diabetes. It is not always easy to diagnose neuropathic pain. There are many conditions and diseases linked with this kind of pain.

What Is the Cause of Neuropathic Pain?

Neuropathic pain can be caused by underlying diseases as listed below:

• Facial nerve problems.

• HIV (human immunodeficiency virus) infections or AIDS.

• Diabetes - A group of diseases that result in too much sugar in the blood.

• Central nervous system disorders.

• Shingles - The reactivation of the chicken pox virus in the body that can cause a painful rash).

• Complex regional pain syndrome.

• Alcoholism - A chronic condition that is caused by uncontrolled alcohol consumption).

Other causes include the following:

• Nerve Compression - A pinched nerve occurs when too much compression and pressure are applied to a nerve by surrounding tissue).

• Trauma or surgeries causing nerve damage.

• Amputation - A loss or removal of a body part such as a finger, hand, foot, toe, or leg.

• Radiation therapy.

• Chemotherapy drugs.

• Spinal nerve compression or inflammation.

What Are the Symptoms of Neuropathic Pain?

The symptoms of neuropathic pain include the following:

• Spontaneous Pain: Burning, shooting, stabbing pain like an electric shock, numbness.

• Evoked Pain: Pain can normally be caused by stimuli of cold, gentle brushing against pressure, skin called allodynia. Evoked pain results due to an increase in pain and due to stimuli such as heat and pinpricks. This pain is called hyperalgesia.

• Emotional problems or troubled sleep due to pain.

• Pain that may be lessened in response to a normally painful stimulus.

• Emotional problems resulting from chronic pain, loss of sleep, and difficulty expressing how low one feels.

How Is Neuropathic Pain Treated?

The goal of treating neuropathic pain is to identify the underlying disease or condition responsible for pain. The important goal aims to provide pain relief, which may help maintain typical capabilities despite the pain and improve quality of life. The most common treatments for neuropathic pain are the following:

• Prescription Medication: Opioid medications are used, along with topical relievers are used that include capsaicin patches, lidocaine patches, and prescription-strength creams and ointments.

• Over-the-counter Pain Medication: NSAIDs, like Aleve and Motrin, are used to treat the condition.

• Anticonvulsants: Anticonvulsants and antiseizure medications are used to treat the condition. Gabapenatnoids are most commonly used.

• Antidepressant Drugs: These drugs help to a great extent. Two types of drugs are tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors.

• Nerve Blocks: Injecting local anesthesia, steroids, and other pain medications can help to ease the pain. This gives temporary relief, and it needs to be repeated to keep working.

• Implantable Devices: Invasive procedures to implant devices in the body are done. The device sends electrical impulses into the brain and spinal cord or nerves.

• Lifestyle Treatment: Relaxation and massage therapies are used to relieve neuropathic pain symptoms. The form of treatment help eases muscles. The provider helps to cope with the pain. Individuals with neuropathic pain may experience an increase in the symptoms after many hours of sitting. The therapist may suggest stretching, sitting, standing, and moving techniques to prevent pain.

What Are the Preventive Methods to Prevent Neuropathic Pain in Older People?

The preventive methods of neuropathic pain in older adults are some non-pharmacological therapies that may be effective as adjuvants with pharmacological co-treatment:

• Physical Therapies: Management of neuropathic pain includes applying superficial and deep-level cold and heat, whirlpool therapy, physical massage, fluid therapy, and TENS (transcranial electrical stimulation and transcranial magnetic stimulation).

• Lifestyle Modifications: Specific etiological conditions can correct inappropriate behavior, or exposure to the modifiable risk factors can reduce the degree of pain and disease progression.

• Acupuncture is an effective therapeutic option to reduce pain due to diabetic neuropathy and low back pain. It appears to be a good adjuvant therapy in the rehabilitation phase following quality of life, improving pain, acute diseases, sleep, and overall well-being.

• Rehabilitation: Rehabilitation is a widely employed element of neuropathic pain to achieve an analgesic effect and improve functionality and quality of life. The effectiveness of exercise depends on the type of underlying neuralgia.

• Cognitive Behavioral Therapy: It is used to treat several conditions. Conditions like anxiety disorder, somatoform disorder, and bulimia are treated. Anxiety is an uncommon condition in an elderly individual. It is a viable alternative for the management of neuropathic pain.

• Varicella-zoster Virus Vaccine: Age is a major risk factor for developing neuropathic pain. People develop herpes zoster and post-herpetic neuralgia. This vaccine reduces the risk of herpes zoster in elderly people. A cell-mediated immunity response comparable to exposure to the varicella-zoster virus is associated with lesser severity and post-therapeutic neuralgia (pain caused by nerve damage and nerve irritation).

Conclusion

A multidisciplinary team can be the best strategy to manage neuropathic pain, especially in elderly individuals. A correct process of diagnosis requires an articulated anamnesis. Medications are more effective than non-pharmacological therapies and are necessary to combine neuropathic pain that is not responsive to drugs. Elderly individuals suffer from many diseases and feel abandoned. Healthcare providers play an important role in supporting such individuals.