Neuropathic pain may persist regardless of the injury or the severity of the damage and may even worsen over weeks, months, and years. This situation is very different from nociceptive pain because nociceptive pain resolves rapidly after the stimulus is removed (88).
Causes of Peripheral Neuropathy
Damage secondary to trauma / surgery / pressure
Metabolic disorders
Infections
Cancer-related
Toxin overload
Iatrogenic
Drug
Secondary to alcohol and smoking
Vascular diseases
Nutritional deficiencies and disorders
Heavy metals
Disruptive fields
Generally, the most common pain syndromes in this group can be listed as diabetic neuropathy, postherpetic neuralgia and CRPS. Neuropathic pain is often described as a burning, pricking and strange feeling that is uncomfortable for patients.
a. Recognizing the pain syndromes that occur after nervous system injuries,
b. It can be listed as the development of animal models in which possible treatment modalities of neuropathic pain mechanisms can be studied and investigated.
Both the duration and amplitude of the increase in sensitivity to the stimulus can reach exaggerated dimensions (hyperalgesia).
Diabetic neuropathy can present as different clinical pictures and can be seen as focal neuropathies, truncal neuropathies or mixed symmetric distal neuropathies. In particular, the differential diagnosis of mononeuropathy from other neuropathic pain syndromes is difficult. Mixed symmetrical distal neuropathies are the most common among different clinical presentations, and they are easiest to diagnose if the patient’s presence of diabetes is known (1, 3, 7, 38).
The most complex of the chronic neuropathic pain syndromes is undoubtedly Complex Regional Pain Syndromes (CRPS). Although there are many research and clinical approaches for CRPS (I and II), which are clinically examined in two groups, it is one of the leading pain syndromes with many unknowns regarding its pathophysiology, course and treatment of the disease. Symptoms vary widely in patients with neuropathic pain or CRPS (54).
We can distinguish between subjective and objective parameters used in the diagnosis of neuropathic pain. The most important factors in the subjective assessment are the determination of pain type and severity. Although many different pain scales are suggested in this evaluation, it should not be forgotten that a detailed and accurate anamnesis is very important in the diagnosis, no matter which scale is used (34, 6, 8, 38, 39)
Objective Tests Used to Support the Diagnosis
1- Pinprick and touch tests: Although very nonspecific, they are the first tests used in neuropathic pain syndromes. Although it is important in demonstrating the presence of hyperalgesia and allodynia, its accuracy rates are low because precise cooperation with the patient and patient education are required. While there are filaments developed for this purpose, some clinicians also use simpler materials such as cotton, brushes and needles. These tests, in which the equipment used is as important as the one performing the test, can be used together with other objective tests, although they do not give very meaningful results on their own.
radiological=”””” sans=”””” specific=”””” style=”””” tests:=”””””>2- Bone Scintigraphy: It is believed that bone scintigraphy can be a helpful method in diagnosis. There are conflicting findings in studies on the subject.
3- Peripheral Blood Flow: Blood flow measured by Laser Doppler Flowmeter provides early diagnosis in sympathetic dysfunction. This method can be helpful in diagnosing peripheral neuropathy or CRPS.
4- Quantitative Sensory Tests: It tests the functions of small nerve fibers that provide the transmission of vibration, heat and cold sensations. Although it is not specific, it can be supportive in the differential diagnosis.
Modern Tests
1- Laser evoked potentials: This method, in which infrared CO2 and heat evoked potentials are used, gives invaluable results in the evaluation of the sensory system, but the expensiveness of the systems used is a significant disadvantage.
2- Skin punch biopsy: It is used to examine unmyelinated and thin myelinated peripheral nerve fibers through special staining methods.
Early evaluation and diagnosis is the first requirement for a more successful treatment in neuropathic pain syndromes. An early classification and a correct sensory evaluation play a very important role in treatment.
The goal of treatment in patients with neuropathic pain should be against the specific signs and symptoms. The treatment approach is to alleviate pain and improve quality of life.
Tricyclic antidepressants in general and especially Amitriptyline are the first chosen agent, and if there is no response to this drug, anticonvulsants are used (54).
Controversy continues regarding the use of opioids in neuropathic pain. While some clinicians claim that neuropathic pain is pain resistant to opioids, another group reports that they are effective, but that dose adjustment should be done correctly and higher doses should be increased if necessary. Tramadol Hydrochloride, which is a weak synthetic agent, is undoubtedly the most effective among opioid agents, and successful results have been reported in studies after it was demonstrated that it acts through serotonergic mechanisms (92).
An important option in the treatment of neuropathic pain in recent years has been gabapentin, and although it has been shown that it does not act on GABA as originally thought, it is effective in neuropathic pain with an unknown mechanism. Gabapentin’s wide therapeutic range and less side effects compared to other agents increase its clinical use. Since it does not bind to proteins, is not metabolized, does not induce and inhibit liver enzymes, it does not interact with other drugs, which also increased its use. (36)
II. Approach to Neuropathic Pain with Neural Therapy:
II.I. Application Conditions of Neural Therapy:
Is application necessary?
Has the diagnosis and the cause of the disease been sufficiently questioned?
II.II. The Importance of Pathophysiology in Neural Therapy and the Concept of Basic Matter
As it is known, all cells in the organism show a close association and are regulated by sympathetic nerve endings. Thus, most of the cell and cell wall functions are organized by these fibers.
Although the Academy of Neural Therapy revealed this years ago based on clinical observations, this research became available with the lifting of the iron curtain (University of Magdeburg, Germany).
If the organism fails to do this, the sympathetic nervous system will be constantly affected and will give a chronic response. Rickers has proven this theory with live animal experiments.
This structure, called the Basic Matter, was formed phylogenetically before the nervous and hormonal systems.
The basic substance is also called the matrix. Detoxifying organs such as kidneys, lungs, liver and skin are under overload
Causes of Peripheral Neuropathy
Damage secondary to trauma / surgery / pressure
Metabolic disorders
Infections
Cancer-related
Toxin overload
Iatrogenic
Drug
Secondary to alcohol and smoking
Vascular diseases
Nutritional deficiencies and disorders
Heavy metals
Disruptive fields
Generally, the most common pain syndromes in this group can be listed as diabetic neuropathy, postherpetic neuralgia and CRPS. Neuropathic pain is often described as a burning, pricking and strange feeling that is uncomfortable for patients.
a. Recognizing the pain syndromes that occur after nervous system injuries,
b. It can be listed as the development of animal models in which possible treatment modalities of neuropathic pain mechanisms can be studied and investigated.
Both the duration and amplitude of the increase in sensitivity to the stimulus can reach exaggerated dimensions (hyperalgesia).
Diabetic neuropathy can present as different clinical pictures and can be seen as focal neuropathies, truncal neuropathies or mixed symmetric distal neuropathies. In particular, the differential diagnosis of mononeuropathy from other neuropathic pain syndromes is difficult. Mixed symmetrical distal neuropathies are the most common among different clinical presentations, and they are easiest to diagnose if the patient’s presence of diabetes is known (1, 3, 7, 38).
The most complex of the chronic neuropathic pain syndromes is undoubtedly Complex Regional Pain Syndromes (CRPS). Although there are many research and clinical approaches for CRPS (I and II), which are clinically examined in two groups, it is one of the leading pain syndromes with many unknowns regarding its pathophysiology, course and treatment of the disease. Symptoms vary widely in patients with neuropathic pain or CRPS (54).
We can distinguish between subjective and objective parameters used in the diagnosis of neuropathic pain. The most important factors in the subjective assessment are the determination of pain type and severity. Although many different pain scales are suggested in this evaluation, it should not be forgotten that a detailed and accurate anamnesis is very important in the diagnosis, no matter which scale is used (34, 6, 8, 38, 39)
Objective Tests Used to Support the Diagnosis
1- Pinprick and touch tests: Although very nonspecific, they are the first tests used in neuropathic pain syndromes. Although it is important in demonstrating the presence of hyperalgesia and allodynia, its accuracy rates are low because precise cooperation with the patient and patient education are required. While there are filaments developed for this purpose, some clinicians also use simpler materials such as cotton, brushes and needles. These tests, in which the equipment used is as important as the one performing the test, can be used together with other objective tests, although they do not give very meaningful results on their own.
radiological=”””” sans=”””” specific=”””” style=”””” tests:=”””””>2- Bone Scintigraphy: It is believed that bone scintigraphy can be a helpful method in diagnosis. There are conflicting findings in studies on the subject.
3- Peripheral Blood Flow: Blood flow measured by Laser Doppler Flowmeter provides early diagnosis in sympathetic dysfunction. This method can be helpful in diagnosing peripheral neuropathy or CRPS.
4- Quantitative Sensory Tests: It tests the functions of small nerve fibers that provide the transmission of vibration, heat and cold sensations. Although it is not specific, it can be supportive in the differential diagnosis.
Modern Tests
1- Laser evoked potentials: This method, in which infrared CO2 and heat evoked potentials are used, gives invaluable results in the evaluation of the sensory system, but the expensiveness of the systems used is a significant disadvantage.
2- Skin punch biopsy: It is used to examine unmyelinated and thin myelinated peripheral nerve fibers through special staining methods.
Early evaluation and diagnosis is the first requirement for a more successful treatment in neuropathic pain syndromes. An early classification and a correct sensory evaluation play a very important role in treatment.
The goal of treatment in patients with neuropathic pain should be against the specific signs and symptoms. The treatment approach is to alleviate pain and improve quality of life.
Tricyclic antidepressants in general and especially Amitriptyline are the first chosen agent, and if there is no response to this drug, anticonvulsants are used (54).
Controversy continues regarding the use of opioids in neuropathic pain. While some clinicians claim that neuropathic pain is pain resistant to opioids, another group reports that they are effective, but that dose adjustment should be done correctly and higher doses should be increased if necessary. Tramadol Hydrochloride, which is a weak synthetic agent, is undoubtedly the most effective among opioid agents, and successful results have been reported in studies after it was demonstrated that it acts through serotonergic mechanisms (92).
An important option in the treatment of neuropathic pain in recent years has been gabapentin, and although it has been shown that it does not act on GABA as originally thought, it is effective in neuropathic pain with an unknown mechanism. Gabapentin’s wide therapeutic range and less side effects compared to other agents increase its clinical use. Since it does not bind to proteins, is not metabolized, does not induce and inhibit liver enzymes, it does not interact with other drugs, which also increased its use. (36)
II. Approach to Neuropathic Pain with Neural Therapy:
II.I. Application Conditions of Neural Therapy:
Is application necessary?
Has the diagnosis and the cause of the disease been sufficiently questioned?
II.II. The Importance of Pathophysiology in Neural Therapy and the Concept of Basic Matter
As it is known, all cells in the organism show a close association and are regulated by sympathetic nerve endings. Thus, most of the cell and cell wall functions are organized by these fibers.
Although the Academy of Neural Therapy revealed this years ago based on clinical observations, this research became available with the lifting of the iron curtain (University of Magdeburg, Germany).
If the organism fails to do this, the sympathetic nervous system will be constantly affected and will give a chronic response. Rickers has proven this theory with live animal experiments.
This structure, called the Basic Matter, was formed phylogenetically before the nervous and hormonal systems.
The basic substance is also called the matrix. Detoxifying organs such as kidneys, lungs, liver and skin are under overload
