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Neuralgia - what is it? Neuralgia = pain at the nerve endings, usually induced by a disturbed "food" supply of a nerve.
Neuropathic PainDamage to sensory nerves can cause neuropathic pain syndromes that are relatively insensitive to antinociceptive suppression. In patients who have had a stroke or spinal cord injury, for example, the nerves that carry touch signals may be destroyed. If enough pain-carrying fibers regenerate, tissues presumed to be anesthetic can produce considerable pain if reinjured or inflamed. This deafferentation pain is most common among patients with spinal cord injuries. Although they may have no normal sensation below the waist, surgery on decubitus ulcers or even a simple bladder infection can be extremely painful. In postthoracotomy and other postoperative pain syndromes, this type of pain is often associated with tactile hypesthesia. Under certain conditions, usually after a tissue injury, the large myelinated nerves (A fibers) that normally carry the sense of touch, sprout new terminal branches that synapse with pain-sensing cells in the superficial layers of the dorsal horn rather than with touch-sensing cells located deeper in the spinal cord. Not only can these A fibers mediate allodynia, but they are also resistant to the inhibiting effects of endorphins or opioid medications because they do not have opioid receptors. That would explain why patients with reflex sympathetic dystrophy have such agonizing pain and do not respond to opioid medications. Damage to the nociceptors themselves can also give rise to opioid-resistant pain. When these nerve fibers are traumatized or severed, opioid receptor proteins manufactured within the nerve cell body cannot be transported down the axon to their final destination in the presynaptic membrane. That is why surgical procedures designed to destroy or cut pain nerves are generally unsuccessful in providing long-term pain relief. Neurodestructive procedures, such as presacral neurectomies for pelvic pain, occipital neurectomies for chronic headaches, and limb amputation for reflex sympathetic dystrophy, that used to be common, have fallen out of favor. Partial spinal cord transections and other neuroablative procedures continue to be performed but are reserved primarily for end-stage cancer patients with intractable pain and very grim prognoses. Text made available by Daniel Brookoff, M.D., University of Tennessee
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