Pain, in any form, can present a difficult challenge for even the most astute pain physician.  The complexity of treating neuropathic or nerve pain stems from a variety of reasons, ranging from the lack of an obvious source of the pain to the inability of the patients to explain what ails them, to a arduous history that was poorly managed with the wrong medications, allowing the pain to progress to a seemingly unmanageable state.  Many people with neuropathic pain are often given escalating doses of opioids in a fleeting attempt to control their discomfort; it is not until much later that they will seek the help of a pain management specialist.

As many can attest, opioids are rarely a good choice for the sole treatment of neuropathic pain.  Neuropathic pain medications, which include certain antidepressants and antiepileptics (indicated for specific types of neuropathic pain), are rarely discussed with these patients in the early stages, and, unfortunately, are often first mentioned late in the disease’s progression.  Moreover, the mere suggestion of these medications for the treatment of neuropathic pain is often met with confusion and even mistrust toward the doctor by patients not appropriately counseled by their physicians, leading to reactions like:  “I’m not depressed,” or “I’m not crazy, I just need a higher dose of my medication…my pain is a ‘15’ on a scale of 1 to 10!”

The growing neuropathic pain epidemic has created an uphill battle for both patients and the physicians trying to help them.  Whereas nocioceptive pain can usually be pinpointed to an actual event (e.g., pain resulting from a broken arm), neuropathic pain can be vague and nondescript in nature.  For many physicians, there is no sense of need to tease out the details from the ambiguity; a prescription is provided for an opioid-pain killer and the patient is sent home.  Not only will the discomfort most likely continue, but now the patient is subjected to an unnecessary risk for prescription drug dependency–another epidemic unto itself.

Understanding what neuropathic pain is and how it might present itself are the first and most important things to consider.  If you believe your pain symptoms are neuropathic, you should ask your doctor these questions:

• My pain is not getting better; could this be neuropathic pain?
• The medications I am taking are not helping; could this be neuropathic pain?
• Are these the appropriate medications for treating neuropathic pain?
• How much experience or training do you have in treating neuropathic pain? Could I get a second opinion?
• Is the medication you are giving me potentially addictive? What else should I know about these medications?
• Can you explain how antidepressants and antiepileptics work to treat neuropathic pain?

Waiting to get appropriate care makes neuropathic pain harder to treat.  However, even severe cases of neuropathic pain can be managed effectively by an informed patient with the proper therapies.

Corey W. Hunter is a pain management specialist and serves on The Neuropathy Association’s Neuropathic Pain Management Medical Advisory Council.  

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