RN: Right. Before, taking on your placement, let’s go through your knowledge about neuropathic pain management. But first of all, how can neuropathic pain be differentiated from excessive nociception?

TN: Well, to put it simply, we refer to nociception as a result of tissue damage caused by physical or chemical agents such as trauma, surgery, or chemical burns. However, neuropathic pain, or nerve pain, is triggered by injury to the somatosensory nervous system.

RN: And what causes neuropathic pain?

TN: As I’ve just mentioned, and contrary to nociceptive pain, theoretically, I know that neuropathic pain originates from diseases or damage directly involving sensory nerves, such as peripheral pain damage, diabetic neuropathy, cancer pain, facial problems, HIV infection, multiple sclerosis, thyroid problems, spine injury, and many other causes. But can I ask you a question? What mechanism is at the base of neuropathic pain?

RN: With neuropathic pain, the body just sends selfgenerated pain signals to the brain. And this tends to get worse over time.

TN: But then, how can pain be diagnosed as neuropathic and not as nociceptive?

RN: Symptoms may vary slightly from one person to another. Meanwhile, there are some common manifestations of this kind of pain, which are usually shooting, burning, or stabbing pain; and the feeling of “pins and needles,” or what we call tingling and numbness.

TN: Therefore, as I understand, neuropathic pain occurs spontaneously, doesn’t it?

RN: Yes. That’s even when pain is “evoked.” In other words, we refer to it as pain caused by events that are typically not painful, such as rubbing against something, being in cold temperatures, or brushing your hair; a chronic sensation of feeling unpleasant or abnormal; emotional problems as a result of chronic pain, difficulty sleeping or resting; and difficulty expressing how you’re feeling.

TN: As such, neuropathic pain cannot be managed by usual painkillers, can it?

RN: That’s right. Unfortunately, neuropathic pain often responds poorly to standard analgesics, which can lead to serious disability. For some people, the use of nonsteroidal antiinflammatory drugs may ease the pain, but others may require stronger painkillers. However, probably an effective approach to provide pain relief is holistic, and should include a multidisciplinary combination of therapies like anticonvulsant and antidepressant drugs as a first line of treatment, electrical stimulation, physical therapy, massage therapy, relaxation therapy, occupational therapy…

TN: And what about patient education?

RN: This is why I mentioned the multidisciplinary approach. Some people with neuropathic pain may experience increased symptoms after sitting for several hours. This might make desk jobs difficult to carry out. A physical therapist can teach patients techniques for sitting, stretching, standing, and moving.