Neuropathic Pain Management

• Neuropathic pain:

  • Neuropathic pain is a clinical description in which, the pain is a result of a lesion or disease of the somatosensory nervous system
  • This can be located within the peripheral or central nervous system
• Neuropathic pain - Subjective Assessment:

  • Negative neural symptoms
  • Loss of sensation
  • Loss of strength/weakness
  • Positive neural symptoms
  • Sharp shooting
  • Burning, pins and Paraesthesia
  • Pain/symptoms felt in a dermatomal distribution
• Neuropathic pain - Objective Assessment:

  • Reduced conduction on neural integrity testing of 1 or more of dermatomes, reflex and myotomes
  • Will present with a positive or negative neural tissue provocation testing (SLR, ULTT, PKB).
• Neuropathic pain - Management recommendations:

  • Early graded movement
  • Active management > Passive management
  • Review area of compromise: modifiable or non-modifiable
  • Gentle mobilisation of the neural tissue – sliders
  • Only once neural integrity is negative
  • and only if Irritability and severity is low to moderate
  • Review areas of irritation of neural tissue
  • Specific pharmacological management