Neuropathic pain: causes, symptoms and treatment - psychology - 2023



Feeling pain at some point is something that happens to everyone.

We hit ourselves, cut ourselves or simply make a bad gesture and our nervous system quickly picks up and reports that there is an injured tissue and causes us that undesirable and annoying aversive sensation that we call pain. Undesirable but adaptive, since it warns us that something is wrong and allows us to act to remedy it.

Nevertheless, sometimes the pain appears without there being a real problem and stops having a meaningor, as occurs in people with neuropathic pain.

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Pain and its transmission

The sensation of pain is a mechanism of our body, mainly somatosensory, which detects the presence of a stimulation or situation that is damaging or has the potential to damage our tissues. And it not only affects us on a physical level, but also on an emotional and mental level. The perception of pain allows us to start a series of actions and behaviors that will make us move away from the harmful stimulus or prevent it from damaging us. It is therefore a mechanism of innate origin, although modifiable through experience and habit that allows our survival and prevents our death and incapacitation.

Thus, although we first know pain through the subjective experience it produces, we must bear in mind that this phenomenon it is not something that only exists for us, in our imagination. In fact, as much as we are the first interested in not suffering pain, it comes from a material process that can be objectively investigated through observation and measurement. Thanks to this we know certain objective and verifiable aspects about pain in general and neuropathic pain in particular; if not, we couldn't say anything about it.

What we know about this physiological and psychological process

At the neurological level, pain is experienced by the activation of a series of receptors present in the vast majority of our body, the nociceptors, which are activated by the break, impingement or intense pressure and send signals to the nervous system.

Specifically, the signal is sent through fibers and ganglia to the posterior horn of the spinal cord, with which they communicate through the use of glutamate and what is known as substance P. The cord will provoke an immediate response in the form of a reflex while sending the pain signal to the brain (the spinothalamic bundle being the best known route).

However, not whenever there is an injury we will feel pain, as there is a circuit of nerve fibers that can inhibit the transmission of signals. This circuit is visible when the level of pain decreases when we rub a hit area or its surroundings. Depending on whether or not the excitatory or inhibitory pain pathways are activated, we will end up perceiving a painful sensation. In addition, once the injury is perceived, the brain proceeds to send endorphins that counteract the pain perception, allowing us to ignore the pain and focus on fighting or escaping the stimulus.

This would be the process that would normally lead to the perception of pain, but as we have said there are people who feel pain without there being any stimulus that should produce it, people who suffer from neuropathic pain. What happens in these cases?

Neuropathic pain: what is it and how is it produced?

Neuropathic pain is known as the type of pain that appears in situations and contexts in which there is not a sufficiently intense or damaging stimulation for pain perceptions to appear. Stimuli that do not normally cause pain do. Thus, small frictions and even some generally pleasant contacts such as a caress or a kiss can become a real torture for people with this type of problem, since their nervous systems perceive them as extremely painful.

The type of pain experienced can vary greatly depending on the cause of the damage and the level of involvement and reactivity of the nerve pathways. It is very common that it appears in the form of burning pain, that is, as if a burn was suffered, or in the form of punctures or pricks. In some cases numbness of the area may also appear. The pains can be maintained continuously in time or they can appear and disappear.

Neuropathic pain poses serious difficulties for those who suffer from it, maintaining a high level of discomfort and frustration. Many of the people with this type of pain can end up suffering from anxiety disorders or serious depression, in some cases with suicidal ideation. It is not uncommon for them to avoid leaving their home as much as possible, to avoid physical contact with other people and to actively limit their social, family and work life, being a very disabling condition. It also produces sleep problems, which in many cases causes great fatigue and stress.

The reason for this disorder is the presence of damage to the somatosensory system, being damaged the nerve bundles that transmit somesthetic information to the brain. This damage can be localized to both the central and peripheral nervous systems. As a consequence, pain-transmitting neurons become hyperexcitable and react with a lesser amount of stimulation, and sometimes even without actual stimulation.


Nerve pathway damage that ends up causing neuropathic pain can stem from a wide number of disorders and conditions, neuropathic pain receiving different names according to its cause.

1. Neurodegenerative diseases

When neuropathic pain occurs due to damage to the nerve pathways It is logical to think that disorders in which there is an alteration or degeneration of the nerves this type of problem may appear. Thus, both in diseases such as multiple sclerosis and in some demential processes it is possible that pain related to nerve degeneration may appear.

2. Diabetes mellitus

People with diabetes mellitus can develop alterations in the nerve pathways over time., by weakening the nerves as a result of vascular alterations or the lack or excess of glucose in the blood. In this case we would be talking about painful diabetic neuropathies. The most common is diabetic peripheral neuropathy, in which there are paresthesias, burning or cooling sensations, loss of sensation, and pain in the extremities.

3. Bad nutrition

Lack of sufficient nutrients in the body can cause nerve cells to become altered and weak, eventually causing the peripheral nerves to end up reacting abnormally.

4. Viral infections: Herpes and HIV

Some viral infections can cause an alteration in the nerve pathways that lead to neuropathic pain. It is common in the case of the herpes zoster virus, in which pain usually appears both in the torso and in the face.

Also in the case of acquired immunodeficiency syndrome or AIDS, caused by HIV, a degeneration of the nervous tissue can appear that can cause pain of this type to appear.

5. Tumors

Some cancers and tumors can damage nerve pathways, both by direct effect of the tumor and by producing a possible clamping of the fibers that carry the painful information.

6. Trauma, hemorrhage and ischemic accidents

Whether due to partial or complete asphyxia of neurons or their impingement with other parts of the body, strokes and head injuries in many cases they can be the origin of neuropathic pain.


The treatment of neuropathic pain is complex and requires a multidisciplinary approach. It is a chronic disorder, although it is possible to reduce the patient's pain and greatly improve their quality of life.

Sometimes the reason causing the pain can be treated more or less directly and prevent permanent damage to the nervous tissue from happening, as in some cases of diabetes. Some of the treatments contemplated are the following.

1. Antidepressants

The use of antidepressants is frequent to alleviate both the level of pain and the psychological effects of it. However, they should be used with caution, as it is intended to reduce the level of pain and not sedate the patient.

In the case of antidepressants, it has been proven that those that have an effect that allows to regulate the level of pain are those that affect both serotonin and norepinephrine, so that SNRIs such as duloxatin are usually used with some success. They seem to work especially well for some cases of neuropathic pain from diabetes.

2. Anticonvulsants

The drugs used to treat epilepsy have also been shown to be very useful against neuropathic pain, both in cases derived from sclerosis and from viral infections, diabetes or others. For example, carbamazepine is used as the treatment of choice for trigeminal neuralgia, one of the most painful disorders that affects the nerves of the face.

3. Opioids and cannabinoids

As with the pain caused by some types of cancer, substances such as morphine have been used in the case of neuropathic pain, marijuana or other derivatives of opium and cannabis to help reduce and manage the level of pain.

4. Other substances: Capsaicin

In addition to those already mentioned, it has been found that other substances such as capsaicin can help fight pain, either orally or applied to the skin or subcutaneous level.

5. Transcranial magnetic stimulation

Stimulation of the nervous centers and the somatic system It has been shown to reduce the level of pain in patients with this problem.

6. Surgery

If the cause of the pain is localized and its realization is feasible, corrective surgery can be applied to help improve and correct the problem. As a last resort, ablation of damaged nerve tissue could be performed.

In addition to this, at a medical level it is possible to block the damaged nerve pathway, either by infiltration of drugs or by radiofrequency.

7. Psychotherapy

Neuropathic pain often leads to maladaptive coping strategies to face day-to-day events, as well as anxiety and depression problems. Psychological treatment and psychotherapy can contribute greatly through programs and therapies that help to cope with and learn how to manage pain, establish routines and appropriate action strategies, and facilitate the expression and communication of emotions and sensations produced by their state.

8. Physiotherapy

Rehabilitation and physical conditioning of the patient can help make them less sensitive to pain and improve their quality of life, being able to reduce the intensity and frequency of pain and improving their physical and mental state.

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  • Pérez, I. and Ayuga, F. (s.f.) Neuropathic Pain. Neurology Service of the Virgen de la Salud Hospital in Toledo. SESCAM. Toledo.
  • Valverde, J.A. (2012). Recommendations for the pharmacological treatment of neuropathic pain. Neuroaxis, 25 (2).