Neuropathy or nerve pain - what happens?

[Josephine]

Neuropathy is a very unpleasant roaring hot sensation that the body interprets as pain. It can arise almost anywhere in the body but it's origins are in the brain. But first I will need to explain how nerves work.

Nerves are a kind of electrical system with many interconnecting parts.

Nerve cells are the basic functioning component in the nervous system. Every part of the system, whether peripheral or central, is comprised of neurons that collect and distribute information to make the body function. Different types of nerve cells exist that respond to light, sound, touch and other stimuli.

The basic structure of a neuron helps it to perform its function. Signals propagated by chemical ions distribute an electrical charge that proceeds from neuron to neuron, passing information. The nucleus is surrounded by the dendrite, which receives signals from other neurons or cells. This electrical charge is then transferred through the cell body called the soma and onto the axon. The axon is long thin part of the neuron covered by myelin sheath. This information then reaches the axon terminal and again transfers the electrical charge to another cell.

Neuropathy is the term used to describe a problem with the nerves, usually the 'peripheral nerves' as opposed to the 'central nervous system' (the brain and spinal cord).

What actually happens is that instead of flowing smoothly from one neuron to the next as they were intended to do, the electrical signals passing from one neuron to the next become totally scrambled and go down to the sensory nerves where the results are interpreted by the 'victim' as pain.

Here are some key points about neuropathy. More detail and supporting information is in the main article.

• Neuropathy is a complication of a number of different medical conditions and is a common condition.
• Three types of nerve can be involved; autonomic nerves, motor nerves and sensory nerves.
• Sometimes single nerves or nerve sets are affected.
  
• Physical trauma, repetitive injury, infection, metabolic problems and exposure to toxins and some drugs can all lead to neuropathy.
• While neuropathy can't really be treated, the underlying causes can be targeted. 2,6

Symptoms Sensory Neuropathy

• Tingling and numbness.
• Pins and needles and hypersensitivity.
• Increased pain or the loss of ability to feel pain.
• Loss of ability to detect changes in heat and cold.
• Loss of co-ordination and proprioception.
• Burning, stabbing, lancing, boring or shooting pains - which may be worse at night.

Drug treatment of neuropathic pain

• Gabapentin (Neurontin), pregabalin (Lyrica) and carbamazepine (Carbatrol, Tegretol, others) - all three are epilepsy drugs.
• Duloxetine (Cymbalta) and venlafaxine (Effexor) - from a class of antidepressant called serotonin and norepinephrine reuptake inhibitor.

In my case, I ended up on 300mgs gabapentin twice daily. This I took for about 5 months and then decided it was time to see what life would be without it. So I set up a schedule of reductions - or as we nurses call it, titrating off the medications - which went like this

Week 1: 200mg am, 300mg pm
Week 2: 200mg am, 200mg pm
Week 3: 100mg am, 200mg pm
Week 4: 100mg am, 100mg pm
Week 5: 50mg am, 100mg pm
Week 6: 50mg am, 50mg pm
Week 7: 500mg am
Week 8: stopped