You are currently viewing [3 in 1] Neuropathic Pain : [Med Notes+MCQ+Q&A]

Neuropathic pain is a type of chronic pain that is caused by damage or dysfunction of the nervous system. It is characterized by an unusual burning, tingling, or electric shock-like quality and may occur spontaneously or be triggered by very light touch. Neuropathic pain is often severe and resistant to standard treatments for pain.

NEUROPATHIC PAIN [MEDNOTES+MINDMAP]

  • Causes
    • Peripheral nerve damage (e.g. diabetic neuropathy, herpes zoster infection)
    • Central nervous system damage (e.g. trauma, vascular injury)
  • Characteristics
    • Burning, tingling, electric shock-like quality
    • Spontaneous or triggered by light touch
    • Sensory deficit co-extensive with pain
    • Hyperpathia (exaggerated pain response to stimuli)
    • Allodynia (pain evoked by light stimuli)
  • Mechanisms
    • Increased sensitivity and spontaneous activity due to increased density of sodium channels in damaged nerve fibers
    • Sensitivity to norepinephrine in damaged primary afferents
    • Spontaneous activity in spinal cord pain-transmission neurons cut off from normal input

SYMPATHETICALLY MAINTAINED PAIN (CRPS)

      • Types
        • CRPS type II (occurs after identifiable nerve injury, also known as posttraumatic neuralgia or causalgia)
        • CRPS type I (occurs without obvious nerve injury, also known as reflex sympathetic dystrophy)
      • Causes
        • Fractures
        • Soft tissue trauma
        • Myocardial infarction
        • Stroke
      • Symptoms
        • Spontaneous pain
        • Swelling of affected extremity
        • Periarticular bone loss
        • Arthritic changes in distal joints
      • Treatment
        • Symptomatic treatment for CRPS type I
        • More aggressive treatment for CRPS type II

NEUROPATHIC PAIN [CLINICAL SCENARIO MCQ] 

Scenario 1:

A patient comes to the clinic with severe pain in their lower leg and foot. The pain is described as a burning sensation and is triggered by very light touch. The patient also reports a sensory deficit in the same area as the pain. The doctor suspects neuropathic pain.

Question: What is the most likely cause of the patient’s pain?

A) Peripheral nerve injury

B) Central nervous system injury

C) Diabetes

D) Herpes zoster infection

Answer: D) Herpes zoster infection

Explanation: The patient’s pain is triggered by light touch, which is a characteristic of neuropathic pain. In addition, the patient has a sensory deficit in the same area as the pain, which is also characteristic of neuropathic pain. The description of the pain as a burning sensation is commonly seen in patients with herpes zoster infection, which can result in pain that is referred to the body region innervated by the damaged nerves.

 

 

Scenario 2:

A patient comes to the clinic with spontaneous pain in their arm and hand. The pain is described as a burning sensation and is accompanied by swelling of the extremity, periarticular bone loss, and arthritic changes in the distal joints. The doctor suspects complex regional pain syndrome (CRPS).

Question: What is the most likely cause of the patient’s pain?

A) Peripheral nerve injury

B) Central nervous system injury

C) Fracture

D) Soft tissue trauma

Answer: A) Peripheral nerve injury

Explanation: The patient’s pain is described as having a burning quality and is accompanied by swelling of the extremity, periarticular bone loss, and arthritic changes in the distal joints. These symptoms are characteristic of complex regional pain syndrome (CRPS), which is caused by peripheral nerve injury. In addition, the patient’s pain may be relieved by a local anesthetic block of the sympathetic innervation to the affected extremity, which is another characteristic of CRPS.

 

Scenario 3:

A patient comes to the clinic with severe pain in their lower back and legs. The pain is described as an electric shock-like quality and is triggered by light touch. The patient also reports a sensory deficit in the same area as the pain. The doctor suspects neuropathic pain.

Question: What is the most likely cause of the patient’s pain?

A) Spinal cord injury

B) Brainstem injury

C) Thalamic injury

D) Vascular injury

Answer: A) Spinal cord injury

Explanation: The patient’s pain is triggered by light touch and has an electric shock-like quality, which are both characteristic of neuropathic pain. In addition, the patient has a sensory deficit in the same area as the pain, which is also characteristic of neuropathic pain. The description of the pain as being in the lower back and legs is consistent with damage to the spinal cord, which can produce neuropathic pain.

 

 

Scenario 4:

A patient comes to the clinic with spontaneous pain in their upper arm and shoulder. The pain is described as a burning sensation and is accompanied by swelling of the extremity, periarticular bone loss, and arthritic changes in the distal joints. The doctor suspects complex regional pain syndrome (CRPS).

Question: What is the most likely cause of the patient’s pain?

A) Soft tissue trauma

B) Myocardial infarction

C) Stroke

D) Reflex sympathetic dystrophy

Answer: D) Reflex sympathetic dystrophy

Explanation: The patient’s pain is described as having a burning quality and is accompanied by swelling of the extremity, periarticular bone loss, and arthritic changes in the distal joints. These symptoms are characteristic of complex regional pain syndrome (CRPS). In this case, the pain appears without an obvious nerve injury, which is consistent with CRPS type I, also known as reflex sympathetic dystrophy. The patient’s pain may also be relieved by a local anesthetic block of the sympathetic innervation to the affected extremity, which is another characteristic of CRPS.

 

Scenario 7:

A patient comes to the clinic with severe pain in their lower back and legs. The pain is described as an electric shock-like quality and is triggered by light touch. The patient also reports a sensory deficit in the same area as the pain. The doctor suspects neuropathic pain.

Question: What is the most likely cause of the patient’s pain?

A) Spinal cord injury

B) Brainstem injury

C) Thalamic injury

D) Vascular injury

Answer: A) Spinal cord injury

Explanation: The patient’s pain is triggered by light touch and has an electric shock-like quality, which are both characteristic of neuropathic pain. In addition, the patient has a sensory deficit in the same area as the pain, which is also characteristic of neuropathic pain. The description of the pain as being in the lower back and legs is consistent with damage to the spinal cord, which can produce neuropathic pain.

 

 

Scenario 8:

A patient comes to the clinic with spontaneous pain in their upper arm and shoulder. The pain is described as a burning sensation and is accompanied by swelling of the extremity, periarticular bone loss, and arthritic changes in the distal joints. The doctor suspects complex regional pain syndrome (CRPS).

Question: What is the most likely cause of the patient’s pain?

A) Soft tissue trauma

B) Myocardial infarction

C) Stroke

D) Reflex sympathetic dystrophy

Answer: D) Reflex sympathetic dystrophy

Explanation: The patient’s pain is described as having a burning quality and is accompanied by swelling of the extremity, periarticular bone loss, and arthritic changes in the distal joints. These symptoms are characteristic of complex regional pain syndrome (CRPS). In this case, the pain appears without an obvious nerve injury, which is consistent with CRPS type I, also known as reflex sympathetic dystrophy. The patient’s pain may also be relieved by a local anesthetic block of the sympathetic innervation to the affected extremity, which is another characteristic of CRPS.

 

Scenario 9:

A patient comes to the clinic with severe pain in their lower back and legs. The pain is described as an electric shock-like quality and is triggered by light touch. The patient also reports a sensory deficit in the same area as the pain. The doctor suspects neuropathic pain.

Question: What is the most likely cause of the patient’s pain?

A) Spinal cord injury

B) Brainstem injury

C) Thalamic injury

D) Vascular injury

Answer: A) Spinal cord injury

Explanation: The patient’s pain is triggered by light touch and has an electric shock-like quality, which are both characteristic of neuropathic pain. In addition, the patient has a sensory deficit in the same area as the pain, which is also characteristic of neuropathic pain. The description of the pain as being in the lower back and legs is consistent with damage to the spinal cord, which can produce neuropathic pain.

 

 

Scenario 10:

A patient comes to the clinic with spontaneous pain in their lower leg and foot. The pain is described as a burning sensation and is accompanied by swelling of the extremity, periarticular bone loss, and arthritic changes in the distal joints. The doctor suspects complex regional pain syndrome (CRPS).

Question: What is the most likely cause of the patient’s pain?

A) Peripheral nerve injury

B) Central nervous system injury

C) Fracture

D) Soft tissue trauma

Answer: A) Peripheral nerve injury

Explanation: The patient’s pain is described as having a burning quality and is accompanied by swelling of the extremity, periarticular bone loss, and arthritic changes in the distal joints. These symptoms are characteristic of complex regional pain syndrome (CRPS), which is caused by peripheral nerve injury. In addition, the patient’s pain may be relieved by a local anesthetic block of the sympathetic innervation to the affected extremity, which is another characteristic of CRPS. The description of the pain as being in the lower leg and foot is consistent with damage to peripheral nerves, which can result in CRPS.

Dr. Arin Nandi

Passionate About Medical Science & Helping Future Doctors Achieve Top Ranks In Medical Exams. He is professionally a dentist as well as a public health expert from JIPMER working in govt.health department
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