Neuropathic pain describes pain arising from any part of the sensory nervous system and can be a complex and difficult-to-treat presentation of pain.
Anatomically we can divide sources of neuropathic pain into central (affecting the brain or spinal cord, such as lesions of the thalamus or Chiari malformation / syringomyelia), peripheral (affecting nerve roots and axons of nerves, such as lateralised intervertebral disk extrusions and nerve entrapment within the iliopsoas muscle), and small fibre ( affecting the nerve endings, commonly associated with diabetes in humans but an underinvestigated area in animals and could be the underlying mechanism in conditions such as feline hyperaesthesia syndrome).
Clinical signs associated with neuropathic pain can be varied and may include sudden vocalisation, or turning to the affected area, excessive licking or grooming of an affected area, a painful response to light touch, and changes in behaviour and temperament.
Treatment is dependent on the underlying type of neuropathic pain, and the optimal treatments have not been described in many conditions. Drugs including some types of antiarrhythmics, anti-epileptics, and antidepressants may be of use, but it is likely that each patient will exhibit individual responses and should be carefully assessed by a suitably qualified Veterinary surgeon.
Neuropathic pain is an area of particular interest for James, who has published a case report on the use of ivabradine in peripheral neuropathic pain (1), and has submitted further work on the use of nerve injections to manage neuropathic pain in dogs.
In many cases, a coordinated approach between Veterinary surgeons and physiotherapists, and other professionals such as hydrotherapists can help to ensure the optimal long term outcome.
You can find a client friendly information sheet on neuropathic pain here
1. Hunt J. Use of the hyperpolarisation-activated cyclic nucleotide-gated (HCN) channel blocker ivabradine in the management of suspected spontaneous trigeminal pain in a dog. Vet Anaesth Analg [Internet]. 2021 May 28;48(4):623–5. Available from: https://doi.org/10.1016/j.vaa.2021.03.007
