The Cost of Pain report is a comprehensive financial analysis of pain in Australia. More than three million Australians experience consistent pain which prevents them from working, sleeping, and maintaining relationships. Chronic pain is a growing issue, with Australia’s ‘pain price tag’ currently at $139 billion. This figure will rise to more than $215 billion by 2050. Read on to learn about a form of chronic pain which affects 7-10% of the population: Neuropathic Pain. Visit www.painaustralia.org.au to read the Cost of Pain report for yourself and use #CostofPain to share this on social media.
Neuropathic Pain
Neuropathic pain (or nerve pain) is caused by damage to the brain, spinal cord or peripheral nervous system. This is usually due to trauma, surgery or diseases such as diabetes or after having shingles.
In a recent review of studies of neuropathic pain, it was estimated that prevalence was in the order of 7-10%. Risk factors include aging population and hence and increased risk of developing diseases such as shingles and diabetes.
Approximately 8% of patients who experience neuropathic pain would be due to shingles (post herpetic neuralgia) and 26% due to Type 2 Diabetes (diabetic neuropathy). The rest are due to other disease processes, dietary factors (such as vitamin deficiency, excessive alcohol consumption) or as a side effect from treatments (for example chemotherapy).
Symptoms of neuropathic pain can include: burning, shooting, electric shock, tingling, prickling and numbness.
This type of pain can be:
• associated with touch not usually associated with pain, ie with soft touch (termed allodynia)
• unusually increased pain with pin prick (called hyperalgesia)
• loss of sensation to soft touch/vibration (termed sensory loss)
• low pain response to a usually painful stimulus (called hypoalgesia).
Managing neuropathic pain can be challenging as it is generally difficult to alleviate this sort of pain with currently available medications. Medications that are widely used that you may have tried include:
• Tricyclic antidepressants eg. amitriptyline (Endep), nortryptline (Allegron)
• SNRIs (Serotonin -norepinephrine reuptake inhibitors, eg. duloxetine (Cymbalta), venlafaxine (Effexor)
• Anticonvulsants, for example gabapentin (Neurontin) or pregabalin (Lyrica)
• Topical treatments, such as capsaicin cream (Zostrix)
• Tramadol, a weak opioid.
Unfortunately, these medications only provide modest pain relief and many of these medications have side effects such as somnolence (excessive sleepiness), dizziness, imbalance and memory impairment.
If not treated, pain can have a disabling impact on other areas of your life such as sleep disturbance, work, exercise, relationships, day to day activities and lifestyle. The current recommendation is to take a approach involving targeting not just the physical but also psychological and social factors. This can involve seeking assistance from health professionals such as your GP, psychologist, nurses and physiotherapists.
These links provide more information on neuropathic pain from Australian advocacy groups:
• http://www.painmanagement.org.au/2014-09-11-13-34-03/2014-09-11-13-35-16/121-neuropathic-pain.html
• www.painaustralia.org.au/static/uploads/files/painaust-factsheet9final-printer-version-wfnonocuwnjz.pdf
Diabetes and Neuropathic Pain
Peripheral neuropathy due to diabetes usually occurs when diabetes is uncontrolled and most often symptoms are experienced in either the hands or feet.
The most common symptoms of diabetic neuropathy are numbness, tingling, burning sensation, aching, cramps and weakness, usually beginning in the hands or feet. These symptoms may later spread to their arms and legs.
Diabetic neuropathy can also contribute to:
• pain and discomfort in yours arms or legs, especially at night
• sleep problems
• bloating and digestion
• heat intolerance
• problems with walking.
Even though there is no cure, early diagnosis and treatment can improve quality of life and reduce the risk of further complications.
You can reduce your risk by
• keeping your blood sugar levels within the recommended ranges
• exercising regularly
• maintaining a healthy weight
• quitting smoking
• reducing other risk factors, such as high blood pressure or cholesterol
All people with diabetes should have their feet checked at least yearly by your regular doctor, podiatrist or diabetes educator, or sooner if you have signs of problems with your feet or other complications of your diabetes. People should consult your doctor promptly if they have symptoms including pain, numbness or tingling in their hands or feet.
This link provides more information on diabetic neuropathy:
• www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetic-neuropathy
Post Herpetic Neuralgia
This type of pain is defined as persistent pain at the sites of the shingles rash for 3 months or more after the rash has disappeared. This typically occurs as the nerves are damaged from the virus infection, resulting in exaggeration of pain messages transmitted from the skin to the brain.
Risk appears to be greater with increasing age and appears to be higher in those who were not able to receive treatment for the initial rash with antiviral medications (eg Valtrex, Famvir) or adequate pain relief.
Other ways to reduce your risk include vaccination against shingles (with the Herpes Zoster Vaccine). This is currently covered free of charge by the Australian Government to those above the age of 70 (Zostavax) and can be obtained from your health care provider or GP.
This link provides more information on post herpetic neuralgia:
• www.painmanagement.org.au/2014-09-11-13-34-03/2014-09-11-13-35-16/124-post-herpetic-neuralgia.html
AusTrials is currently recruiting volunteers for a trial involving at new medication for those who suffer with chronic neuropathic pain due to either complications of their diabetes or after having shingles. This is a medication that would be added to any current medications that you are taking for your pain.
For more information regarding this trial please contact us at AusTrials on 07 3278 5255, by email to info@momentumclinicalresearch.com.au.