Hello and welcome to the Zero to Finals podcast. My name is Tom and in this episode I'm going to be talking to you about neuropathic pain.

And you can follow along with written notes on this topic at zero definals.com slash neuropathic pain or in the neurology section of the Zero to Finals Medicine book. So let's get straight into it. Neuropathic pain or in the neurology section of the zero to finals medicine book. Let's get straight

into it. Neuropathic pain is caused by abnormal functioning of the sensory nerves, delivering abnormal

and painful signals to the brain. Abnormal signals from the skin such as burning, tingling,

pins and needles and numbness is called

paristhesia. So what's the presentation? Neuopathic pain affects a wide variety of areas

with a number of different causes. Post-hopetic neuralgia from shingles is in the distribution

of a dermatome and usually on the trunk. There may be

nerve damage after surgery. Patients with multiple sclerosis often have neuropathic pain of various

nerves throughout the body. Diabetic neuralgia typically affects the feet and patients can have burning

sensations or pins and needles coming from their extremities.

There's a condition called trigeminal neuralgia where patients develop neuropathic pain affecting the trigeminal nerve.

And there's a condition called complex regional pain syndrome or CRPS, which we'll talk a little bit about later.

So what are the typical features of neuropathic pain?

Well, patients might describe the pain as burning, tingling, pins and needles,

feeling like there's an electric shock, or a loss of sensation to touch in the affected area.

It's worth being aware of the DN4 questionnaire, which is used to assess

the characteristics of a pain to determine whether the pain is likely to be neuropathic. It involves

a combination of symptoms and examination, and they're scored out of 10, and a score of 4 or more

indicates there could be neuropathic pain in place.

So what are the options for managing patients who have neuropathic pain? Well, there are four

first-line treatments for neuropathic pain that you can choose from. Amatryptylene is a tricyclic

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