The management of pain is a major public health issue in France. However, there are still areas of shadows in the management of certain pain, including neuropathic pain.
WHAT IS NEUROPATHIC PAIN?
Neuropathic pain is the direct result of central or peripheral nervous system injury or dysfunction. As a result, it can be caused by multiple causes (spinal cord injury, brainstem lesion, painful polyneuropathy linked to infection, inflammation, etc.). These pains greatly alter the quality of life of the affected people in many areas: professional, social and family, personal.
Indeed, the clinical picture reveals a permanent component of a painful background that places these ailments in the field of chronic pain.
These pains are characterized by burns, tightness, tingling (paresthesia) or numbness.
There is also a paroxysmal component which is characterized by painful peaks which increase the intensity of the nociceptive sensations mentioned above, or it gives new sensations, often described by the patients in a very visual way, stabbing, electric shocks etc …
These pains are triggered random ways, sometimes linked to external factors such as climate, sometimes related to endogenous factors, fatigue, stress and emotional context.
People with this type of pain often face years of wandering before a medical diagnosis is made and therapeutic responses are proposed. This is often insufficient.
So far, it is proposed to patient drug treatment compounds as first line antidepressants, antiepileptics, local anesthetics, to switch to second line treatment if ineffective above, opioid analgesics, antiepileptic and allies antidepressants.
We can see that some of these molecules act on the nervous system but also on the area of the frontal and limbic cortex, zones related to nociceptive messages. Also, it is important to emphasize that depressive symptoms are very often associated with any form of chronic pain.
Thus, nonmedicinal management is also envisaged, linked to the analgesic limits of the molecules, the number of adverse effects and the habituation observed in some patients.
This is why Transcranial Magnetic Stimulation, which is initially central and then peripheral , is a non-medicinal alternative of quality insofar as there are no side effects. This method, by stimulating the painful areas, makes it possible to reformat in the brain new connections (neuronal plasticity). The brain will therefore bring new responses to the same painful sensation. Thus, a longer-term relief is seen in many patients.
In addition, it is essential that psychological care and psycho-physical therapy be put in place in order to ensure the perpetuation of improvements.