Neuropathic pain (central sensitisation) occurs as the result of an injury or dysfunction of the nervous system. Sometimes it is secondary to an injury to the peripheral nerve (for example, after a herpes infection, associated with diabetes or due to a problem with the nerve roots) and on other occasions it is caused by an injury to the central nervous system (either in the brain or in the spinal cord) as is the case after a stroke, traumatic brain injury, head injury or spinal inflammation, brain or spinal tumour, or diseases such as multiple sclerosis. Neuropathic pain is different from joint or muscle pain.

It is usually manifested in different ways:

• Tingling
• Burning or stabbing sensation
• Perception of pressure or alteration in temperature
• On many occasions, the patient perceives certain stimuli as painful even though they should not be (a caress, the rubbing of clothes or sheets, etc.)

Neuropathic pain does not usually respond to regular analgesics, with drugs that act on the nervous system being needed as a first step. Local treatments can sometimes be used, mainly when the neuropathic pain is caused by a peripheral nerve injury.

TREATING NEUROPATHIC PAIN

We can sometimes see “sensitisation phenomena” in neuropathic pain, which involve an increase in the perception of pain at the peripheral or central level. This phenomenon leads to emotional changes and functional alteration, and affects the patient’s health and social situation. Therefore, one of the treatment goals in neuropathic pain is aimed at preventing the onset of these symptoms, controlling pain with the use of one or several drugs. However, in most cases a therapeutic approach that includes a psychological and rehabilitative approach is also necessary.

At Guttmann Barcelona, we have developed a new treatment that combines non-invasive brain stimulation (TDCs) with virtual reality. Combining these two techniques induces a more intense and longer lasting analgesic effect, without unwanted effects; this is an alternative complementary therapeutic solution to pharmacological treatments.

Neuropathic pain currently encompasses different pathologies, not all of which are recognised, but that seem to share common production mechanisms that can provide an explanation for many of the symptoms: fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, temporomandibular joint dysfunction, multiple chemical sensitivity, chronic migraine, tension headache, painful bladder syndrome, vulvodynia, restless legs syndrome or complex regional syndrome, among others.