Neuropathic pain: Physical and psychological treatments

Editor’s Note: Dr Mailis-Gagnon will be writing for CARP Action Online on a semi-regular basis. Should you have any questions about pain please write to us at [email protected] We will try to integrate some of your concerns in Dr. Mailis- Gagnon’s future columns.

Some physical therapies are good for all kinds of pain conditions and not just neuropathic pain (like exercises for strength, range of movement or flexibility and balance, or application of pain relieving modalities such as deep heat or cold). One specific treatment that may work for both musculoskeletal and neuropathic pains, Transcutaneous Electrical Nerve Stimulation (TENS), is used over 40 years now.

It is applied through a small machine, a little bigger than a cell phone with wires around the pain area (it is really meant to treat fairly defined pain areas like a knee, back , neck or even face). It makes the patient feel weird tingling sensations in the same area where pain is felt. The treatment is based on the concept that pain messages “can be blocked” by the tingling sensations. It is recommended that a TENS trial is done in a physiotherapy department for a few times. If the treatment helps for a few hours or days, the patient can rent or buy the machine from large stores that sell specifically health supplies (these are not regular drug stores).

Another specific treatment that has been used in physiotherapy clinics for neuropathic pain is “desensitization” for pain areas that are uncomfortably sensitive to touch. A physiotherapist will bring the sensitive skin in gradual and repeated contact with materials of different texture (cotton first, then wool, etc). In some cases, the excessive sensitivity will gradually subside. Of note, all physiotherapy treatments have been removed at least in Ontario where I practice from OHIP coverage for those age 20-64 unless one pays from their pocket or they have extended coverage.

Similarly, chiropractic treatments have been taken off OHIP coverage in Ontario for a number of years now. Of course, different provinces may have different coverage and you should ask your physician what types of treatments are indicated for your condition. Please remember, that eating properly and keeping physically active (gardening, walking, running, swimming, exercising at home, the gym or in organized classes) are essential for our wellbeing, no matter how young or old we are, and what kind of pain condition we might have.

Alternative treatments with a hands-on approach, such as acupuncture, may help some patients. Nevertheless, my experience is that few patients only with neuropathic pain may benefit. Other alternative treatments (not specific, however, for neuropathic pain) include massage, craniosacral therapy, chiropractic management etc. Ask your physician as to what is appropriate for your condition. In my experience, all of these treatments work better for musculoskeletal than neuropathic conditions. Remember, when it comes to neuropathic pain treatments, there is not one single medicine or form of treatment that works for everyone. This is why patients with neuropathic pain “need choices”.

One particular treatment specific for people with post-amputation pain, is the “mirror treatment”. Amputees very often suffer from phantom limb pain (a type of ghost pain in the missing limb). To know more about this type of debilitating neuropathic pain check a video in the ACTION Ontario website (www.actionontario.ca) from a young lady who has lost her arm and describes how this pain feels. Scientific studies in amputees have shown that the brain is distorted because it still thinks there is a hand. If the amputee has lost the right hand, he sees the healthy left hand in a mirror, but (because the mirror shows things exactly opposite to the way we are), his brain “thinks” it is the right hand. Moving and stretching the hand in the mirror seems to be able to “retrain” the patient’s brain and the distorted image of the missing hand.