Neuropathic Pain: Diagnosis and Treatment

Posted by Helen Potter on 22 February 2018 | Filed under Uncategorized

Neuropathic Persistent Pain: Physiotherapy Diagnosis and Treatment

Helen Potter May 2019

Persistent pain and Neuropathic pain (related to nerve pathology) are challenging to treat. Often because by the time I see you many other unsuccessful treatments have been abandoned and months or years have passed.

Recent research now tells us that the original reason for pain (any damage or strain to tissues) has healed but the brain and nervous system remember the pain and the way you moved to protect the pain source. This is called maladaptive.

When you first felt pain your brain put it in a context of a simple burn/blister, a minor sprain or a warning that something disastrous was occurring in your body. Your nervous system carries messages that something has happened to a tissue or area of your body. The message is quiet and precise.

With time when recovery does not occur as you wish, or your beliefs that something serious is wrong amplify the messages. We call these thought viruses. You then take more evasive actions to protect the "injury." The messages to your brain become stronger until they dominate your day and you stop doing anything because of fear.

A you've experienced this situation does not improve on its own. My approach is to look at your belief systems and help you understand what the pain represents and how you can learn to move again. Raining you life and enjoyment is possible. We have to take a systematic approach. I seek medication or advice from your medical specialists to help your sleep quality and or a psychologist if you need more assistance with specific reactions or life circumstances.

I am delighted to have the opportunity to work with you and walk on a new path to recovery.

What is Neuropathic Pain?

Neuropathic pain starts from a neurological lesion or disease of the bodies' sensory system and grows with misinformation, fear and anxiety. It needs different treatment approach to an acute pain injury.

The nervous system becomes sensitised over time (as it does in fibromyalgia, after poor sleep or when you have multiple physical or social problems). You can probably picture how grumpy you are after a few nights of deprived sleep).

I often find little in terms of nerve damage. This means you can get better.

  • Neuropathic, persistent pain and acute nociceptive pain need specific treatment
  • An accurate diagnosis is essential 
  • Matching your goals with my plan will optimise your improvement
  • There are medications to help persistent pain. I can discuss these with you so that you can then talk to your doctor. 
  • Low-dose amitriptyline (Endep/Dothep) is a first-line treatment of neuropathic pain and is a first line treatment often prescribed by your doctor. If you see on Google that it is an antidepressant - don't be misled. Neuropathic pain treatment needs only 10-20 mg whereas antidepressant doses maybe >300mg

Examples of Neuropathic Pain

  • My physical examination establishes the link between the pain and a fault with the nerves feeling/sensory system.
  • I use a stepwise approach to build evidence by excluding other problems to confirm the true diagnosis of neuropathic pain.
  • The most important change you can make for yourself is learn about pain and how our minds and bodies respond.

Neuropathic Pain Diagnosis

Neuropathic pain is a possible diagnosis if you have:

  1. A history of a relevant neurological lesion (like herpes zoster or a traumatic nerve injury)
  2. Pain descriptors such as burning, shooting, pricking and pins and needles
  3. Non-painful numbness or tingling
  4. Pain area explainable by a lesion or disease in the somatosensory system, or typical of an Medication underlying neuropathic disorder

I do tests to find if you have true sensory changes in specific areas.


Panadol and anti-inflammatories do not work for neuropathic pain. More specific medication is needed. They act slowly and you will need to balance the effect gained with the side effects.

I will teach you strategies to treat, manage and live life despite pain.

Please see /pain -

Diagrams about paths to chronic pain,

How to pace you activity,

Challenging thought viruses and

Taking control.

Amitriptyline for nerve pain: fact sheet for patients

Helping patients live with neuropathic pain: patient action plan

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