Neurogenic pain

Nervous system basics

The nervous system is an electrical system that carries information and messages throughout the body.  It can be grouped into two very broad categories:

Central nervous system (CNS): Brain and spinal cord

Peripheral nervous system (PNS): Branches from the spinal cord to the limbs and internal organs.

The brain is the computer, the body is the machine.  All information is sent from the CNS out to the PNS, and in turn the PNS feeds back information to the CNS about what’s happening at the periphery (i.e stepping on a nail = danger signal)

Symptoms of the nervous system

  • Numbness/tingling
  • Burning, sharp pain
  • Reduced strength
  • Loss of balance/coordination
  • Headache
  • Visual disturbances (blurriness, eye fatigue)
  • Poor reflexes
  • Severe pain

Common injuries

Neuropathic pain differs to neurogenic pain as it is the direct disease or damage of a nervous system structure (such as the thalamus in stroke victims).
Neurogenic pain is more common and much more treatable by an Osteopathic Practitioner.

Osteopathic Practitioners treat a range of neurogenic pain syndromes such as:

  • Nerve root compression (fig.1)
    • Pain radiates from the spine into the limbs
  • Neuropraxia
    • Blunt force injury – hockey stick to forearm causing pain/loss of sensation
  • Peripheral weakness
    • Information from the brain to the periphery isn’t being conducted adequately – generally unaccompanied by pain
  • Headaches
    • Many sources but often related to compression of nerves under the base of the skull or a source within the brain (such as the eyes)
  • Digestive issues
    • Broad diagnoses of IBS or other digestive “syndromes” that have varied symptoms without any evidence of pathology (such as a stomach ulcer) can often be attributed to a range of nervous system dysfunctions that reduce the function of the parasympathetic nervous system responsible for digestion.

Fig.1

Illustration of compression of the spinal cord by a herniated disk that will commonly cause pain to travel down the leg.

Treatment and recovery

The nervous system is incredibly complex and is still not fully understood. Testing the reflexes, muscle strength and ocular function are useful and reliable tools in identifying underlying problems that are directly related to pain production.

Conservative treatment including both osteopathy and physiotherapy can reduce symptoms (4-6 weeks) and improve function (6-12 weeks) through both manual treatment and rehabilitation programs that educate and train the sufferer to avoid future injury or relapse.

Is this a serious condition?

Treatment of the underlying cause of pain is paramount and must be assessed for severity.  Often a low-grade injury can cause severe pain if affecting the nerves.  Further investigation such as imaging (x-ray, MRI) may be warranted depending on examination findings.

Long term compression or untreated nerve damage may result in permanent loss of function and extended periods of pain.

Management

  • Initial Phase (weeks 1-4)
    • Reduce inflammation and pain. Anti-inflammatory medication may be advised.
    • Treating pain generating structure (such as a disk bulge)
  • Intermediate phase (weeks 4-6)
    • Once pain has subsided, increase load bearing and exercises as tolerated
  • Advanced phase (weeks 6-12)
    • Return to full capacity exercise, challenging injured structure (with physiotherapist monitoring)

 

 

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