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December 2011, Volume 41 Number 12 , p 61 - 62


  • Yvonne D'Arcy MS, CRNP, CNS


WHEN PAIN is neuropathic in origin, patients may struggle to describe it accurately. Most patients describe surgical pain or acute pain from injury as aching or sharp, but patients with neuropathic pain use descriptors such as burning, painful tingling, or shooting.Because assessing pain having a neuropathic source is difficult, these conditions can end up being treated like nonneuropathic pain, providing less-than-optimal outcomes. Consider the following case studies.Case study 1. Ms. S, 46, had a radical mastectomy for breast cancer 6 months ago. She's a legal secretary who works on a computer. When she returns to work after her surgery, the limited mobility of her surgical shoulder begins to give her difficulty. She reports continued pain in her shoulder and great difficulty raising her arm. When asked about her pain, she replies, "My surgical pain is gone, but I'm having odd prickling and shooting sensations through my armpit. The pain is about a 7 out of 10. The pain just comes and goes without any warning and makes doing my mobility exercises much more difficult. When I take pain medication to help me move my arm, it not only doesn't help, but it makes me sleepy. These feelings also wake me up at night. I've stopped telling my healthcare providers about the sensations because the medications they've given me don't help."Ms. S is motivated to recover so she can function better at her job. Although her surgical pain is gone, she's significantly limited by prickling and shooting pain in the surgical area. What type of pain is she experiencing and why don't her pain medications work?Case study 2. Mr. B, 54, who had an above-the-knee amputation, has returned to your clinic after his rehab. When you ask him about pain, he tells you, "I don't like to talk about it much because I don't want people to think I'm crazy. The foot that was amputated feels as if it's located just at my knee. Isn't that strange? I have some burning pain like the neuropathy that I had before

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