Neuropathic Pain-Unlike ordinary pain, appears in humans not due to the reaction to physical damage. As a result of pathological excitation of neurons in the peripheral or central nervous system. Responsible for the reaction to physical damage to the body. The term “neuropathic pain” indicates a pain syndrome that occurs when the function of both the peripheral and the central nervous system is affected or violated. Neuropathic refers to the pain that occurs in the case of an organic lesion or a violation of the function of different departments of the nervous system.  Neuropathic pain, it is a signaling function of the body, it has no connection with violations of the work of any organ. Pain can last a long time-it is chronic pain. It is associated with a complex disease that continues for several months. It becomes excruciating, violates the normal rhythm of human life, acts on his psyche. It is connected with the defeat of nerves. This pathology is becoming more and more common disease in recent years, neuropathic pain of different severity levels affects 7 out of 100 people. In neurology, the term “neuropathic” usually indicates the lesion of the peripheral nerve. This pain can make it painful to perform the simplest of actions. Simply dressing clothes can turn into an insurmountable obstacle. The patient simply cannot describe to the doctor the nature of pain and its peculiarities.

Examples of neuropathic pain are:

• Trigeminal neuralgia,
• Phantom Pains,
• Post-stroke Central pain,
• Pain syndrome in multiple sclerosis,
• Syringomyelia
• Spinal cord lesions.

Very often patients ‘ pains are treated as vascular. This leads to inadequate therapeutic interventions. Many people have to change two or three specialists. Until they get adequate help. The main purpose of therapy is to eliminate or reduce pain.

Apply a combination of 2-3 drugs:

• Antidepressant
• anticonvulsants drug,
• drug.

It is not always possible for a specialist to make an adequate diagnosis and start effective treatment. Symptoms of pain can be permanent or episodic. Accompanied by burning, the sensation of frost on the skin, itching, cutting pain, sometimes-stabbing, numbness. The disease develops as a result of damage of nerve fibers or violation of its nutrition. So, if the nerve fiber ceases to work normally, the brain is sent a signal, for example, that the person touched the hot, although in fact he did not touch anything at all. Neuropathological Pain has its own peculiarities. It is accompanied by specific sensitive disorders. The mechanisms of neuropathological pain syndrome are complex. In neuropathic pain treatment cannot be prolonged, it is necessary to contact your doctor.

The preference in the treatment of most forms of neuropathological pain syndrome is given to Neurontin (Gabapentin). Its advantages include almost complete absence of contra-indications. Very fast offensive effect (after 1 week). Beneficial effect on the quality of life and minimal risk of side effects (dizziness, drowsiness).

It can develop in children and adults regardless of age.

Types of neuropathological pains.

In medicine several types of neuropathological pains are revealed:

• Moderate neuropathological pain. This pain creates psychological discomfort in the person, it is felt in the limbs in the form of burning and tingling. No special concern.

• Constant pain, burning sensation, tingling: most often these sensations are localized in the fingers of the upper and lower limbs. Pain intensifies during rest. Patients should take strong drugs to provide more or less calm and full sleep.

• Short-term bouts of acute pain. The attack lasts from a few seconds. Treatment of these types of pain is conducted anticonvulsant drugs such as Neurontin. The relief will be palpable and come a few days after the start of treatment.

• Pressing, garter pain. The patient’s shin and foot ache. This is joined by other types of neuropathic syndrome, significantly worsening the patient’s condition. The person should know that completely to get rid of pain will not help even strong analgesics.

• Sensation of painful cold. In the fingers of the lower limbs. It is not enough to be safe with drugs.

• Hypersensitivity to the touch. Accompanied by painful spontaneous sensations, ordinary touch to the skin of the patient. causes him severe discomfort. The complexity of the situation is also that for the night such a person wears cotton gloves and socks. Wraps his feet in the edge of the bed sheet. Not to make unnecessary movements in a dream. That can wake up and cause pain. To alleviate this condition can be the appointment of tricyclic antidepressants, such as Neurontin.

Symptoms and diagnosis of neuropathological pains.

The patient may also be disturbed by spontaneous pain. They arise in the obvious absence of any external influence.

Symptoms of neuropathological Pain:

• Tingling
• The appearance of pain in response to the stimulus, which in normal conditions does not cause pain. Or it can be dynamic, arising at moving stimuli, for example, easy irritation of a skin a brush or a finger.
• Sleep disturbance due to the presence of unpleasant (painful) sensations;
• Anxiety, with the possibility to become depressed;
• numbness
• Pain syndrome;
• Reducing the quality of life;

The doctor will follow the pain zones and compare them with the healthy side. Listens attentively to the patient. It correlates the localization of pain with the topography of the nervous system. Explores pain, tactile and temperature sensitivity.  Studies the patient’s motor system. At this stage of the development of medicine, there are about 10 questionnaires. which are designed to more accurately diagnose neuropathic pain. Specially designed scales are used for objective estimation of pain, by means of which the intensity and severity of pain syndrome can be clarified when interviewing the patient. Not always the degree of pain is directly proportional to the severity of the condition of the sufferer, although such dependence certainly exists.

Visual technique. This method is based on the patient’s assessment of the pain on a ten-point scale. Digits from 0 to 10. Consistently reflect the transition from weak, to moderate, and to pronounced pain.  “10” on the scale means unbearable pain. The patient is offered to show that figure on the scale. Which according to the patient, corresponds to his pain syndrome.  The assessment of patients with pain intensity may vary depending on the effectiveness of treatment, after taking an analgesic drug. Each central pain syndrome has its own system, the structure of which usually involves the defeat of three levels of the central nervous system of the central nervous system:

• The lower section of the trunk, the intermediate brain (thalamic, a combination of thalamic lesions, basal ganglia and inner capsule),

• Bark and the adjacent white matter of the brain. At the same time various emotional and vegetative manifestations of pain are formed.

Another method of assessing pain is using the “pain tolerance” scale. So “light pain” is evaluated as a pain that can be ignored. “Severe pain”-complicates the basic needs of man, “unbearable pain”-forcing the patient to stay on the bed. The pain may vary greatly in different patients.

Treatment of neuropathological pains. Neurontin (Gabapentin)

The product is produced in the form of solid capsules for oral use. Who swallow the whole. Filled with white or yellowish-tinged powder. The active component of the drug is gabapentin. Be sure to drink enough liquid.

The substance has a anticonvulsants effect and contributes to the pain of neuropathic character. Neurontin (Gabapentin) has been developed for the treatment of epilepsy, but is now used to treat various forms of chronic pain.

Patients need to pay attention that simple analgesics anti-inflammatory drugs are not effective, with neuropathic pain and are not used for its treatment. In neuropathic pain used antidepressants and anticonvulsants in the treatment of chronic pain used since 1942.

Neurontin is a structural analogue of gamma-aminobutyric acid (GABA) and refers to antiepileptic drugs. In animal experiments, the preparation strengthens the synthesis of GABA. has a modulating effect on the NMDA-receptors. Significantly reduces the flow of calcium ions, which play a crucial role in the emergence of neuropathic pain. Blocks α2δ sub unit calcium channels. Reduces the release of Monoamines. Reduces synthesis and transport glutamate. Helps to reduce the frequency of potentials of peripheral nerves. Unlike “Carbamazepina” and “Fenitin”, the medication in question does not enter into interaction with sodium channels. The combination of the above mechanisms of action. Provides high therapeutic efficacy of neurontin (gabapentin) in various forms of neuropathological pain syndrome. Neurontin is well tolerated. Extremely rarely causes adverse reactions (mostly mild dizziness and drowsiness). It should refrain from its use in combination with alcohol, tranquilizers, antihistamines, barbiturates, Anticonvulsants, sleeping pills, drugs. The combination of gabapentin with antidepressants enhances its effect. The maximum concentration of gabapentin in plasma reaches a peak through 2-3 hours after admission, the dosing interval should not exceed 12 hours. It is recommended to take no earlier than 2 hours after taking antacids. The drug displayed kidneys. Does not metabolized in the liver. If the patient has impaired kidney function dose gabapentin pick up with regard to cleanliness.

Children are more susceptible to the side-actions of Neurontin. In older people the excretion of it from the body slows down. Therefore, the dose for them should be reduced. It is known that Neurontin is excreted with breast milk. But this influence on the child’s body is not studied.

Application of Neurontin (Gabapentin).

The drug is well demonstrated in the treatment:

• Neuropathic pain in adult patients (18 years and older),
• Monotherapy or as an additional drug for the treatment of partial seizures, accompanied by secondary generalization in adults and adolescents from 12 years.

The use of Neurontin (gabapentin) in all forms of neuropathic pain is given in the pill, the daily therapeutic dose of neurontin is 1800-3600 mg per day. The efficacy of gabapentin in neuropathic pain was studied in controlled clinical trials in a sufficient number of patients.

Neurontin is one of the most effective means in the treatment of neuropathic pain in diabetic polyneuropathy, the dose is 1800-2400 mg per day.  Gabapentin caused not only the expressed reduction of pain syndrome, but also the improvement of sleep, mood and quality of life of patients:

• Pain with multiple sclerosis. Neurontin caused a decrease in pain syndrome in patients with multiple sclerosis. It was used to treat pain in patients with multiple sclerosis. Received drugs that have been canceled due to inefficiency or undesirable side effects. It was used for edema of night pain spasms. In all cases, a credible reduction or total disappearance of the pain syndrome has been achieved. The dose of the drug was 300 mg a day, it increased to 900 mg a day and more for 3 weeks.

• Neurontin gave an effect in patients with neuralgia, which did not respond to treatment by other means. Full pain relief was observed.

• Complex regional pain syndrome. In the study, Neurontin caused a fair reduction in pain. Improved wellbeing. Reducing the severity of hyperpathy, Allodynia. Normalization of skin color in patients with complex regional pain syndrome

• Lower back pain. Neurontin used in 105 patients with low back pain. The pain decreased by an average of 56%. Patients were able to stop taking one or more of the drugs they had taken before the study began.

• Carpal Tunnel channel syndrome. Neurontin (gabapentin) was used to treat neuropathic pain in various mono neuropathies and tunnel syndromes. Its effectiveness is confirmed in a comparative study. Which for various reasons was denied surgical treatment.

• Headache. Neurontin has been demonstrated to be highly effective in the prevention and treatment of primary forms of headache. In the application of gabapentin headaches arose reliably less often. There is a decrease in the severity of accompanying symptoms-nausea, photophobia. The effectiveness of Neurontin (Gabapentin) is also fixed in other studies. Patients with migraines, accompanied and not accompanied by aura. Transformable migraine. Cluster headache. Chronic daily headache, not treatable by other drugs.

Use the drug with caution.

This dgur should be applied cautiously and strictly observing the prescriptions of the attending physician. It is not recommended to drink capsules without prior consultation with a specialist. The drug has many contraindications and side effects. They can only aggravate the situation and worsen the condition of the patient. Instruction on the use of gabapentin before taking capsules is mandatory to study. The medicine is taken orally, the daily dose depends on the age of the patient, the pathology that worries him, the presence of comorbidities.

Dosage and method of use of the drug prescribed by the attending physician.

If you need to stop taking the drug. You can’t do that right away. You may experience a withdrawal syndrome. The dose of the drug should decrease, smoothly within 1 – 2 weeks. A drastic cessation of therapeutic therapy may cause an attack. This is a condition where seizures of epilepsy follow one another. And in between, the patient does not come into consciousness.

In the period of carrying the baby to use the pill only in case of extreme need. According to the doctor’s testimony.  If the benefits to the mother surpasses, the existing risks to the fetus.

Alcohol during the reception gabapentin strengthens side reactions. It is not recommended to drink alcoholic beverages during treatment. It is advisable to refrain from managing transport.

It is allowed to take oral contraceptives and other anti-epileptic medications simultaneously with the medicine:

• Carbamazepine
• Phenobarbital
• Phenytoin.

These drugs do not affect the intake of antacids and sorbents are better minimized because they reduce the bioavailability of gabapentin. In the treatment of antacids and sorbents are irreplaceable. Take them and the main drug you need with a time difference of 2 to 3 hours.

These medications, like antacids, are used with medication cautiously, as they contribute to the increase of its toxicity. If you take the drug together with morphine, the pharmacology of morphine does not change, but you need to strictly control the adverse reactions that can occur from the nervous system.

If the treatment means in patients are:

• Ataxia
• Dizziness
• Drowsiness
• A sharp increase in body weight
• children have excitability,

The pill should be gradually stopped.

Neurontin overdose is characterized by symptoms:

• Speech disorders;
• Drowsiness
• Dizziness
• Lethargy Stool disorder

In overdose, the doctor appoints: washing the stomach; Hemodialysis Reception of Sorbents.

Contraindications for the admission of Neurontin (gabapentin):

• Age up to 3 years in the focal epileptic seizures, accompanied by convulsions;
• Intolerance of galactose;
• impaired glucose absorption;
• Age up to 12 years in neuralgia;
• Pregnancy.