welcome back I wanted to dive in today and discuss an algorithmic real world approach to treating neuropathic pain this is one of the commonest pains we treat it's one of the most complex pains we treat and we need to use expertise experience and a little bit of something extra to apply all the research to the person sitting in front of me struggling with pain sometimes it's easy to do sometimes it's not easy to do because no two people are the same your pain is your fingerprint your pain is unique how do I apply research that
is focused on 50y olds with diabetic neuropathy and using amitryptiline how do I apply that research to a 35-year-old sitting in front of me with difficulty how do I take research out there that is specific and targeted Sometimes good sometimes not and apply it to the person sitting in in front of me here is a paper that shows us a an algorithmic approach to treat neuropathic pain it's taken another a number of other studies and combined it and I think it's quite a good paper so let's dive in and have a look at it we
know that neuropathic pain is prevalent we know it is debilitating we know there are many causes of neuropathic pain have a look at some of the other other videos we've talked talked about causes we've talked about diagnosis we've talked about medications let's talk about putting it all together combining with an Interventional approach to treating neuropathic pain you've got to be good at diagnosing neuropathic pain you've got to think about neuropathic pain before you do anything and how many times do I see through the week people coming in and they have not had their neuropathic pain
diagnosed it's been months sometimes years and they've been struggling and no one has been able to diagnose their neuropathic pain it happens way too often that's why this channel exists that's why we're here educating people please like subscribe share with us your pain journey in the comments below ask questions let's raise awareness I'm sick and tired of seeing people suffer and struggle with pain we've got to do something about it let's dive in here is the algorithm let's go through each step in turn diagnose neuropathic pain you've got to make that assessment you've got to
start off treatments so you've got to have that knowledge to diagnose and treat it and if you're GP is unable to do so if your medical specialist is unable to do so do it yourself have a look at the diagnostic video on neuropathic pain see if you've got neuropathic pain ask questions let's work it out together let's let's work out a bit of a plan of action and of course yes this is not medical advice this is educational content step one use the medications available we have a number of medications available to treat neuropathic pain
tricyclic anti-depressants serotonin noradrenaline reuptake Inhibitors the gabapentinoids and topical medications that you can apply topically you will probably already know that I enjoy using AB I don't enjoy using Gabapentin I prefer using Gabapentin as one of the antineuropathic because it's got a lowish number needed to treat and a highish number needed to harm and that definition has been discussed elsewhere use these medications if they are not helpful in you uh when you're using them alone the second step is to combine these medications and we combine these medications a lot again the person sitting in front
of me needs to have the supply to them not from what the research has said still on step two sometimes Tramadol can be useful uh as a very weak nonopioid opioid we'll discuss Tramadol at another Point as well let me know your thoughts if step two combination antineuropathic and consideration for tramol is not helpful then this algorithm recommends getting getting you to a specialist center a pain specialist center Pain Specialist Network um clearly we are a pain specialist center and network and we sometimes see people way at the beginning of the neuropathic pain Journey not
after they've tried a couple of treatments so step three if you're not winning on First Steps single medications combination medications with Tramadol get them to a specialist center get to a specialist center and specialist center is going to consider other medications and or intervention therapies and we've mentioned Interventional therapies and over time we'll elaborate on Interventional therapies but just a reminder some of the interventions that may be appropriate depending on the person sitting in front of me because neuropathic pain is so complicated and so varied include nerve blocks sympathetic plexus blocks neurotic blocks with alcohol
or phenol adhesiolysis where we sometimes break up scar tissue around nerves radio frequency ablation which can be divided into radio frequency neurotomy where we damage destroy burn cized nerves or pulsed radio frequency ablation where we don't we use an alternating current or current that's on and off so the needle doesn't get hot it doesn't damage the nerves but it can suppress nerve function and pain other medications might include infusions of ketamine infusions of lignine so there are many Interventional approaches that can be applied to the person sitting in front of you or in front of
me should I say one of the things that is so difficult is I can't tell you now what treatments I should be using for X pain because it's different for every person sitting in front of me what I can do is if you share with me for example a pain diagnosis I can share with you a possible treatment algorithmic approach which we might do at another Point as well so that is step three medications Interventional approaches then step four is what we call neuromodulation targeted therapeutic delivery not skatun delivery like medications might be not scaton
delivery like Rehabilitation techniques might be we know that Rehabilitation Physical Therapy psychological therapy is safe we know that it can be effective but even so studies that have been done don't follow patients up for more than 3 months so we know that some of these effects of Rehabilitation fizzle out over time it needs to be ongoing I've seen many people that have had Rehabilitation it hasn't helped or it hasn't provided lasting effects so neuromodulation not scat gun targeted treatments targeted to a nerve peripheral neurom modulation targeted to a group of nerves the back of the
spinal cord spinal cords to simulation and even tar and even targeted drug delivery which is not step four that's neuromodulation where we at at the moment and the aim of neuromodulation is to use it where people's pain is neuropathic where people's pain is refractory it's not responding to treatments where people are what we call psychologically sound there are no other serious factors at play incredibly high levels of distress litigation various other factors so we need to make that assessment and sometimes screen people appropriately for neuromodulation and the thing about neuromodulation is we're not looking for
a small amount of pain control we're looking for a substantial significant amount of pain control because there are risks with neuromodulation there are more risks with neuromodulation than Rehabilitation strategies so we want a profound amount of pain control 50% or more and nowadays we're looking for 60 70 90% pain control before we consider neuromodulation as a treatment if neuromodulation fails because sometimes pain is like that then step five might include consideration for low dose opioid therapy and there are many things we can talk about in terms of opioids we'll get to opioids there are some
lectures for GPS on opioids down below so have a look at them ask questions about these medications so we can work out videos to provide you with answers step six if all this fails and we can use targeted drug delivery this is where we use things like morphine pumps local anesthetic pumps where we apply the therapy directly to the spinal cord space the CSF this the cerebros spinal fluid through a catheter the catheter is connected to a uh we call it a little drum and the drum is filled with medications we control the delivery of
medic medications into the spinal fluid uh targeted drug delivery step six not without its risks but absolutely can be life-changing if used for the correct person for the correct pain so what I've shown you is a real life approach I've gone through six steps in treating neuropathic pain there is no treatment that is appropriate for every single person that walks through the CL iic door you've got to apply it to the person sitting in front of you remember all along the way I've said this before using our Clinic stepped uh algorithmic approach Empower educate provide
hope that is such an important factor um and combine that with physical therapies combine that with Rehabilitation therapies combine that with sleep hygiene combine that with uh uh mood management combine that with relationship management it doesn't matter what you combine it with as long as you're looking at the person holistically diet management diet Improvement there are so many factors at Play
