Touching a raw nerve

Neuropathic pain is extremely painful yet surprisingly common. Now, reports Barbara Lantin, a new drug offers hope to sufferers

It has been likened to being stung by a swarm of wasps, scorched by a Bunsen burner or stabbed by thousands of tiny needles. Peripheral neuropathic pain, caused by nerve damage, is like no other. Clothes or sheets against the skin can feel like shards of glass. It affects 1.4 million people in Britain, the same number as have diabetes – and yet you may never have heard of it.

Peripheral neuropathic pain (NeP) occurs when damaged nerves transmit the wrong signals to the brain. This can happen after an operation, a fracture, a stroke or cancer. Up to one in three mastectomy and hernia patients and one in five people with diabetes experience NeP. The pain that lingers after shingles is neuropathic, as is the cruel torture of a phantom limb. The cause is not known: somebody who experiences NeP after surgery in one leg will not necessarily develop it after surgery on the other.

With no test to show that nerve damage has occurred, diagnosis can be slow and the pain is sometimes dismissed as psychosomatic. Although a range of treatments is available, none works for everybody and all have been designed primarily to treat other conditions. This week saw the launch of the first drug created specifically for the treatment of NeP.

"The best way to describe neuropathic pain is that it is like the worst sunburn you can imagine," says Dr Barbara Hoggart, consultant in pain management with the Birmingham Heartlands and Solihull NHS Trust. "The skin is so sensitive to touch that clothes or shoes will irritate it. Patients are often unable to sleep, they cannot move the affected limb because of the pain and therefore lose muscle strength which immobilises them further; they may lose their jobs and they place a great burden on their carers."

Vanessa Wood, now 37, was in the fourth year of a five-year degree course in youth work and expecting her first child when her hands became swollen and painful. Aged 26, she was diagnosed with diabetes and, a year later, with diabetic peripheral neuropathy.

"I couldn't complete my course because I couldn't write my assignments," says Wood, who lives in Loughborough with her husband, Colin, and children, Matthew, 10, and Kathryn, eight. "When I try to write, my hands feel like lead weights. I can use the computer, but not for very long, and I have to lie down to hold a book. Holding my children's hands sends shock waves up my arms. Sometimes, I think it would be better to have no hands at all."

A recent study showed that 74 per cent of people with NeP who are of working age are unable to work and almost two out of three need a walking aid to stay mobile. Secondary symptoms included fatigue, disrupted sleep and loss of balance. Half thought that their condition was poorly managed. One in four suffered from depression.

"There have been periods in the past 11 years when I have thought: `What is the point in getting up in the morning?' " says Wood. "I am often in despair, but my faith helps me enormously."

Wood has tried many treatments, none of them successful. The most commonly prescribed are analgesics, tricyclic anti-depressants, non-steroidal anti-inflammatories and anti-convulsants, which are commonly used to treat epilepsy. Of these, the best known is gabapentin, which blocks the transmission of the faulty nerve signals that causes NeP.

Pregabalin (brand name Lyrica), launched by Pfizer this week, operates in a similar way but is said to be 10 times more strongly attracted to the pain receptors and therefore works more quickly and effectively. Unlike some of the alternatives, it does not need close supervision while the dose is increased and so is more likely to be prescribed by GPs.

GP Dr Martin Johnson from the Ashville Medical Centre in Barnsley, who has a special interest in pain management, has seen good results with the new drug. "One 57-year-old patient has had his life transformed in four weeks after suffering unbearable pain in his feet for 15 years," says Dr Johnson. "He has experienced 95 per cent reduction in pain and was able to go to the coast for the first time without his wheelchair."

For those who cannot be treated at primary care level, a referral to one of Britain's 200 pain clinics may be the best option.

"Pain clinics are multi-disciplinary in their approach," says Dr Beverly Collett, president of the Pain Society and a consultant in pain management at the University Hospitals of Leicester. "They will have a physiotherapist, a clinical psychologist, an occupational therapist, nurses and doctors. Their aim is to reduce the pain and improve the patients' quality of life."

Wood refuses to surrender to her disability. "I am a support worker in a local primary school and I have two fantastic children and a wonderful husband. I am determined that my condition is not going to control me."

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