ABSTRACT
In primary care as well as many types of specialty practice, the term neuropathic pain has been most often thought of as simply meaning painful peripheral neuropathy, as commonly occurs in severe diabetes mellitus. In theory, almost any of the pathologic processes known to create damage or dysfunction to neural tissue can be considered as potential causes for neuropathic pain. The abnormal sodium channel involved in neuropathic pain states may be a tetrodotoxin-insensitive subtype, found only in neural tissue. The pathogenesis of neuropathic pain commonly involves the loss of peripheral axons and inappropriate peripheral and central adaptation of neuronal signaling secondary to this loss. Low-back pain is one of the most common disorders, effecting about two-thirds of the adult population at some time in their lives. Parasympathetic dysfunction has been found in 65% of type 2 diabetics at 10 years post diagnosis of diabetes; combined sympathetic and parasympathetic neuropathic is found in 15.2% of patients.
