Overview
Neuropathic pain arises from damage to or dysfunction of the nervous system itself — the peripheral nerves, spinal cord, or brain — rather than from tissue injury in the conventional sense. It produces a distinct quality of pain: burning, electric shock-like, stabbing, or a constant aching accompanied by abnormal sensations (paresthesias) such as tingling, numbness, or hypersensitivity. Neuropathic pain can be among the most difficult types of pain to treat with conventional analgesics alone, making Dr. Migdale's specialization in neuromodulation and interventional techniques particularly valuable.
Types of Neuropathic Pain
Neuropathic pain encompasses a wide range of conditions including: diabetic peripheral neuropathy (from nerve damage due to chronic high blood sugar); post-herpetic neuralgia (nerve pain following shingles); chemotherapy-induced peripheral neuropathy; phantom limb pain; central sensitization syndromes; intercostal neuralgia; post-surgical neuropathic pain (including post-mastectomy pain); and peripheral nerve injuries from trauma or compression.
Why Neuropathic Pain Responds Poorly to Opioids
Neuropathic pain is generated by the nerve itself rather than by a nociceptive signal from injured tissue. This means that opioids — which work primarily on nociceptive pain pathways — are often only partially effective for neuropathic pain and carry the risk of tolerance and dependence. This is precisely why Dr. Migdale's interventional approach — targeting the nervous system directly — is so important for these patients.
Interventional Options
Dr. Migdale's training encompasses the full range of interventional approaches to neuropathic pain. Spinal cord stimulation and peripheral nerve stimulation work by modulating the nervous system at the level of the spinal cord or peripheral nerve, interrupting abnormal pain signaling. For specific nerve distributions, targeted nerve blocks and pulsed radiofrequency can provide significant relief. Medical acupuncture — which Dr. Migdale is certified in through McMaster University and has also completed Battlefield Acupuncture training through the VA — is an effective adjunct for many neuropathic conditions.