Allodynia

What is allodynia?

Allodynia is a type of neuropathic pain (nerve pain). People with allodynia are extremely sensitive to touch. Things that don’t usually cause pain can be very painful. These may include cold temperatures, brushing hair or wearing a cotton t-shirt.

Allodynia can result from several conditions. The most common causes of allodynia include diabetes, shingles, fibromyalgia and migraine headaches.

To relieve allodynia, your provider will treat the condition that’s causing pain. They may also recommend a pain management plan. The plan may include medications to relieve pain and therapy to help you respond to pain in a different way.

How common is allodynia?

Healthcare providers don’t know exactly how many people have allodynia. Up to 10% of people in the US have some type of neuropathic pain. About 15% to 20% of people with neuropathic pain have allodynia.

What are the types of allodynia?

There are three types of allodynia:

• Dynamic (or mechanical), when pain results from an object moving across the skin.
• Static (or tactile), which results from gentle touch or pressure.
• Thermal, which results from mild changes in temperature.

What are the most common causes of allodynia?

Usually, your nerves send messages (or electrical signals) between your brain and your skin, muscles, and organs. Allodynia happens when the nervous system doesn’t work like it should. There’s a problem with how the nerves send and receive messages. Many injuries and conditions can cause issues with this communication network, including:

• Diabetes: Diabetes-related neuropathy happens when nerves become damaged and don’t work properly.
• Disorders and conditions: Many health conditions and disorders can lead to allodynia, including trigeminal neuralgia (TN), complex regional pain syndrome (CRPS), amplified musculoskeletal pain syndrome (AMPS), multiple sclerosis (MS) and fibromyalgia.
• Fibromyalgia: This condition causes fatigue, memory problems and pain all over the body.
• Medications: Some opioids can make you more sensitive to pain. Providers call this condition opioid-induced hyperalgesia. Chemotherapy drugs for cancer treatments can also lead to allodynia.
• Migraine headaches: Migraines occur along with allodynia up to 70% of the time.
• Nutritional deficiencies and diet: A severe lack of vitamin D or vitamin B can lead to allodynia. Drinking too much alcohol can cause nerve damage.
• Shingles: Allodynia can linger for months or years after a shingles rash has disappeared. Providers call this type of pain post herpetic neuralgia.
• Trauma: Some people get allodynia after an injury to the nerves (such as a deep cut). Nerve damage can also come from an amputation or radiation therapy. Trauma from a stroke can cause a heightened sensitivity to pain.

How will my provider determine the cause of allodynia?

Your provider will examine you and ask questions about the pain. They will want to know how often you feel it and what makes it better or worse. Your provider will also ask you to rate your pain on a scale from 0 to 10 and describe how it feels. Many people with allodynia say their skin is sensitive to touch. They usually describe the pain as sharp, stinging or burning. Some describe it as if they have a bad sun burn.

To determine the cause of allodynia, your provider will ask about your health history. They will also want to know about any medications you’re taking. They may perform several tests to check for diabetes, neurological disorders or other conditions. Some of these tests include:

• Blood tests (complete blood count or CBC) and urine tests.
• MRI or CT scan to look for signs of MS, stroke or another disease or injury.
• Electromyogram (EMG) and nerve conduction study (NCS).
• Quantitative sensory testing (QST), which uses a computer to evaluate nerve damage.

How do healthcare providers treat allodynia?

Your provider will treat the condition that’s causing allodynia. If no treatments are available or your provider isn’t sure what’s causing it, they will focus on reducing the pain. As part of a comprehensive pain management plan, your provider may recommend:

• Oral Medications: Several types of drugs can relieve allodynia. These include medicine to treat seizures (anticonvulsants) and some medications to treat depression. Healthcare providers commonly prescribe pregabalin (Lyrica®) to treat fibromyalgia pain. Triptans (drugs to treat migraines) can relieve allodynia that happens with migraines. You take these medications orally (by mouth).
• Topical medications: These medications come in creams or lotions that you apply to the skin. You can also wear a patch on the skin that delivers medication throughout the day. Topical medications include capsaicin and lidocaine.
• Counseling and therapy: Living with chronic pain can be challenging and emotionally exhausting. Your provider may recommend counseling, especially if you have signs of depression. Cognitive behavioral therapy (CBT), mindfulness training and biofeedback can change the way you respond to pain.
• Physical therapy (PT): Your provider may recommend a PT plan that focuses on desensitization. Your provider touches or puts gentle pressure on an area of your skin. Over several sessions, your provider gradually increases the pressure until it’s no longer painful.
• Nerve blocks: To reduce pain in a nerve or group of nerves, your provider may recommend a nerve block injection.
• Surgery: If other treatments aren’t successful, you may need surgery. Your provider may recommend spinal cord stimulation. For this treatment, your provider implants a device that delivers electricity directly to the spinal cord. The low levels of electricity reduce pain.

How can I prevent allodynia?

You may not be able to prevent allodynia. But you can lower your risk of some conditions that cause allodynia by:

• Getting plenty of exercise: Regular exercise can help you manage stress. It also helps reduce your risk of migraine headaches. Exercise also plays a major role in the management of fibromyalgia.
• Knowing your history: If you have a family history of fibromyalgia, MS, stroke or diabetes, talk to your provider. You may need regular checkups so your provider can monitor your health.
• Maintaining a healthy weight: People who carry excess weight or have obesity are at a higher risk for diabetes, which can lead to allodynia. Excess weight is also a risk factor for the development of chronic migraines.
• Staying up-to-date on vaccines: Ask your provider about getting the shingles vaccine to protect you from the viral infection.
• Watching your diet: Eating a balanced diet rich in fruits and vegetables can help you avoid vitamin deficiencies and stay healthy.

When should I call my doctor about allodynia?

Call your healthcare provider if you have any signs of allodynia. This is especially important if the pain gets in the way of your daily activities or makes it hard for you to sleep. You should call your provider right away if allodynia comes on suddenly or is very painful. It’s important to see your provider for an evaluation and to determine what’s causing the pain.

A note from Cleveland Clinic

Allodynia is a symptom of many injuries, diseases and conditions. To help people with allodynia, healthcare providers treat the condition that’s causing the pain. Your provider may recommend a combination of treatments, which can include medications, therapy, PT and counseling. Talk to your provider if allodynia gets worse or interferes with your day-to-day activities. Your provider will work with you to create a plan to reduce pain, help you feel better and improve your quality of life.