Neuralgias: What You Need to Know

Neuralgia is a chronic pain disorder that causes extreme, sporadic, sudden burning or shock-like face pain. This debilitating pain can occur suddenly and persist for prolonged periods, affecting both physical comfort and emotional well-being. In this article, we delve into the complexities of neuralgia, exploring its symptoms, causes, diagnosis, and management strategies, with an aim to empower individuals to seek timely medical attention and find relief from the challenges posed by this condition. Let’s start with some basics.

What is Neuralgia?

Neuralgia refers to a type of pain that originates from a nerve or nerves. It is often described as sharp, stabbing, or burning, and it can occur along the path of a specific nerve or in a widespread area. This condition can significantly impact daily life, causing discomfort and interfering with normal activities.

Doctor says, “The pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur.”

What are the Types of Neuralgia?

Neuralgia refers to various types of nerve pain characterised by acute sensations. Common types of neuralgia include:

• Trigeminal Neuralgia: Characterised by severe, stabbing pain in the trigeminal nerve, which controls sensation in the face.
• Postherpetic Neuralgia: Occurs as a complication of shingles (herpes zoster), causing persistent pain in the areas affected by the shingles rash.
• Glossopharyngeal Neuralgia: Involves sudden, sharp pain in the throat, tongue, ear, and tonsils, often triggered by swallowing or speaking.
• Occipital Neuralgia: Causes sharp, shooting pain in the back of the head and neck, often radiating to the scalp.
• Intercostal Neuralgia: Results in sharp, burning pain along the intercostal nerves, which run between the ribs.
• Peripheral Neuralgia: Refers to nerve pain occurring in the peripheral nervous system, leading to symptoms such as tingling, numbness, or shooting pain in the extremities.

What are the Causes of Neuralgia?

Neuralgia can be caused by various factors that affect the nerves and disrupt their normal function. Some common causes of neuralgia include:

• Nerve compression: Pressure on a nerve due to surrounding structures, such as muscles, bones, or blood vessels, can lead to irritation and inflammation, causing neuralgia.
• Nerve damage: Injury, trauma, or surgical procedures may damage nerves, leading to neuralgia symptoms.
• Inflammation: Inflammatory conditions, such as infections or autoimmune diseases, can cause inflammation of the nerves, resulting in neuralgia.
• Chronic diseases: Certain chronic health conditions, including diabetes, multiple sclerosis, and cancer, can damage nerves and increase the risk of neuralgia.
• Degenerative disorders: Degenerative conditions, such as degenerative disc disease or arthritis, can lead to changes in the spine or other structures, resulting in nerve compression and neuralgia.
• Infections: Viral or bacterial infections, such as herpes zoster (shingles), Lyme disease, or HIV/AIDS, can affect nerves and cause neuralgia symptoms.
• Genetic factors: Some individuals may have a genetic predisposition to develop neuralgia due to inherited nerve disorders or abnormalities.
• Other causes: Certain medications, toxins, or environmental factors may also contribute to the development of neuralgia in some cases.

The underlying cause of neuralgia can vary depending on the specific type of neuralgia and individual factors. Therefore, identifying the cause is essential for determining the most appropriate treatment approach and managing symptoms effectively.

What are the Symptoms of Neuralgia?

Neuralgia is characterised by various symptoms that can vary depending on the type and location of the affected nerve. Common symptoms of neuralgia may include:

• Sharp, stabbing, or shooting pain along the path of a nerve.
• Burning or tingling sensations.
• Electric shock-like sensations.
• Hypersensitivity to touch or pressure in the affected area.
• Muscle weakness or paralysis in severe cases.
• Pain triggered or worsened by certain activities or stimuli, such as movement, touch, or temperature changes.
• Persistent or intermittent pain that may be localised or radiate to other areas of the body.
• Numbness or loss of sensation in the affected area.

Note: These symptoms can significantly impact an individual's quality of life and may vary in severity and duration depending on the underlying cause and individual factors.

How is Neuralgia Diagnosed?

As there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. However, finding the cause of the pain is important as the treatments for different types of pain may differ. Diagnosing neuralgia typically involves a comprehensive evaluation by a healthcare provider to assess symptoms, medical history, and perform various tests to identify the underlying cause. The diagnostic process may include:

• Medical history review: Your healthcare provider will ask about your symptoms, medical history, and any factors that may contribute to neuralgia, such as previous injuries or medical conditions.
• Physical examination: A thorough physical examination, including a neurological examination, may be conducted to assess nerve function and identify areas of tenderness or sensitivity.
• Imaging tests: Imaging tests, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, may be performed to visualise the affected area and identify any structural abnormalities or nerve compression.
• Nerve conduction studies: Nerve conduction studies or electromyography (EMG) may be used to assess nerve function and identify abnormalities in nerve signals.
• Blood tests: Blood tests may be done to rule out underlying conditions, such as infections or autoimmune disorders, that may be causing or contributing to neuralgia.
• Diagnostic nerve blocks: In some cases, a diagnostic nerve block may be performed, where a local anaesthetic is injected near the affected nerve to temporarily block pain signals. If the pain is relieved after the nerve block, it may help confirm the diagnosis of neuralgia.
• Other tests: Depending on the suspected cause of neuralgia, additional tests or consultations with specialists may be needed to determine the underlying cause and develop an appropriate treatment plan.

How is Neuralgia Treated?

Treatment for neuralgia aims to alleviate pain, manage symptoms, and address the underlying cause of the condition. The specific treatment approach may vary depending on the type and severity of neuralgia and individual factors. Common treatment options for neuralgia include:

Medication

• Anticonvulsants: Medications such as carbamazepine, gabapentin, or pregabalin may help reduce nerve pain by stabilising abnormal electrical activity in the nerves.
• Tricyclic antidepressants: Drugs like amitriptyline or nortriptyline may be prescribed to help relieve nerve pain and improve sleep.
• Topical agents: Capsaicin cream or lidocaine patches may provide relief by numbing the affected area or desensitising nerve endings.
• Analgesics: Over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may help alleviate mild to moderate neuralgia pain.

Note: Typical analgesics and opioids are NOT usually helpful in treating the sharp, recurring pain caused by TN. 

Nerve blocks

If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, Interventional Pain Treatment is recommended done on an outpatient basis in which TN is blocked by Neurolytic drug or Radiofrequency with good results. It involves injecting a local anaesthetic or corticosteroid medication near the affected nerve to provide temporary relief from pain by blocking nerve signals.

Physical therapy

Techniques such as massage, stretching exercises, and transcutaneous electrical nerve stimulation (TENS) may be prescribed to help reduce pain, improve muscle function, and enhance overall mobility.

Surgical procedures

As a last resort, several surgical procedures are available which are more complex and require hospitalisation. These include:

• Microvascular decompression: A surgical procedure to relieve pressure on the affected nerve by removing surrounding blood vessels or tissues.
• Percutaneous procedures: Minimally invasive techniques, such as radiofrequency ablation or nerve blocks, may be used to disrupt nerve signals and alleviate pain.
• Neurostimulation: Implantation of devices, such as spinal cord stimulators or peripheral nerve stimulators, to deliver electrical impulses to the affected nerves and interrupt pain signals.

Complementary techniques

Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves.

What triggers Neuralgia pain?

The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind.

Who does Neuralgia affect?

TN occurs most often in people over age 50, but it can occur at any age and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening.

What is the prognosis of Neuralgia?

The prognosis of neuralgia depends on several factors, including the underlying cause, type of neuralgia, severity of symptoms, and response to treatment. In many cases, neuralgia can be effectively managed with medications, lifestyle modifications, and other treatment approaches, allowing individuals to experience significant relief from pain and improve their quality of life.

For some individuals, however, neuralgia may be chronic or recurrent, requiring ongoing treatment and symptom management. In these cases, the prognosis may be less favourable, and individuals may experience fluctuations in symptoms over time. That said, with appropriate management, many individuals with neuralgia can experience significant improvement in symptoms and achieve long-term relief from pain.

Wrap up

If you or someone you know has been experiencing symptoms of neuralgia or have concerns about nerve pain, it's crucial to seek medical attention for proper evaluation and treatment. The specialists at Max Hospitals are equipped with the expertise and resources to diagnose and manage neuralgia effectively. With a patient-centred approach and state-of-the-art facilities, our team of healthcare professionals is committed to providing personalised care and support tailored to your needs. Don't let neuralgia pain disrupt your life. Take the first step towards relief by scheduling a consultation with the specialists at Max Hospitals.