What is neuralgia?
Your nervous system consists of two anatomic parts. The central nervous system, made up of the brain and spinal cord, acts as the central processing station for nerve signals. The peripheral nervous system transmits sensory information between the muscles, tissues and nerves in the rest of the body to the brain. Neuralgia, or nerve pain, is pain that is felt anywhere along the path of a nerve.
When neuralgia originates in the peripheral nervous system it can produce burning, numbness, pins-and-needles sensations, muscle weakness or paralysis, and sensitivity. These symptoms may be caused by a local injury, in which the pain can be directly related to a trauma, or a systemic illness that affects your entire body. With referred pain, a more complex condition, the sensation of pain is felt in a different part of your body from where the injury or illness actually occurred. Referred pain is the most difficult to diagnose and treat.
The most common form of neuralgia is trigeminal neuralgia, a form of neuralgia that affects one of the cranial nerves belonging to the central nervous system. This condition produces extreme facial pain that can feel like burning or an electric shock. The pain is severe enough that daily activities such as chewing, eating, or tooth brushing can be agonizing.
Neuralgia can affect any body part, leading to impaired function due to pain or muscle weakness. It is most common in people over the age of 60 (Source: PubMed).
Neuralgia due to a malfunctioning of the autonomic nervous system (part of the peripheral nervous system) may accompany a disruption of actions such as breathing, swallowing, bladder control, or perspiration. Low blood pressure, dizziness or vertigo, or loss of consciousness may also occur. Seek immediate medical care (call 911) if you, or someone you are with, have any of these symptoms as they can be life threatening.
What are the symptoms of neuralgia?
Symptoms of neuralgia include burning, stabbing, pins-and-needles sensations, and electric shock-like sensations, but they can also include numbness or lack of feeling in the affected area. The pain may be so severe that touching or brushing alongside the area can produce discomfort.
Common symptoms of neuralgia
The symptoms of neuralgia are diverse and can include the following:
Lack of perspiration
Pain from an origin that does not usually cause pain
Pain that follows the course of a specific nerve
Paralysis or the inability to move a body part
Pins-and-needles (prickling) sensation
Serious symptoms that might indicate a life-threatening condition
In some cases, neuralgia may be associated with a malfunction in the autonomic nervous system (a part of the peripheral nervous system) that may be life threatening and should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:
Change in level of consciousness or alertness, such as passing out or unresponsiveness
Dizziness or vertigo
Garbled or slurred speech or inability to speak
Loss of muscle coordination
Sudden paralysis or inability to move a body part
What causes neuralgia?
The causes of neuralgia are as diverse as the nervous system itself. A common origin for neuralgia is the peripheral nervous system, which transmits sensory signals from the rest of the body to the central nervous system (the brain and spinal cord).
Neuralgia can stem from autoimmune diseases, such as lupus or Guillain-Barré syndrome, or from an infection with viruses such as human immunodeficiency virus (HIV) or Epstein-Barr virus. The varicella-zoster virus that causes chickenpox can, much later in life, produce painful nerve conditions such as shingles and postherpetic neuralgia. Shingles is an outbreak of painful blisters on your body, sometimes accompanied by fever, aches and pains, and general malaise and lethargy. Postherpetic neuralgia (persisting pain) can occur in the affected areas long after the rash has gone.
Infectious causes of neuralgia
Some infections can result in damage to the nerves and nerve pain including:
Human immunodeficiency virus (HIV)
Other bacterial and viral infections of the brain or meninges (the membranes lining the brain and spinal cord)
Varicella-zoster virus (the virus that causes chickenpox)
Chronic disease causes of neuralgia
Chronic disease can affect the nerves as well as other body systems. Examples of chronic diseases that can cause neuralgia include:
Complex regional pain syndromes
Diabetes (a chronic disease that affects your body’s ability to use sugar for energy)
Hypothyroidism (underactive thyroid)
Multiple sclerosis (a disease that affects the brain and spinal cord causing weakness, coordination and balance difficulties, and other problems)
Porphyria (a disorder of the heme metabolism)
Spinal stenosis or other problems of the spinal column (vertebrae)
Systemic lupus erythematosus (a disorder in which the body attacks its own healthy cells and tissues)
Other causes of neuralgia
Other causes of neuralgia include:
Alcohol or illicit drug abuse
Guillain-Barré syndrome (autoimmune nerve disorder)
Trauma or compression of nerves
Serious or life-threatening causes of neuralgia
Neuralgia can also occur in association with serious or even potentially life-threatening causes including:
Brain or spinal cord tumors
Transient ischemic attack (temporary stroke-like symptoms that may be a warning sign of an impending stroke)
A number of factors increase the risk of developing neuralgia. Not all people with risk factors will get neuralgia. Risk factors for neuralgia vary according to the type of condition. Some risk factors for neuralgia include:
Alcohol or illicit drug abuse
Occupational activities with exposure to nerve injury (trauma, toxins)
Repeated physical motion or stress
How is neuralgia treated?
Treatment for neuralgia begins with seeking medical care from your health care provider. The cause, duration and severity of your neuralgia will determine the appropriate treatment. The goals of therapy are to manage the pain and to treat the underlying condition, if possible. Therapies include medication, surgery, and injections of local anesthetics, as well as complementary treatments such as biofeedback, acupuncture and massage.
Medications for neuralgia
Different types of medications may be used to treat neuralgia including:
Analgesics, such as codeine, fentanyl (Duragesic, Fentora, Actiq), and oxycontin (OxyContin, Roxicodone)
Anticonvulsants such as gabapentin (Neurontin, Gabarone)
Antidepressants, particularly tricyclic antidepressants such as amitriptyline (Elavil)
Antiviral medications (to reduce the recurrence of postherpetic neuralgia)
Local anesthetics or topical nerve blocks
Medications specifically to treat nerve pain, such as pregabalin (Lyrica)
Other treatments for neuralgia
Other treatment options for neuralgia may include:
Control of blood sugar (to prevent neuropathy in patients with diabetes)
Injection of local anesthetics
Injection of nerve blocks
Motor cortex stimulation
Surgery to block nerve sensations causing pain
Surgery to remove tumors or other obstructions on the nerve
Some complementary treatments may help some people better deal with neuralgia. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.
Complementary treatments may include:
Nutritional dietary supplements, herbal remedies, tea beverages, and similar products
Because neuralgia can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including: