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Neuralgia

What is neuralgia?

Neuralgia is a stabbing, burning, and often severe pain due to an irritated or damaged nerve. The nerve may be anywhere in the body, and the damage may be caused by several things, including:

  • aging
  • diseases such as diabetes or multiple sclerosis
  • an infection, such as shingles

Treatment for the pain of neuralgia depends on the cause.

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Types

Types of neuralgia

Postherpetic neuralgia

This type of neuralgia occurs as a complication of shingles and may be anywhere on the body. Shingles is a viral infection characterized by a painful rash and blisters. Neuralgia can occur wherever the outbreak of shingles was. The pain can be mild or severe and persistent or intermittent. It can also last for months or years. In some cases, the pain may occur before the rash. It will always occur along the path of a nerve, so it’s usually isolated to one side of the body.

Trigeminal neuralgia

This type of neuralgia is associated with pain from the trigeminal nerve, which travels from the brain and branches to different parts of the face. The pain can be caused by a blood vessel pressing down on the nerve where it meets with the brainstem. It can also be caused by multiple sclerosis, injury to the nerve, or other causes.

Trigeminal neuralgia causes severe, recurrent pain in the face, usually on one side. It’s most common in people who are older than 50 years.

Glossopharyngeal neuralgia

Pain from the glossopharyngeal nerve, which is in the throat, is not very common. This type of neuralgia produces pain in the neck and throat.

Causes

Causes of neuralgia

The cause of some types of nerve pain is not completely understood. You may feel nerve pain from damage or injury to a nerve, pressure on a nerve, or changes in the way the nerves function. The cause may also be unknown.

Infection

An infection can affect your nerves. For example, the cause of postherpetic neuralgia is shingles, an infection caused by the chickenpox virus. The likelihood of having this infection increases with age. An infection in a specific part of the body may also affect a nearby nerve. For example, if you have an infection in a tooth, it may affect the nerve and cause pain.

Multiple sclerosis

Multiple sclerosis (MS) is a disease caused by the deterioration of myelin, the covering of nerves. Trigeminal neuralgia may occur in someone with MS.

Pressure on nerves

Pressure or compression of nerves may cause neuralgia. The pressure may come from a:

  • bone
  • ligament
  • blood vessel
  • tumor

The pressure of a swollen blood vessel is a common cause of trigeminal neuralgia.

Diabetes

Many people with diabetes have problems with their nerves, including neuralgia. The excess glucose in the bloodstream may damage nerves. This damage is most common in the hands, arms, feet, and legs.

Less common causes

If the cause of neuralgia isn’t infection, MS, diabetes, or pressure on the nerves, it may be from one of many less-common factors. These include:

  • chronic kidney disease
  • medications prescribed for cancer
  • fluoroquinolone antibiotics, used to treat some infections
  • trauma, such as from surgery
  • chemical irritation
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See a doctor

When to seek medical help

The pain of neuralgia is usually severe and sometimes debilitating. If you have it, you should see your doctor as soon as possible.

You should also see your doctor if you suspect you have shingles. Besides neuralgia, shingles also causes a red, blistering rash. It’s usually on the back or the abdomen, but it may also be on the neck and face. Shingles should be treated as soon as possible to prevent complications. These can include postherpetic neuralgia, which can cause debilitating and lifelong pain.

Diagnosis

What to expect at a doctor’s appointment

When you see your doctor for neuralgia, you can expect to be asked a series of questions about your symptoms. Your doctor will want you to describe the pain and to tell them how long the pain has been a problem. You will also need to inform them of any medications you take and any other medical issues you have. This is because neuralgia may be a symptom of another disorder, such as diabetes, MS, or shingles.

Your doctor will also perform a physical exam to pinpoint the location of the pain and the nerve that’s causing it, if possible. You may also need to have a dental exam. For example, if the pain is in your face, your doctor may want to rule out other possible dental causes, such as an abscess.

To find an underlying cause of your pain, your doctor may order certain tests. You may need to have blood drawn to check your blood sugar levels and kidney function. A magnetic resonance imaging (MRI) test can help your doctor determine if you have MS. A nerve conduction velocity test can determine nerve damage. It shows how fast signals are moving through your nerves.

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Treatment

Treatment of neuralgia

If your doctor can pinpoint the cause of your neuralgia, your treatment will focus on treating the underlying cause. If the cause is not found, treatment will focus on relieving your pain.

Potential treatments may include:

  • surgery to relieve the pressure on the nerve
  • better control of blood sugar levels in people with diabetes-caused neuralgia
  • physical therapy
  • nerve block, which is an injection directed at a particular nerve or nerve group and that is intended to “turn off” pain signals and reduce inflammation
  • medications to relieve the pain

Medications prescribed may include:

  • antidepressants such as amitriptyline or nortriptyline, which are effective in treating nerve pain
  • antiseizure medications such as carbamazepine, which is effective for trigeminal neuralgia
  • short-term narcotic pain medications, such as codeine
  • topical creams with capsaicin
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Outlook

Outlook for neuralgia

There is no cure for neuralgia, but treatment can help improve your symptoms. Some types of neuralgia improve over time. More research is being done to develop better treatments for neuralgia.

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