Neuralgia refers to severe shooting pain that occurs due to a damaged or irritated nerve. Neuralgia can affect any part of the body, causing mild to severe pain. Certain medications and surgical procedures can effectively treat neuralgia.
Severe neuralgia can affect a person's ability to perform everyday tasks and can affect their quality of life.
Neuralgia has many possible causes, including:
- infections such as shingles, Lyme disease, or HIV
- pressure on bone nerves, blood vessels or tumors
- other medical conditions such as kidney disease or diabetes
- aging
This article examines the different types of neuralgia, their symptoms, and available treatment options.
Types of neuralgia
Medical professionals divide neuralgia into categories based on the areas of the body that it affects. The following are some common types of neuralgia :
Trigeminal neuralgia
TN can cause shooting pain in the face.
Trigeminal neuralgia (TN) involves the trigeminal nerve in the head. It has three branches that send signals from the brain to the face, mouth, teeth and nose.
TN is divided into two divisions: type 1 and type 2.
Type 1 TN causes a painful burning or electric shock sensation in some parts of the face. People with type 1 TN experience irregular episodes that come on suddenly.
The duration of these episodes varies among individuals, but can last up to 2 minutes, according to the National Institute of Neurological Disorders and Stroke.
Type 2 TN produces a constant, dull, aching sensation on the face.
The exact cause of TN remains unclear. However, pressure from the enlarged blood vessel can irritate or even damage the trigeminal nerve.
Multiple sclerosis (MS) can lead to TN. MS is a neurological disorder that causes inflammation that damages the myelin sheath surrounding nerve fibers in the central nervous system.
Postherpetic neuralgia
Postherpetic neuralgia (PHN) is a painful condition that affects the nerves of the skin.
According to the Centers for Disease Control and Prevention (CDC), PHN is the most common complication of shingles, affecting about 10–13% of people who develop it.
Shingles is a viral infection that causes blisters and a painful skin rash. The varicella zoster virus, which causes chickenpox, remains dormant in the nervous system and becomes active later in life, causing shingles.
When the virus is reactivated, it can cause inflammation of nerve fibers. This inflammation can lead to permanent nerve damage, which causes pain even after the infection subsides.
Occipital neuralgia
This form of neuralgia affects the occipital nerves, which originate in the neck and send signals to the back of the head.
Occipital neuralgia causes throbbing or shooting pain that begins at the base of the skull and spreads along the scalp. Pain in occipital neuralgia may flow to the back of the eyes.
Occipital neuralgia has many potential causes, including:
- sudden head movements
- tense neck muscles
- lesions or tumors in the neck
- inflamed blood vessels
- infections
- gout
- diabetes
- neck injuries
Peripheral neuralgia
Peripheral neuralgia, or peripheral neuropathy, refers to pain that occurs due to nerve damage in the peripheral nervous system. This includes all nerve fibers outside the brain and spinal cord.
Peripheral neuralgia can affect one nerve or entire nerve groups.
Sustained damage to the peripheral nervous system can affect the nerves that control muscle movement, transmit sensory information, and regulate internal organs.
Peripheral neuralgia can cause pain or numbness in the arms, legs, arms and legs. Other symptoms may include:
- involuntary muscle twitching or spasms
- loss of coordination
- difficulty performing complex motor tasks such as buttoning a shirt or tying shoelaces
- hypersensitivity to touch or temperature
- excessive sweating
- gastrointestinal problems
- difficulty eating or swallowing
- it's hard to talk
Intercostal neuralgia
Intercostal neuralgia affects the nerves that sit just below the ribs. Doctors call the muscles in this area the intercostal muscles.
Several potential factors may contribute to intercostal neuralgia, such as:
- injuries or surgical procedures involving the chest
- pressure on the nerves
- shingles or other viral infections
Intercostal neuralgia causes sharp, burning pain that affects the chest wall, upper abdomen, and upper back. Certain physical movements, such as breathing, coughing, or laughing, can make the pain worse.
Additional symptoms may include:
- tightness or pressure that envelops the chest
- tingling or numbness in the upper chest or upper back
- muscle twitching
- loss of appetite
Diabetic neuropathy
Diabetic neuropathy is the most common complication of diabetes. Because diabetes affects so many people, rates of peripheral neuropathy are now starting to rise.
Symptoms include loss of balance and numbness, tingling and pain. The best way to prevent diabetic neuropathy is to keep your blood sugar levels within an acceptable range.
Drug therapy
Drug therapy involves the use of the following groups of drugs:
- Anticonvulsants (Lyrica, Neurontin, others). These drugs have shown good effectiveness against neuropathic pain. However, they have a number of side effects, the most common of which are decreased concentration, drowsiness and swelling of the legs;
- Antidepressants. Some antidepressants (Amitriptyline, Duloxetine) affect the production of special brain substances that are responsible for both depressive states and the perception of pain. Doctors often prescribe minimal doses of antidepressants in the complex treatment of postherpetic neuralgia. Their main side effects include: drowsiness, dry mouth, dizziness;
- In cases of severe pain and insufficient effectiveness of other drugs, patients may be prescribed narcotic analgesics.
Treatment of neuralgia
Treatment options for neuralgia vary depending on the type and severity of the condition.
Ointments, local nerve blocks, and steroid injections may provide temporary pain relief for mild neuralgia.
Treatment for severe neuralgia pain may require prescription drugs, surgical procedures, or both.
Medications
Painkillers are generally not very effective in controlling neuralgia pain. Medications that can treat the underlying causes of neuralgia include :
- anticonvulsants such as carbamazepine, topiramate, and lamotrigine
- antidepressants such as amitriptyline
- muscle relaxants such as baclofen
- membrane stabilizing drugs such as gabapentin
Diagnostic methods
You need to see a general practitioner. After examination and exclusion of other pathologies, the therapist refers to a neurologist who determines the symptoms and treats intercostal neuralgia. The doctor examines the images, prescribes tests and medical examinations.
Instrumental diagnostic methods of examination:
- Radiography. Allows you to examine the bone structure. Makes it possible to determine the presence of non-traumatic or traumatic disorders. X-rays are taken in direct, oblique and lateral projections.
- CT scan. Examines bone and muscle structure in combination. More often used to detect pathological changes in bone structures.
- Myelography. A contrast agent is injected into the spinal canal. This is the main method for diagnosing soft tissue structures (nerve roots and spinal cord).
- Contrasting discography. During the procedure, a contrast agent is injected into the intervertebral disc.
- Magnetic resonance imaging. Allows you to obtain images of organs and tissues. Detects pathological changes in soft tissue structures: nerve tissue, muscles, ligaments, hernias and degenerative changes in intervertebral hernias.
- Electrospondylography. Using the computer diagnostic method, it is possible to assess the condition of the spinal column, identify the disease at an early stage, determine the extent of damage and monitor the course of the disease.
Surgery
Certain surgical procedures can help relieve neuralgia pain when the condition does not respond to treatment.
Examples of surgical procedures that may help treat neuralgia include:
Microvascular decompression : Helps remove an enlarged blood vessel affecting a nerve. The procedure involves placing a soft pad between the blood vessel and the affected nerve.
Stereotactic surgery : This is a non-invasive procedure that directs highly concentrated beams into the root of the damaged nerve. The radiation disrupts the transmission of pain signals to the brain.
Percutaneous balloon compression : This involves inserting a small balloon into the affected nerve. The balloon is inflated, causing controlled, deliberate nerve damage. This procedure prevents the affected nerve from sending pain signals to the brain. However, the effects of the procedure usually wear off after 1-2 years.
Causes of pathology
The reasons for the development of neuralgia can be different: inflammatory processes, injuries, bacteria and viruses, poisoning with drugs and various substances, autoimmune diseases, circulatory disorders in the vessels supplying the nerve.
- infections such as shingles, Lyme disease, or HIV
- pressure on bone nerves, blood vessels or tumors
- kidney disease or diabetes
- age
Serious life-threatening symptoms
Severe, debilitating pain can make breathing very difficult. Pain can also occur for life-threatening reasons, such as a heart attack. You should seek help if any of these symptoms appear:
- Chest pain that may spread to the jaw, shoulder, left arm, or back.
- Pressure in the chest, cramps and a feeling of rupture.
- Cough with yellow-green mucus
- Cardiopalmus.
- Breathing problems, such as severe shortness of breath and inability to breathe deeply.
- Severe abdominal pain.
- Severe chest pain when breathing and coughing.
- Confusion, dizziness, fainting.
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