Multiple Sclerosis Neurology / Neuroscience

What to know about neuralgia

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 interfere with a person’s ability to perform everyday tasks and may impact their quality of life.

Neuralgia has many possible causes, including:

  • infections, such as shingles, Lyme disease, or HIV
  • pressure on nerves from bones, blood vessels, or tumors
  • other medical conditions, such as kidney disease or diabetes
  • aging

This article covers the different types of neuralgia, their symptoms, and the treatment options available.

Types of neuralgia

Healthcare professionals divide neuralgia into categories depending on the areas of the body it affects. The following are some common types of neuralgia:

Trigeminal neuralgia

Woman experiencing headache and neuralgia in face holding glass of water in pain
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 falls into two subdivisions: type 1 and type 2.

Type 1 TN causes a painful burning or electric shock-like sensation in parts of the face. People with type 1 TN experience irregular episodes that come on suddenly.

The duration of these episodes varies among people 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 in the face.

The exact cause of TN remains unclear. However, pressure from an enlarged blood vessel can irritate or even damage the trigeminal nerve.

Multiple sclerosis (MS) can give rise 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 in 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 reactivates later in life, causing shingles.

When the virus reactivates, it can cause inflammation in the nerve fibers. This inflammation can lead to permanent nerve damage that 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 a throbbing or shooting pain that starts near the base of the skull and radiates along the scalp. Occipital neuralgia pain can flow to the back of the eyes.

Occipital neuralgia has numerous 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

Difficulty eating or swallowing are potential symptoms of peripheral neuralgia.
Difficulty eating or swallowing are potential symptoms of 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 of the brain and spinal cord.

Peripheral neuralgia can affect a single nerve or entire nerve groups.

Sustaining damage to the peripheral nervous system can affect nerves that control muscle movements, transmit sensory information, and regulate internal organs.

Peripheral neuralgia can cause pain or numbness in the hands, feet, arms, and legs. Other symptoms may include:

  • involuntary muscle twitching or cramping
  • loss of coordination
  • difficulty performing complex motor tasks, such as buttoning a shirt or tying shoelaces
  • hypersensitivity to touch or temperature
  • excess sweating
  • gastrointestinal problems
  • difficulty eating or swallowing
  • difficulty speaking

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 that involve the chest
  • pressure on the nerves
  • shingles or other viral infections

Intercostal neuralgia causes a sharp, burning pain that affects the chest wall, upper abdomen, and upper back. Certain physical movements, such as breathing, coughing, or laughing, can worsen the pain.

Additional symptoms may include:

  • tightness or pressure that wraps around 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 beginning to rise.

Symptoms include loss of balance and numbness, tingling, and pain. The best way to prevent diabetic neuropathy is to bring blood sugar levels within a suitable range.

Learn more about diabetic neuropathy here.

Symptoms

In general, neuralgia causes intense and distinct symptoms, including:

  • sudden episodes of extreme shooting or stabbing pain that follows the path of a damaged or irritated nerve
  • persistent aching or burning pain
  • tingling or numbness
  • muscle weakness
  • loss of muscle mass, or atrophy
  • involuntary muscle twitching or cramping

Treatments

Treatment options for neuralgia vary depending on the type and severity of the condition.

Topical ointments, local nerve block, and steroid injections may offer temporary pain relief for mild neuralgia.

Treating severe neuralgia pain may require prescription medications, surgical procedures, or both.

Medications

A doctor may prescribe medication to treat neuralgia.
A doctor may prescribe medication to treat neuralgia.

Pain relievers tend not to be very effective at 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 medications, such as gabapentin

Surgery

Some surgical procedures can help relieve neuralgia pain when the condition does not respond to medication.

Examples of surgical procedures that can help treat neuralgia include:

  • Microvascular decompression: This helps remove an enlarged blood vessel pressing on a nerve. The procedure involves placing a soft pad between the blood vessel and the affected nerve.
  • Stereotactic surgery: This is a noninvasive procedure that delivers highly concentrated radiation beams to the root of a damaged nerve. The radiation disrupts the transmission of pain signals to the brain.
  • Balloon compression: This involves inserting a small balloon into the affected nerve. The balloon inflates, resulting in controlled, intentional 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.

Outlook and takeaway

Neuralgia causes painful symptoms that vary in duration and severity. As well as pain, neuralgia can cause numbness, muscle weakness, and hypersensitivity.

If a person does not receive treatment, neuralgia can interfere with their ability to perform daily tasks.

People can work with a healthcare provider to establish the best course of treatment for their specific symptoms. If the condition does not respond to initial treatments, a healthcare provider may refer the person to a pain management specialist.

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