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Neuralgias Causes and Risks:
The cause of neuralgias may be injury or irritation of the nerve, but in many cases the cause is unknown or unidentifiable. Neuralgias occur most commonly in elderly persons but can occur at any age.
Trigeminal neuralgia ( tic douloureux ) is the most common form of neuralgia. It affects mostly women, usually those older than 50 years. It involves sudden, severe pain on one side of the face, in one of the areas supplied by the trigeminal nerve. The pain may be severe enough to cause a facial tic . The cause is occasionally a blood vessel or small tumor pressing on the nerve, or disorders such as multiple sclerosis . Certain movements such as speech, chewing, swallowing, or similar movements, or touching an area of the face, may trigger a spasm of excruciating pain. In some cases, even a breeze blowing on the affected area can cause pain.
Some neuralgias occur as a result of herpes infections such as shingles (postherpetic neuralgia). This can produce a constant burning pain, worsened by movement or contact with the affected area. The pain can be debilitating long after signs of the original herpes infection have disappeared.
Neuralgias that occur after injury to an area may involve any area of the body. Neuralgias other than trigeminal neuralgia and postherpetic neuralgia are rare.
Prevention:
In many cases, no prevention is known. Treatment of associated disorders may or may not prevent development of neuralgia.
Symptoms:
- pain located anywhere, usually superficial (on the surface of the body)
- location does not change for subsequent episodes
- sharp, stabbing pain or constant, burning pain
- nerve pain or pain along the path of a specific nerve
- sharp or stabbing or constant burning pain
- usually no loss of function
- increased sensitivity of the skin, any touch or pressure is interpreted as pain
- any touch or pressure is interpreted as pain
- movement may be painful
Signs and Tests:
Neurologic examination shows pain occurring along a nerve tract. Trigeminal neuralgia has pain usually along the second and third nerve divisions (lower face and jaw), and rarely involves the first nerve division (temple and forehead). It may have specific trigger points (areas where even a slight touch triggers pain). A dental examination is used to rule out dental disorders that may cause facial pain . The presence of other symptoms (such as redness or swelling ) may indicate disorders causing the pain, such as infections, fractures , rheumatoid arthritis , or other disorders.
No tests are specific for neuralgia, but tests may be used to rule out other causes of the pain.
Treatment:
No known cure exists for neuralgias. Treatment is aimed at control of the pain. Treatment varies depending on the cause (if known), location of the pain, severity of the pain, and other factors.
The cause (if known) should be treated. This may include surgical removal of tumors or surgical separation of the nerve from blood vessels or other structures that compress the nerve.
Mild over-the-counter analgesics such as aspirin (see salicylates - oral), acetaminophen - oral, or ibuprofen may be helpful for mild pain. Narcotic analgesics such as codeine may be needed for a short time to control severe pain. Carbamazepine or phenytoin may be helpful for pain associated with trigeminal neuralgia . Antidepressant medications may be helpful to control pain in some cases.
Other treatments may include nerve blocks or surgical procedures to decrease sensitivity of the nerve. Physical therapy may be helpful for some types of neuralgia, especially postherpetic neuralgia.
Prognosis:
Most neuralgias are not life threatening and do not indicate other life-threatening disorders. Pain can be severe and in some cases, incapacitating. Neuralgia pain has been known to drive some people to suicide .
Most neuralgias respond to treatment. Attacks of pain are usually episodic (occur at intervals, alternating with relatively pain-free periods of time). As the person ages, attacks may be more frequent.
Complications:
- unnecessary dental procedures prior to diagnosis of neuralgia
- disability caused by pain
- complications of surgery
- side effects of medications used to control pain (see the specific medication)
Call Your Healthcare Provider:
Call for an appointment with your health care provider if symptoms of neuralgia are present, especially if prolonged or unrelieved by over-the-counter analgesics .
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