Causes, incidence, and risk factors

Causes of neuralgia include:

• Chemical irritation

• Chronic renal insufficiency

• Diabetes

• Infections, such as herpes zoster ( shingles), HIV, Lyme disease, and syphilis

• Medications such as cisplatin, paclitaxel, or vincristine

• Porphyria

• Pressure on nerves by nearby bones, ligaments, blood vessels, or tumors

• Trauma (including surgery)

In many cases, the cause is unknown.

Postherpetic neuralgia and trigeminal neuralgia are the two most common forms of neuralgia. A related but less common neuralgia affects the glossopharyngeal nerve, which provides feeling to the throat.

Neuralgia is more common in elderly people, but it may occur at any age.

Symptoms

• Increased sensitivity of the skin along the path of the damaged nerve, so that any touch or pressure is felt as pain

• Numbness along the path of the nerve

  • In the same location each episode

  • Sharp, stabbing

  • May come and go (intermittent), or be constant, burning pain

  • May get worse when the area is moved

• Weakness or complete paralysis of muscles supplied by the same nerve

Signs and tests

The health care provider will take a complete history, including:

• When the pain started

• Any potentially related medical problems

• Any recent injuries or changes in health

An examination may show:

• Abnormal sensation in the skin

• Loss of deep tendon reflexes

• Loss of muscle mass

• Lack of sweating (sweating is controlled by nerves)

• Tenderness along a nerve, often in the lower face and jaw and rarely in the temple and forehead

• Trigger points (areas where even a slight touch triggers pain)

A dental examination can rule out dental disorders that may cause facial pain (such as a tooth abscess). Other symptoms (such as redness or swelling) may help rule out conditions such as infections, bone fractures, or rheumatoid arthritis.

There are no specific tests for neuralgia, but the following tests may be done to find the cause of the pain:

• Blood tests to check blood sugar, kidney function, and other possible causes of neuralgia

• Magnetic resonance imaging (MRI)

• Nerve conduction study with electromyography

• Spinal tap (lumbar puncture)

Treatment

The goal of treatment is to reverse or control the cause of the nerve problem (if found), and provide pain relief. Treatment varies depending on the cause, location, and severity of the pain, and other factors. Even if the cause of the neuralgia is never found, the condition may improve on its own or disappear with time.

Surgery to remove pressure on the nerve from nearby bones, ligaments, blood vessels, or tumors may be needed.

See:

• Carpal tunnel syndrome

• Trigeminal neuralgia

Strict control of blood sugar may speed recovery in people with diabetes who develop neuralgia.

Medications to control pain may include:

• Antidepressant medications (amitriptyline, nortriptyline, or duloxetine)

• Antiseizure medications (carbamazepine, gabapentin, lamotrigine, phenytoin, or pregabalin)

• Mild over-the-counter analgesics (aspirin, acetaminophen, or ibuprofen)

• Narcotic analgesics (codeine) for short-term relief of severe pain (however, these do not always work well)

• Topical creams containing capsaicin

Other treatments may include:

• Local injections of pain-relieving (anesthetic) drugs

• Nerve blocks

• Physical therapy (may be needed for some types of neuralgia, especially postherpetic neuralgia)

• Procedures (such as nerve ablation using radiofrequency, heat, balloon compression, or injection of chemicals) to reduce feeling in the nerve

Unfortunately, these procedures may not improve symptoms and can cause loss of feeling or abnormal sensations.

When other treatment methods fail, doctors may try motor cortex stimulation (MCS). An electrode is placed over part of the brain and is hooked to a pulse generator under the skin.

Expectations (prognosis)

Most neuralgias are not life-threatening and are not signs of other life-threatening disorders. However, pain can be severe. For severe pain that does not improve, see a pain specialist so that you can explore all treatment options.

Most neuralgias will respond to treatment. Attacks of pain usually come and go. However, attacks may become more frequent in some patients as they get older.

Complications

• Complications of surgery

• Disability caused by pain

• Side effects of medications used to control pain

• Unnecessary dental procedures before neuralgia is diagnosed

Calling your health care provider

Contact your health care provider if:

• You develop shingles

• You have symptoms of neuralgia, especially if over-the-counter pain medications do not relieve your pain

• You have severe pain (see a pain specialist)

Prevention

Treating related disorders such as diabetes and renal insufficiency may prevent some neuralgias. Strict control of blood sugar may prevent nerve damage in people with diabetes. In the case of shingles, there is some evidence that antiviral drugs and a herpes zoster virus vaccine can prevent neuralgia.