Neuralgia

Neuralgia is a sharp, stabbing pain that follows the path of a damaged or irritated nerve. This condition can occur anywhere in the body and ranges from mild, temporary discomfort to severe, debilitating pain that significantly impacts quality of life.

Table of contents

• What is neuralgia?
• Symptoms of neuralgia
• What causes neuralgia?
• Common types of neuralgia
• How is neuralgia diagnosed?
• Treatment options
• Living with neuralgia

What is neuralgia?

Neuralgia is a medical term for severe, shooting pain that occurs due to a damaged or irritated nerve. The term combines “neur” (meaning nerve) and “algia” (meaning pain). This condition can affect any part of the body, causing mild to severe discomfort.^[1]

Generally, neuralgia is not an illness in its own right, but rather a symptom of injury or a particular disorder. In many cases, the cause of the pain is not known.^[2] While almost everyone will experience mild neuralgia at some point, these episodes are usually temporary and tend to ease by themselves within a few days. However, some types of neuralgia are longer lasting and debilitating, severely reducing a person’s quality of life.^[2]

Older people are most susceptible to neuralgia, but people of any age can be affected.^[2] The pain results from disruption of a nerve’s structure or function, which can happen for many reasons including damage, injury, pressure on a nerve, or changes in the way a nerve functions.^[1]

Symptoms of neuralgia

Neuralgia causes intense and distinct symptoms that can vary depending on which nerve is affected. The most common symptoms include:^[1][2]

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

Additional symptoms may include dysesthesia (unusual skin sensations without a skin-related cause), hyperesthesia (hypersensitivity to touch, sound, or other senses), and allodynia (pain from stimulation that would not typically cause pain, such as a light touch).^[1] Some people may also experience muscle atrophy from prolonged reluctance to move a painful body part.^[1]

The pain can be sharp or burning, depending on the affected nerve. In many cases, the affected area remains functional despite the pain. These symptoms may be long-lasting and persistent due to sensitization of the central nervous system, even if the primary cause of pain has been resolved.^[1]

What causes neuralgia?

Neuralgia causes pain because of disruption of a nerve’s structure or function. Several factors can lead to nerve damage or irritation:^[1][5]

Infections: Various infections can affect nerves and cause neuralgia. Shingles, caused by the same virus as chickenpox, can lead to nerve inflammation. Your likelihood of having shingles increases with age. Other infections include HIV/AIDS, Lyme disease, and syphilis. An infection in a specific part of the body may also affect a nearby nerve, such as a tooth abscess irritating facial nerves.^[5]

Physical pressure or injury: Broken bones, slipped vertebral discs (such as in sciatica), or certain tumors can press on and irritate a nerve. Pressure on nerves can also come from nearby bones, ligaments, or blood vessels.^[2][5]

Chronic medical conditions: Several ongoing health conditions can lead to neuralgia, including multiple sclerosis (MS), diabetic neuropathy, and chronic kidney disease. These conditions can cause changes in nerve function that result in pain.^[1][5]

Medications: Certain chemotherapy medicines such as cisplatin, paclitaxel, or vincristine can cause nerve damage leading to neuralgia.^[5]

Aging: The natural aging process can contribute to nerve irritation or damage.^[1]

In many cases, the underlying cause of neuralgia remains unknown, even after thorough investigation.^[1][2]

Common types of neuralgia

Healthcare professionals divide neuralgia into categories depending on the areas of the body it affects. The following are some of the most common types:^[6]

Trigeminal neuralgia

Trigeminal neuralgia is the most common type of neuralgia, also known as tic douloureux. The trigeminal nerve supplies various areas of the face, including the cheeks and jaw. This nerve has three branches that send signals from the brain to the face, mouth, teeth, and nose.^[2][3]

The condition is characterized by sudden jolts of shooting pain that usually affect one side of the face only. The pain may feel like an electric shock and can be severe enough to cause spasms of the facial muscles. Episodes of pain can last from a few seconds to several minutes.^[3] Trigeminal neuralgia turns everyday activities, such as toothbrushing, shaving, eating, or even encountering a light breeze, into agonizing events.^[2]

Known causes include pressure from blood vessels on the trigeminal nerve, multiple sclerosis, or tumors pressing against the nerve. Women over the age of 50 years are most commonly affected.^[2] About 150,000 people in the United States receive a trigeminal neuralgia diagnosis every year.^[7]

Postherpetic neuralgia

Postherpetic neuralgia is a painful condition that affects the nerves in the skin. According to the Centers for Disease Control and Prevention, it is the most common complication of shingles, affecting about 10-18% of people who develop the infection.^[6]

When the varicella-zoster virus (which causes chickenpox) reactivates later in life, it causes shingles. This reactivation can cause inflammation in the nerve fibers, leading to permanent nerve damage that causes pain even after the infection subsides. The pain may remain long after the shingles rash has disappeared, particularly in areas of the face.^[2][6]

Occipital neuralgia

This form of neuralgia affects the occipital nerves, which originate in the neck and send signals to the back of the head. Irritation of the main nerve that runs from the back of the skull causes occipital neuralgia.^[2]

Occipital neuralgia causes a throbbing or shooting pain that starts near the base of the skull and radiates along the scalp. The pain can extend to the back of the head and may cause severe headaches.^[6]

How is neuralgia diagnosed?

Diagnosis of neuralgia typically begins with a thorough physical examination and a detailed discussion of your symptoms. Your healthcare provider will ask about your symptoms, general health, and any medicines or other treatments you are taking.^[4]

During the physical examination, your doctor will test your nerves by checking:^[4]

• Muscle strength and coordination
• Reflexes
• Sensitivity to touch, pain, and temperature

The examination may reveal abnormal sensation in the skin, reflex problems, loss of muscle mass, lack of sweating (sweating is controlled by nerves), tenderness along a nerve, or trigger points where even slight touch causes pain.^[5]

Your healthcare provider may conduct several tests to diagnose neuralgia and identify underlying causes:^[5]

• Blood tests to check blood sugar, kidney function, and other possible causes of neuralgia
• Magnetic resonance imaging (MRI) to look for possible causes such as multiple sclerosis or a tumor, and to view blood vessels
• Nerve conduction studies with electromyography to measure how quickly nerves carry electrical signals
• Ultrasound or other imaging techniques
• Spinal tap (lumbar puncture) in some cases

For trigeminal neuralgia specifically, diagnosis is mainly based on your description of the pain, including the type (sudden, electric shock-like), location (parts of the face affected), and triggers (eating, talking, light touch).^[9] You may also need to see a dentist if the pain is in your face or jaw, as a dental exam can rule out dental disorders that may cause facial pain.^[5]

Treatment options

Treatment for neuralgia depends on the cause, location, and severity of the pain. The goal is to address the underlying cause and relieve pain through various approaches.^[1]

Medications

Medicines to control pain are often the first line of treatment:^[5]

• Anticonvulsants (antiseizure medications): These drugs, originally developed to treat epilepsy, can help relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to send pain messages. Carbamazepine is currently the only medicine licensed to treat trigeminal neuralgia in some countries and can be very effective initially.^[10] Other anticonvulsants include oxcarbazepine, lamotrigine, gabapentin, pregabalin, and topiramate.^[10]
• Antidepressants: These medications can help control nerve pain in some cases.^[5]
• Pain medicines: Over-the-counter or prescription pain medications, including pain medicines in the form of skin patches or creams, may provide relief.^[5]
• Muscle relaxants: Baclofen can be prescribed, alone or in combination with other drugs.^[14]

It’s important to note that painkillers like paracetamol are not effective in treating neuralgia.^[10] Anticonvulsants need to be taken regularly, not just when pain attacks happen, and you should increase dosage slowly and reduce it gradually if the pain goes into remission.^[10]

Injections and nerve blocks

Shots with pain-relieving (anesthetic) medicines or nerve blocks can provide relief in some cases. Some relief has been found through trigeminal nerve-blocking injections using agents such as botulinum toxin (Botox), and to a lesser extent phenol, alcohol, and glycerol. However, these treatments typically only last a few months.^[22][5]

Surgical procedures

If medicine does not adequately control symptoms or causes persistently troublesome side effects, surgery or other procedures may be considered:^[10]

Microvascular decompression (MVD): This is the most common surgical procedure for treating trigeminal neuralgia. A small incision is made behind the ear, and under microscopic visualization, the trigeminal nerve is exposed. If a blood vessel is compressing the nerve, it is moved away and padding is placed between them. This procedure offers the most long-term relief.^[14]

Stereotactic radiosurgery (Gamma Knife): This procedure uses focused radiation to damage the trigeminal nerve and reduce pain signals.^[10][13]

Percutaneous procedures: These include balloon compression, glycerol rhizolysis, and radiofrequency lesioning. These minimally invasive procedures intentionally damage the trigeminal nerve to block pain signals.^[10][13]

Other treatments

Additional treatment options may include:^[5]

• Physical therapy for some types of neuralgia, especially postherpetic neuralgia
• Alternative therapies such as acupuncture or biofeedback
• Nerve or spinal cord stimulation procedures when other treatments fail

Living with neuralgia

Most neuralgias are not life threatening and are not signs of other life-threatening disorders. For severe pain that does not improve, it’s important to see a pain specialist to explore all treatment options.^[5]

Most neuralgias respond to treatment. Attacks of pain usually come and go, but attacks may become more frequent in some people as they get older. Sometimes, the condition may improve on its own or disappear with time, even when the cause is not found.^[5]

While neuralgia can be managed with medication and physical therapy, the condition can be life-altering. Activities as simple as chewing, talking, smiling, and brushing teeth can trigger brief bouts of intense pain, making neuralgia both a physical and emotional condition.^[7]

There are several strategies that can help manage daily life with neuralgia:^[21]

• Try to identify and avoid triggers such as cold wind, certain foods, or specific activities
• Practice stress reduction techniques, as stress can heighten nerve sensitivity
• Maintain a support network and consider joining a support group with others who have this condition
• Follow your treatment plan carefully and communicate regularly with your healthcare team

With modern treatments and protocols, neuralgia can become a manageable condition. Whether through medication, injections, or surgery, there are ways to lessen or even eliminate pain symptoms.^[22] Being diagnosed with neuralgia does not mean you must resign yourself to a life of pain – several treatment plans and coping methods exist to minimize the condition’s effects and protect your quality of life.^[17]