Neuralgia overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Neuralgia is a painful disorder of the nerves. Under the general heading of neuralgia are trigeminal neuralgia (TN), atypical facial pain, and postherpetic neuralgia (caused by shingles or herpes).

The affected nerves are responsible for sensing touch, temperature sensation and pressure sensation in the facial area from the jaw to the forehead. The disorder generally causes short episodes of excruciating pain, usually for less than two minutes and on only one side of the face. The pain can be described in a variety of ways such as "stabbing," "sharp," "like lightning," "burning," and even "itchy". In the atypical form of TN, the pain can also present as severe or merely aching and last for extended periods. The pain associated with TN is recognized as one of the most excruciating pains that can be experienced.

Simple stimuli such as eating, talking, washing the face, or any light touch or sensation can trigger an attack (even the sensation of a gentle breeze). The attacks can occur in clusters or as an isolated attack. Some patients will have a muscle spasm which led to the original term for TN of "tic douloureux" ("tic", meaning 'spasm', and "douloureux", meaning 'painful', in French).

Neuralgia is a form of chronic pain and can be extremely difficult to diagnose. Patients usually show no physical abnormalities, and with the attacks generally lasting a very short time, it can be difficult to reach a doctor before the attack is over. Postherpetic neuralgia is the easiest to diagnose because it follows an obvious cause (shingles).

Neuralgia is rare, especially in those under 30. Women are more likely to be affected than men, and those over 50 are at the greatest risk. In some cases, multiple sclerosis is related to nerve damage, causing the pain, so doctors will likely ask about family history to help diagnose. Nothing unusual can be seen in brain scans, so diagnosis is usually based on the description of the symptoms.

Medication for seizures has shown promise in managing neuralgia, and some people have found relief with surgery, though not always permanent relief.

Epidemiology and Demographics

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

Diagnosis

Laboratory Findings

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

Other Diagnostic studies

• Nerve conduction study with electromyography
• Spinal tap (lumbar puncture)

Treatment

Surgery

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

• Carpal tunnel syndrome
• Trigeminal neuralgia