Neuralgia Pain

Neuralgia is an abnormal condition in which a particular nerve is inflamed and sends abnormal pain signals to the brain. The pain can be mild to annoying or it can be quite severe. One type of neuralgia, and a good example of it, is the neuralgia pain which occurs with shingles. When a person has chicken pox, particularly before the age of one, the varicella virus can remain dormant in the spinal cord and central nerve roots. Then, for reasons that are sometimes unclear or due to a stressor in the body and the nervous system, the virus becomes activated and moves down a particular nerve. Two things happen as a result of this disease process. The first is pain over the distribution of that nerve. The second is that after a few days later, a rash breaks out over part or all of the nerve distribution. The rash appears as blisters of various sizes in close conjunction with one another, that is, it looks like the chicken pox. The treatment of herpes zoster, or shingles, is usually two parts. First an antiviral medication such as acyclovir is started to kill the virus. The earlier in the process it is started, the better the result. Secondly, a pain medicine is usually required due to the burning and throbbing nature of the pain. The rash and neuralgia can appear over any part of the body including the face and eyes. It is invariably present over one side of the body and stops at the midline. Most people will eventually recover from a case of the shingles, but some do not. It can leave an aching, painful neuralgia in the area where the rash was located. Pain management for this neuralgia can be challenging. Sometimes the pain can be controlled with patches and gels, along with non-narcotic medicines like ibuprofen. However, if the pain is chronic and severe, narcotic medicines may be necessary. There are several other pain relief options which are available but will not be discussed here

 Another type of neuralgia may appear over one side of the face. It can be present over the eyes, under the eyes, and at the chin. This is the distribution of the trigeminal nerve. It is not clear exactly what causes trigeminal neuralgia but the pain can be quite severe. Treatment usually consists of a short course of corticosteroids, and either non-narcotic or narcotic pain medicine. An interesting form of treatment to reduce this and similar pains is the use of SSRI antidepressants. The mechanism by which pain is modulated by these drugs is not entirely understood but they do work.

Neuralgia pain can occur virtually anywhere on the body. Neuralgia in the scalp or neck can lead to significant headaches. Neuralgia can follow an injury where a nerve is damaged or irritated. An injury to the shoulder can damage the complex circuitry of nerves in the maxilla or underarm.  A low back injury can cause neuralgia in the back and some which radiate into the legs.

Pain management of these types of conditions can be accomplished in a number of ways. Sometimes the nerve can receive a dose of local anesthetic injections near the affected neural sheath; a corticosteroid may be added to this injection. On some occasions a nerve stimulator can be used to relieve nerve pain. On occasion surgery may be appropriate to relive a trapped nerve. The process of treatment is to try to establish what nerve is causing the neuralgia. Then various medicines may be employed to reduce the pain. Sometimes a patient has to live with neuralgia, and the best choice of treatment is simply to reduce the pain.