Neuralgia is a stabbing, burning, and often quite severe pain that occurs along a damaged nerve. The damaged nerve may be anywhere in the body, but is most common in the face and neck. The cause of a damaged nerve may be a disease like diabetes or multiple sclerosis, an infection like shingles, or the result of old age. Treatment for the pain of neuralgia depends on the cause.
Neuralgia can occur in different parts of the body and can have various causes. Oftentimes, the cause for this pain is unknown.
This type of neuralgia occurs as a complication of shingles and may be anywhere on the body. Shingles is a viral infection characterized by a painful rash and blisters. Neuralgia can erupt wherever the outbreak of shingles occurred and can be mild or severe, persistent or intermittent, and can last for months or years.
This type of neuralgia is associated with pain from the trigeminal nerve, which goes from the brain to the face. The particular cause of pain is believed to be a blood vessel pressing down on the trigeminal nerve where it meets with the brainstem. Trigeminal neuralgia causes pain in the face, usually on one side, and is most common in the elderly.
Pain from the glossopharyngeal nerve, which is in the throat, is not very common. This type of neuralgia produces pain in the neck and throat.
The underlying cause of any type of neuralgia is damage to a nerve. Each nerve in your body is protected by a coating called the myelin sheath. When the myelin is damaged or wears away from the nerve, the stabbing, severe, shock-like pain of neuralgia results. There are many different factors, including old age, which can cause damage to the myelin. Unfortunately, in many cases of neuralgia, a cause can never be found.
The cause of postherpetic neuralgia is shingles, an infection caused by the chickenpox virus. The likelihood of having this infection increases with age. Lyme disease, HIV, and syphilis can also cause neuralgia.
Multiple sclerosis (MS) is a disease that is caused by the degradation of myelin. Among the many symptoms that result from MS is neuralgia, often in the face.
Pressure on Nerves
The myelin on nerves can be worn away by pressure. The pressure may come from a bone, ligament, blood vessel, or a tumor that is pressing on the nerve. The pressure of a swollen blood vessel is a common cause in trigeminal neuralgia.
Many people with diabetes will suffer from some type of neuralgia because excess glucose in the bloodstream can lead to myelin damage.
Less Common Causes
If the cause of neuralgia cannot be blamed on an infection, MS, diabetes, or pressure on the nerves, it may be from one of many less common factors. These include:
- chronic kidney disease
- porphyria (a rare blood disease)
- medications like cisplatin, paclitaxel, or vincristine (prescribed to cancer patients)
- trauma, such as that caused by surgery
- chemical irritation
The pain of neuralgia is usually very severe and can be debilitating. If you experience such pain, you should see your doctor as soon as possible, especially when the pain is not helped by over-the-counter medications.
You should also see your doctor if you suspect you have shingles. In addition to the pain of neuralgia, shingles causes a red, blistering rash. It is usually on the back or abdomen, but may also be on the neck and face.
When you see your doctor for neuralgia, you can expect to be asked a series of questions about your symptoms. Your doctor will want you to describe the pain and to tell him or her how long the pain has been a problem. You will also need to inform your doctor of any medications you are taking and of any other medical issues you have. This is because neuralgia may be a symptom of another disorder like diabetes, MS, or shingles.
Your doctor will also perform a physical exam to pinpoint the location of the pain, and if possible, the nerve causing it. You may also need to have a dental exam. If the pain is in your face, your doctor may want to rule out other possible dental causes, such as an abscess. An abscess is a bacterial infection of the tooth that causes a very painful toothache, along with other unpleasant symptoms like pus and tissue swelling. Left untreated, it can lead to extremely serious, life-threatening complications.
To find an underlying cause of your pain, your doctor may order certain tests. You may need to have blood drawn to check your blood sugar levels and kidney function. An MRI (magnetic resonance imaging) test can help your doctor determine if you have MS. A nerve conduction velocity (NCV) test can show the speed at which signals are moving through your nerves; this test helps to determine nerve damage.
If your doctor is able to pinpoint the cause of neuralgia, your treatment will focus on the underlying cause. If the cause is not found, treatment will focus on relieving your pain.
Potential treatments may include:
- surgery to relieve the pressure on the nerve, which could be caused by blood vessels, bones, ligaments, or tumors
- better control of blood sugar levels in those with diabetes-caused neuralgia
- physical therapy
- nerve block, which is an injection directed at a particular nerve or nerve group that is intended to “turn off” pain signals and reduce inflammation
- medications to relieve the pain
Medications prescribed may include:
- over-the-counter pain relievers like aspirin or ibuprofen
- antidepressants like amitriptyline or nortriptyline
- anti-seizure medications like carbamazepine
- narcotic pain medications for the short-term like codeine
- topical creams with capsaicin
Written by: Mary Ellen Ellis
Medically reviewed by George Krucik, MD