Neuralgia: Causes, Different Types, Diagnosis, and Treatment

Neuralgia occurs with irritation or inflammation of a nerve, causing pain, burning, numbness, tingling, aching, muscle twitching, or any irritating sensation of the nerve; however, there is usually an initial onset of severe and shooting pain.

Key takeaways:
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    Neuralgia occurs with irritation or inflammation of a nerve.
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    The symptoms of neuralgia can vary but usually consist of pain, burning, numbness, tingling, aching, muscle twitching, or any irritating sensation of the nerve.
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    Causes of neuralgia include direct pressure on the nerve, infections, toxic agents, diabetes, kidney disease, or caused by medications.
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    There are different types of neuralgias, including trigeminal neuralgia, postherpetic neuralgia (from shingles), occipital neuralgia, peripheral neuropathy, and others.
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    Neuralgias are diagnosed by a combination of history, neurological exam, laboratory tests, imaging studies, and special tests like nerve conduction and electromyogram (EMG).
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    Treatments vary depending on the cause and symptoms but can include medications (pills and topical), physical and occupational therapy, injection, or surgery.

The first word in neuralgia comes from the Greek word "neura," meaning nerve; the second word comes from the Greek word "algos" or "algein," to feel pain.

Neuralgia can be debilitating and affect the person's ability to perform the activities of daily living (ADL).

What causes neuralgia?

There are numerous causes of neuralgia, including:

  • Direct pressure on the nerve from trauma, tumor, bone problem, or vascular issue (blood vessel) produces a similar effect to when you feel “pins and needles” on your leg or arm.
  • Infections such as herpes zoster (shingles), Lyme disease, or syphilis. In addition, a bacterial infection, like an abscess, can place pressure on the nerve.
  • Toxic agents such as pesticides, industrial agents, animal venom, heavy metals, etc.
  • Diabetes, kidney disease, and aging.
  • Numerous medications.

What are the different types of neuralgia?

A: Trigeminal neuralgia involves the trigeminal nerve in the face: it is the fifth of twelve cranial nerves.

If you're curious, the name trigeminal comes from the Latin or Greek for three, “tres” and “treis,” respectively, since the trigeminal nerve has three branches. The 2nd part comes from the Latin word "geminatus," meaning twinned, since branches are on both sides of the face.

In trigeminal neuralgia, there are electric-like shocks and pain in the face, mouth (including lips and teeth), and nose. The pain is usually sharp, stabbing, and burning. Trigeminal neuralgia is typically unilateral, meaning it affects one side (of the face).

B: Postherpetic neuralgia, also known as shingles neuralgia, is caused by the herpes zoster virus that causes chickenpox, when we are younger. After the breakout and remission of the skin lesions, the virus stays dormant in the nerve root.

It is not known what reactivates this virus, but when it does, it causes pain, burning, and even a stabbing sensation along the affected nerve.

C: Occipital neuralgia occurs when there is irritation of the occipital nerve, which runs from the spinal cord, through the base of the neck, to the posterior scalp, occasionally reaching the top of the forehead.

Occipital neuralgia causes the same sharp, stabbing, and burning pain seen in trigeminal neuralgia (discussed above); however, the pain is in a different location.

D: Peripheral neuropathy is a type of peripheral neuralgia usually involving the extremities (arms and legs). Occasionally, the terms are used interchangeably.

E: Many other types of neuralgia exist, including:

  • Intercostal neuralgia, where the nerves under the ribs are affected.
  • Auriculotemporal neuralgia affects the auriculotemporal nerve, causing symptoms at the ear area and side of the face.
  • Supraorbital neuralgia involves the supraorbital nerve, causing symptoms above the eye and at the scalp.

How is neuralgia diagnosed?

Your physician or medical provider will start by taking a history and performing a full physical examination, emphasizing the neuromuscular system, called a neurological exam.

The muscles will be checked for tenderness, atrophy (thinning or loss of muscle mass), and reflexes. In addition, the symptomatic areas will be checked for sensation, motor function, vibration, proprioception (positioning), and nerve tenderness.

With pain in the facial area, a dentist evaluation can be helpful to rule out a tooth infection or abscess.

Laboratory tests can assist with diagnosing many conditions that can cause or mimic neuralgia:

  • An elevated white blood cell (WBC) count usually indicates an infection.
  • An erythrocyte sedimentation rate (ESR) test screens for inflammatory conditions.
  • To evaluate for rheumatoid arthritis, a rheumatoid factor (RF) and antinuclear antibody (ANA) should be done.
  • Blood calcium needs to be checked since low calcium levels can result in muscle cramps.
  • Labwork can also help determine kidney function and screen for diabetes.

Imaging studies and special tests:

Plain X-rays are needed to evaluate the underlying bones for serious conditions such as a fracture (break), cancer, bone spurs (prominent bony areas at the ends of the bones), and osteoporosis (thinning of the bones that can cause them to break easier than expected).

Cancer from a different organ that has spread to the bone, called metastatic, can appear as "punched out" lesions on x-rays. The punched-out lesions look like raindrops hitting a surface and splashing.

A computed tomography (CT or CAT) scan produces computerized images from different angles, allowing comprehensive three-dimensional viewing. However, even though the CT scan provides viewing of the soft tissues and the bones, it does not yield as much soft tissue details as an MRI (discussed below).

Magnetic Resonance Imaging (MRI) combines magnetic and radio waves to produce computerized three-dimensional images. It is considered the "gold standard" for evaluations of soft tissues and bone.

A nerve conduction study measures the functioning (conduction) of the nerves, while an electromyogram (EMG) measures muscle activity. An EMG test frequently accompanies nerve conduction studies.

How is neuralgia treated?

The treatments for neuralgia are diverse and depend on the condition's causation, symptoms, and severity, including:

  • Correction of the neuralgia's cause is the first line treatment.
  • Medications like anti-inflammatories, ant-seizure meds, muscle relaxers, and pain medications can be useful.
  • Various topical over the counter and prescription medications can help, like Voltaren (diclofenac) gel, an anti-inflammatory gel.
  • Physical therapy (PT).
  • Occupational therapy (OT).
  • Injection or even surgery may be needed.

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