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What Causes Neuralgia to Flare-up?


A neuralgia flare-up occurs from irritation or pressure on a nerve, at the nerve root, or anywhere along the course of the nerve.

Bacterial infections

Direct pressure on a nerve can be from an abscess, a collection of pus caused by bacteria; it can be in various locations, including the trunk, an extremity (arms and legs), or the mouth (tooth abscess).

Other infectious agents

Viral infections like herpes zoster (shingles) can have flare-ups when different stresses cause the dormant virus to become active.

In addition, a flare-up can result from the bacteria causing Lyme disease and syphilis (a sexually transmitted disease that can present with neurological symptoms in advanced stages).

Musculoskeletal issues

The musculoskeletal system consists of nerves, muscles, tendons, ligaments, and bones. Within these structures, a sophisticated balance allows our system to function properly.

  • When trauma occurs, it interferes with this balance and can result in pressure on the nerves. The trauma can be from an auto accident, work-related injury (occupational illness), sports injury, fall, or anything else that interferes with the normal balance of the muscles, bones, joints, tendons, or ligaments. The trauma can cause broken bones (fractures) and disc herniation, both of which can cause a neuralgia flare-up. For example, one study published in 2019 clearly showed how a person with a fracture of the 2nd cervical vertebra developed trigeminal neuralgia.
  • Overuse injuries, also known as cumulative trauma, frequently occur in workers with an occupation that involves repeated muscle or tendon use patterns.
  • Muscular strain or spasm occurs when there is impairment in the normal contraction and relaxation process, with more contraction than relaxation. This strain or spasm (severe contraction) can impinge the nerves. One example is how a neck strain can lead to occipital neuralgia.

Tumor (cancerous growth)

A tumor that presses on a nerve will cause a neuralgia flare-up. The tumor can be a primary tumor which means it is at the site where it started, or a metastatic tumor, where the cancer cells came from somewhere else.

Chronic medical issues

  • Chronic kidney disease (CKD) is diagnosed when poor kidney function lasts three months or more. CKD causes an imbalance of electrolytes, disrupting the transmission through the nerves, and can cause neuralgia symptoms.
  • Diabetes causes increased levels of blood sugars and lipids (fats), including triglycerides, which damage nerve function. Furthermore, one study published in 2016 found a clear correlation between diabetes and trigeminal neuralgia.
  • Aging.

Aging can be a factor in the re-emergence of neuropathic pain since several biological nerve changes occur when we age, including loss of nerve fibers and neurons (cells of the nervous system), the slower sending of signals, and overall decreased function of the neurotransmitters (the chemical substance between the nerves which are needed for nerve transmission).

Neurological disorders

Certain neurological disorders can cause the symptoms of neuralgia to flare up, most specifically multiple sclerosis (MS), in which the lining of the nerve, called myelin, is attacked by the body, placing it in the category of auto-immune diseases.

Vascular (blood vessel) disorders

Certain diseases of the blood vessels can cause them to dilate (swell) and compress a nerve, most seen in trigeminal neuralgia. In addition, an arteriovenous malformation can result in an abnormal connection between an artery and vein, placing pressure on nerves.

Other causes of neuralgia flare-ups

Basically, anything that irritates a nerve by direct contact can cause a neuralgia flare-up. For instance, shaving, washing your face, or brushing one's teeth can cause trigeminal neuralgia, while using too hard a pillow at night could result in occipital neuralgia.

Weather changes play a role, including strong winds or cold weather. In addition, changes in barometric pressure outdoors or from an airplane cabin can exacerbate neuralgia. Lastly, even certain foods that are hot, cold, sweet, or spicy can aggravate neuralgia.

Stress

Stress has been found to have many adverse effects on the body, including flare-ups of neuralgia.

Whether stress is causing muscle tightness, increased blood pressure, or higher levels of glucose in the system, all can lead to neuralgia.

Many studies have shown how psychological or stressful life events have led to outbreaks of herpes zoster (shingles), with resulting neuralgia.

References:

Arnold, Ria, Tushar Issar, Arun V Krishnan, and Bruce A Pussell, ‘Neurological Complications in Chronic Kidney Disease’, JRSM Cardiovascular Disease, 5 (2016), 2048004016677687 <https://doi.org/10.1177/2048004016677687>

Giovannini, Silvia, Daniele Coraci, Fabrizio Brau, Vincenzo Galluzzo, Claudia Loreti, Pietro Caliandro, and others, ‘Neuropathic Pain in the Elderly’, Diagnostics, 11.4 (2021), 613 <https://doi.org/10.3390/diagnostics11040613>

Koh, Wenjun, Huili Lim, and Xuanxuan Chen, ‘Atypical Triggers in Trigeminal Neuralgia: The Role of A-Delta Sensory Afferents in Food and Weather Triggers’, The Korean Journal of Pain, 34.1 (2021), 66–71 <https://doi.org/10.3344/kjp.2021.34.1.66>

Sansone, Randy A., and Lori A. Sansone, ‘Herpes Zoster and Postherpetic Neuralgia: An Examination of Psychological Antecedents’, Innovations in Clinical Neuroscience, 11.5–6 (2014), 31–34

Shim, Yong Woo, Sung Hwa Paeng, Keun Soo Lee, Sung Tae Kim, and Won Hee Lee, ‘Trigeminal Neuralgia Resulting from Delayed Cervical Cord Compression after Acute Traumatic Fracture of Odontoid Process’, Korean Journal of Neurotrauma, 15.1 (2019), 38–42 <https://doi.org/10.13004/kjnt.2019.15.e10>

Xu, Zhenq, Ping Zhang, Li Long, Huiy He, Jianch Zhang, and Shup Sun, ‘Diabetes Mellitus in Classical Trigeminal Neuralgia: A Predisposing Factor for Its Development’, Clinical Neurology and Neurosurgery, 151 (2016), 70–72 <https://doi.org/10.1016/j.clineuro.2016.10.015>

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