Neuralgia

Neuralgia is an intense burning or stabbing pain caused by nerve irritation or damage. The pain is usually brief but may be severe. It is usually felt inthe part of the body that is supplied by the irritated nerve and often feelsas if it is shooting along the nerve.

Disease, infection, and inflammation can cause neuralgia, as can pressure ona nerve or irritation of a nerve. The problem can arise from tooth decay, eyestrain, poor diet, nose infections, or exposure to damp and cold. Postherpetic neuralgia is an intense debilitating pain felt at the site of a previous attack of shingles. Trigeminal neuralgia (also called tic douloureux, the mostcommon type of neuralgia), causes a brief, searing pain along the trigeminalnerve, which supplies sensation to the face. The facial pain of migraine neuralgia lasts between 30 minutes and an hour and occurs at the same time on successive days. The cause is not known.

Glossopharyngeal neuralgia is an intense pain felt at the back of the tongue,in the throat, and in the ear--all areas served by the glossopharyngeal nerve. The pain may occur spontaneously, or it can be triggered by talking, eating, or swallowing (especially cold foods such as ice cream). Its cause is notknown.

Occipital neuralgia is caused by a pinched occipital nerve. There are two occipital nerves, each located at the back of the neck, each supplying feeling to the skin over half of the back of the head. These nerves can be pinched dueto factors ranging from arthritis to injury, but the result is the same: numbness, pain, or tingling over half the base of the skull.

Neuralgia is a symptom of an underlying disorder; its diagnosis depends on finding the cause of the condition creating the pain.

Glossopharyngeal, trigeminal, and postherpetic neuralgias sometimes respond to anticonvulsant drugs, such as carbamazepine or phenytoin, or to painkillers, such as acetaminophen. Trigeminal neuralgia may also be relieved by surgeryin which the nerve is cut or decompressed. In some cases, compression neuralgia (including occipital neuralgia) can be relieved by surgery.

People with shingles should see a doctor within three days of developing therash, since aggressive treatment of the blisters that appear with the rash can ease the severity of the infection and minimize the risk of developing postherpetic neuralgia. However, it is not clear whether the treatment can prevent postherpetic neuralgia.

If postherpetic neuralgia develops, the physician may try a variety of treatments, as their effectiveness varies from person to person. These treatments may include:

  • Antidepressants such as amitriptyline (Elavil)
  • Anticonvulsants (phenytoin, valproate, or carbamazepine)
  • Capsaicin (Xostrix), the only medication approved by the FDA for treatment of postherpeticneuralgia
  • Topical painkillers
  • Desensitization
  • TENS(transcutaneous electrical nerve stimulation)
  • Dorsal root zone (DREZ) surgery (a treatment of last resort).

Some alternative treatments also are used for neuralgia. B-complex vitamins,primarily given by intramuscular injection, can be effective. A whole foods diet with adequate protein, carbohydrates, and fats that also includes yeast,liver, wheat germ, and foods that are high in B vitamins may be helpful. Acupuncture is a very effective treatment, especially for postherpetic neuralgia.Some botanical medicines may also be useful. For example, black cohosh (Cimicifuga racemosa) appears to have anti-inflammatory properties.

The effectiveness of the any type of treatment depends on the cause of the neuralgia, but many cases respond to pain relief. Trigeminal neuralgia tends tocome and go, but successive attacks may be disabling. Although neuralgia isnot fatal, the patient's fear of being in pain can seriously interfere with daily life. Some people with postherpetic neuralgia respond completely to treatment. Most people, however, experience some pain after treatment, and a fewreceive no relief at all. Some people live with this type of neuralgia for the rest of their lives, but for most, the condition gradually fades away within five years.

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