Neuralgia

Symptoms of neuralgia include burning, stabbing, pins-and-needles sensations, and electric shock-like sensations, but they can also include numbness or lack of feeling in the affected area. The pain may be so severe that touching or brushing alongside the area can produce discomfort.

The symptoms of neuralgia are diverse and can include the following:

• Burning feeling

• Lack of perspiration

• Muscle weakness

• Numbness

• Pain from an origin that does not usually cause pain

• Pain that follows the course of a specific nerve

• Paralysis or the inability to move a body part

• Pins-and-needles (prickling) sensation

• Sensitivity

• Tingling

In some cases, neuralgia may be associated with a malfunction in the autonomic nervous system (a part of the peripheral nervous system) that may be life threatening and should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

• Change in level of consciousness or alertness, such as passing out or unresponsiveness

• Difficulty swallowing

• Dizziness or vertigo

• Garbled or slurred speech or inability to speak

• Loss of muscle coordination

• Respiratory or breathing problems such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking

• Sudden paralysis or inability to move a body part

The causes of neuralgia are as diverse as the nervous system itself. A common origin for neuralgia is the peripheral nervous system, which transmits sensory signals from the rest of the body to the central nervous system (the brain and spinal cord).

Neuralgia can stem from autoimmune diseases, such as lupus or Guillain-Barré syndrome, or from an infection with viruses such as human immunodeficiency virus (HIV) or Epstein-Barr virus. The varicella-zoster virus that causes chickenpox can, much later in life, produce painful nerve conditions such as shingles and postherpetic neuralgia. Shingles is an outbreak of painful blisters on your body, sometimes accompanied by fever, aches and pains, and general malaise and lethargy. Postherpetic neuralgia (persisting pain) can occur in the affected areas long after the rash has gone.

Some infections can result in damage to the nerves and nerve pain including:

• Hepatitis C

• Human immunodeficiency virus (HIV)

• Lyme disease (inflammatory bacterial disease spread by ticks)

• Other bacterial and viral infections of the brain or meninges (the membranes lining the brain and spinal cord)

• Varicella-zoster virus (the virus that causes chickenpox)

Chronic disease can affect the nerves as well as other body systems. Examples of chronic diseases that can cause neuralgia include:

• Complex regional pain syndromes

• Connective tissue disorders

• Diabetes (a chronic disease that affects your body’s ability to use sugar for energy)

• Hypothyroidism (underactive thyroid)

• Multiple sclerosis (a disease that affects the brain and spinal cord causing weakness, coordination and balance difficulties, and other problems)

• Porphyria (a disorder of the heme metabolism)

• Spinal stenosis or other problems of the spinal column (vertebrae)

• Systemic lupus erythematosus (a disorder in which the body attacks its own healthy cells and tissues)

• Vascular disorders

Other causes of neuralgia include:

• Alcohol or illicit drug abuse

• Guillain-Barré syndrome (autoimmune nerve disorder)

• Repetitive stress injuries, for example, carpal tunnel syndrome

• Trauma or compression of nerves

Neuralgia can also occur in association with serious or even potentially life-threatening causes including:

• Brain or spinal cord tumors

• Stroke

• Transient ischemic attack (temporary stroke-like symptoms that may be a warning sign of an impending stroke)

A number of factors increase the risk of developing neuralgia. Not all people with risk factors will get neuralgia. Risk factors for neuralgia vary according to the type of condition. Some risk factors for neuralgia include:

• Alcohol or illicit drug abuse

• Diabetes

• Nutritional deficiencies

• Occupational activities with exposure to nerve injury (trauma, toxins)

• Repeated physical motion or stress

Treatment for neuralgia begins with seeking medical care from your health care provider. The cause, duration and severity of your neuralgia will determine the appropriate treatment. The goals of therapy are to manage the pain and to treat the underlying condition, if possible. Therapies include medication, surgery, and injections of local anesthetics, as well as complementary treatments such as biofeedback, acupuncture and massage.

Different types of medications may be used to treat neuralgia including:

• Analgesics, such as codeine, fentanyl (Duragesic, Fentora, Actiq), and oxycontin (OxyContin, Roxicodone)

• Anticonvulsants such as gabapentin (Neurontin, Gabarone)

• Antidepressants, particularly tricyclic antidepressants such as amitriptyline (Elavil)

• Antiviral medications (to reduce the recurrence of postherpetic neuralgia)

• Local anesthetics or topical nerve blocks

• Medications specifically to treat nerve pain, such as pregabalin (Lyrica)

Other treatment options for neuralgia may include:

• Control of blood sugar (to prevent neuropathy in patients with diabetes)

• Injection of local anesthetics

• Injection of nerve blocks

• Motor cortex stimulation

• Physical therapy

• Surgery to block nerve sensations causing pain

• Surgery to remove tumors or other obstructions on the nerve

Some complementary treatments may help some people better deal with neuralgia. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

• Acupuncture

• Massage therapy

• Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

• Yoga

Because neuralgia can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

• Paralysis or inability to move a body part

• Permanent nerve damage

• Permanent or chronic pain

• Permanent physical disability

• Side effects from medications, including addiction to painkillers

• Spread of cancer

• Spread of infection