All About Neuralgia. In this article, you will get to know about what is neuralgia, what are the types of neuralgia, what are the symptoms of neuralgia, and what are the treatments of neuralgia.
What Is Neuralgia?
By definition, “Neuralgia is pain related to nervous dysfunction”. You should know that there are two main types of pain; nociceptive pain and neuropathic pain.
In the context of nociceptive pain, a pain receptor is stimulated (pressure, inflammation, hot, cold, etc.). “The activated receptor sends a message to the brain via the nerves. It is an excess of painful impulses injected into the nervous system. This type of pain responds to conventional analgesics, like paracetamol, NSAIDs (Anti-Inflammatory Non-Steroids), and morphine.
In the context of neuropathic pain, it is directly the nerve (or the root of this nerve) that gets damaged or compressed and sends a message of pain to the brain. “The feeling is different and the pain does not respond to conventional analgesics. Neuropathic pain can be neuralgia, but there are also neuropathic pains linked to dysfunctions of other parts of the nervous system such as the spinal cord and the brain.
What Are The Types Of Neuralgias?
Many nerves can be affected by neuralgia. Some nerves are more frequently affected than others.
-In cervicobrachial neuralgia: It is a cervical nerve root that is causing the pain.
-In sciatica: It is a lumbar nerve root that is affected by the crisis. In both cases, the pain follows a very precise path which corresponds to the territory of innervation of the root (from the cervical region to the hand for cervicobrachial neuralgia and from the buttock to the foot for sciatica). According to the affected root, the painful course will be different.
-In facial neuralgia: It is the trigeminal nerve that is most often affected during the attack. This motor and sensory nerve innervate a large part of the face. Again, the topography of the pain will depend on the branch affected;
–Dental neuralgia corresponds to the irritation of one of the nerves that innervate all the oral elements.
-In Arnold’s neuralgia, the pain follows the course of the occipital nerve and causes pain radiating from the base of the skull to eye level.
-In pudendal neuralgia, the pudendal nerve (formerly called the pudendal nerve) is affected and causes genital and anal pain.
-In carpal tunnel syndrome, the median nerve is compressed as it passes through the carpal tunnel at the wrist. The pain predominates in the first 3 fingers of the hand.
What Are The Symptoms Of Neuralgia?
The pains described by the patient during neuralgia are characteristic sensations of electric shock, tingling, burning, a sensation of painful cold, paralysis or loss of sensitivity in an area, and pain when get touched. These pains are often very difficult to bear. In some neuralgia, there is a trigger zone, that is to say, an area that is when stimulated will awaken the pain. For example, the jaws are a trigger zone in trigeminal neuralgia.
How Is The Diagnosis Of Neuralgia Made?
In neuralgia, the diagnosis is essentially clinical. The examination is based on the description of the pain by the patient.
The topography of the pain also helps in the diagnosis. If the painful area is located on the path of a nerve for example; Para-clinical examinations are sometimes useful in case of doubt or to confirm the exact cause. A scanner or an MRI can visualize the compression of a nerve.
What Are The Causes Of Neuralgia?
Neuralgia is caused by damage to a nerve. However, this damage can take different forms. The nerve can be irritated, damaged, stuck or compressed by several causes.
In certain localizations, the nerves compress more easily. A tumour may be the cause of the compression. It can also be a vascular-nervous conflict. When an artery passes close to a nerve, it can compress it by increasing in volume. Its increase in volume may be due to a malformation, an aneurysmal dilation, an atheroma plaque, or arterial hypertension. It is also possible for an artery to become more sinuous with age.
An autoimmune disease affecting the peripheral nervous system can also cause nerve inflammation and neuralgia. Neuralgia can also be linked to damage to several nerves. Sometimes it is not the nerve itself that is affected but its nerve root. It must also be recognized that the exact cause is not always found.
What Is The Management Of The Cause Of Neuralgia?
When the cause is known, the management of patients involves the treatment of what is causing the crisis. For example, in the case of sciatica related to a herniated disc, the treatment is to manage the herniation via surgery.
In the case of carpal tunnel syndrome, surgery is also necessary to release the median nerve from the carpal tunnel.
In the event of compression of a nerve by a tumour, treatments must be implemented to remove the tumour or reduce its volume.
In the case of inflammatory neuralgia, anti-inflammation can be prescribed. Infiltrations can also be beneficial” enumerates the neurologist.
What Are The Treatments Of Neuralgia?
Neuropathic pain, which includes neuralgia, does not respond to conventional treatments and analgesics (paracetamol, NSAIDs, morphine and its derivatives). Another approach is necessary with drugs from other therapeutic classes that can have an effect on neuropathic pain like antiepileptics, antidepressants, anxiolytics, etc.
There are also non-drug treatments such as transcranial magnetic stimulation. Electromagnetic impulses are sent to the level of the skull. This helps relieve neuropathic pain, whether in the head or elsewhere in the body. Hypnosis and many psychotherapies can also be very useful in the management of these pains.
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