Treatment:

The goal of treatment is to reverse or control the cause of the nerve problem (if found), and provide pain relief. Treatment varies depending on the cause, location, and severity of the pain, and other factors. Even if the cause of the neuralgia is never identified, the condition may improve on its own or disappear with time.

The cause (if known) should be treated. This may include surgery to remove tumors or separate the nerve from blood vessels or other structures that press on it. This can be done for some cases of carpal tunnel syndrome and trigeminal neuralgia.

Strict control of blood sugar may speed recovery in people with diabetes who develop neuralgia.

Medications to control pain may include:

• Antidepressant medications (amitriptyline, nortriptyline, duloxitine)
• Antiseizure medications (carbamazepine, gabapentin, lamotrigine or phenytoin) for trigeminal neuralgia pain
• Mild over-the-counter analgesics (aspirin, acetaminophen, or ibuprofen)
• Narcotic analgesics (codeine) for short-term relief of severe pain (however, these do not always work well)
• Topical creams containing capsaicin

Other treatments may include:

• Local injections of pain-relieving (anesthetic) drugs
• Nerve blocks
• Surgical procedures (such as ablation using radiofrequency, heat, balloon compression, or injection of chemicals) to reduce feeling in the nerve.

Unfortunately, these procedures do not guarantee improvement and can cause loss of feeling or abnormal sensations.

When other treatment methods fail, doctors may try motor cortex stimulation (MCS). An electrode is placed over the sensory cortex of the brain and is hooked to a pulse generator under the skin.

Treating shingles with antiviral medication may reduce the likelihood of developing postherpetic neuralgia. Postherpetic neuralgia may also be treated with oral (taken by mouth) prednisone.

Physical therapy may be helpful for some types of neuralgia, especially postherpetic neuralgia.

Expectations (prognosis):

Most neuralgias are not life-threatening and are not signs of other life-threatening disorders. However, pain can be severe. For severe pain, be sure to see a pain specialist so that you can explore all treatment options.

Most neuralgias will respond to treatment. Attacks of pain usually come and go. However, attacks may become more frequent in some patients as they get older.

Complications:

• Complications of surgery
• Disability caused by pain
• Side effects of medications used to control pain
• Unnecessary dental procedures before neuralgia is diagnosed

Calling your health care provider:

Contact your health care provider if:

• You develop shingles
• You have symptoms of neuralgia, especially if over-the-counter pain medications do not relieve your pain
• You have severe pain (see a pain specialist)