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Neuralgia

• Overview
• Symptoms
• Treatment
• Prevention

Alternative Names:

Nerve pain; Postherpetic neuralgia

Treatment:

Treatment of neuralgia is aimed at reversing or controlling the cause of the nerve problem (if identified), as well as providing pain relief. Therefore, the 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 spontaneously or disappear with time.

The cause (if known) should be treated. This may include surgical removal of tumors, or surgical separation of the nerve from blood vessels or other structures that compress it. This can be the approach taken for certain cases of carpal tunnel syndrome and trigeminal neuralgia.

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

Mild over-the-counter analgesics such as aspirin, acetaminophen, or ibuprofen may be helpful for mild pain. Narcotic analgesics such as codeine may be needed for a short time to control severe pain. These traditional pain-killers, however, often have disappointing results.

Other types of medications work in different parts of the nervous system and often provide better symptom control. For example, antiseizure medications such as carbamazepine, gabapentin, lamotrigine or phenytoin may be helpful for pain associated with trigeminal neuralgia. The most common side effects of antiseizure drugs are drowsiness, tremor, and incoordination.

Antidepressant medications, such as amitriptyline, may be helpful to control pain in some cases. The topical (local) application of creams containing capsaicin also may help to control pain.

Other treatments may include nerve blocks, local injections of anesthetic agents, or surgical procedures to decrease sensitivity of the nerve. Some procedures involve the ablation (surgical destruction) of the affected nerve using different methods, such as local radiofrequency, heat, balloon compression, and injection of chemicals (such as glycerolysis).

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

Another strategy sometimes used for resistant cases of neuralgia is called motor cortex stimulation (MCS), which consists of surgically placing an electrode over the sensory cortex of the brain. The electrode is hooked to a pulse generator pocketed under the skin. Such surgical procedures, however, are tried only when more conservative approaches have failed.

For some patients, post herpetic neuralgia can be treated with a combination of oral (taken by mouth) prednisone and antiviral medication.

Physical therapy may be helpful for some types of neuralgia, especially postherpetic neuralgia. Treatment of shingles with antiviral medication may decrease the incidence of postherpetic neuralgia.

Expectations (prognosis):

Most neuralgias are not life-threatening and do not indicate other life-threatening disorders. However, pain can be severe and, in some cases, incapacitating. For severe pain, be sure to see a pain specialist so that all options for treatment can be explored.

Most neuralgias will respond to treatment. Attacks of pain are usually episodic (occurring in intervals, alternating with relatively pain-free periods of time). However, attacks may become more frequent in some patients as they age.

Complications:

• Unnecessary dental procedures prior to diagnosis of neuralgia
• Disability caused by pain
• Complications of surgery
• Side effects of medications used to control pain (see the specific medication)

Calling your health care provider:

Call for an appointment with your health care provider if symptoms of neuralgia are present, especially if prolonged or unrelieved by over-the-counter analgesics. See a pain specialist for severe pain.

• Review Date: 9/7/2006
• Reviewed By: Kenneth Gross, M.D., Neurology, North Miami, FL. Review provided by VeriMed Healthcare Network.

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