Neuralgia

What is neuralgia?

Neuralgia is a sharp type of pain that is associated with a problem in a nerve or nerves. It can range in intensity from mild to severe.

Neuralgia is most often associated with two unrelated conditions, trigeminal neuralgia and post-herpetic neuralgia.

Trigeminal neuralgia

Trigeminal neuralgia (TN) is a condition that causes pain in the face and head. The pain is usually on one side of the face. The pain is related to the trigeminal nerve, which runs from the brain to the side of the face.

The pain of TN is often intense and short-lived. Patients often describe the pain as electrical in quality. While often the pain occurs in a burst that lasts for seconds, sometimes the pain can occur in repetitive bursts that last for hours to days. The intermittent frequency of pain can often lead patients to a persistent sense of vigilance and alarm in anticipation of the next burst of pain. This combination of intermittent pain and persistent fear can lead to difficulties with coping. In turn, these difficulties can lead to impairments, such as staying home from work or other activities as a way of attempting to cope with it all.

There is no single cause of TN. Moreover, the known possible causes are not clearly defined. It is thought that compression of the trigeminal nerve by an enlarged blood vessel can cause it. It is also associated with aging. Multiple sclerosis is also sometimes associated with it. Central sensitization may also play a role in the progression TN.1 Central sensitization is a highly reactive state of the nervous system, which amplifies pain. It can occur with most any pain disorder.

Post-herpetic neuralgia

Post-herpetic neuralgia is a nerve pain condition that can result from having shingles. Shingles is a painful rash of blisters on the skin. Shingles itself is caused by the chicken pox virus, which usually lies dormant once having had the chicken pox. The dormant virus can, however, flare up and cause shingles. The onset of shingles often times occurs when someone is under a great deal of stress. After a period of a number of weeks, shingles usually goes away. Sometimes, however, the nerve pain associated with the shingles continues long after the blisters of the shingles heal up. This on-going nerve pain is then called post-herpetic neuralgia.

Post-herpetic neuralgia, but not necessarily shingles, is associated with age, particularly the elderly. That is to say, people can tend to develop shingles at various ages but patients are more likely to develop the complication of post-herpetic neuralgia if elderly. Once someone has had shingles, it typically does not return.

The pain of post-herpetic neuralgia can range in intensity from mild to severe. It is often described as a burning or aching type of pain in the same general area where there were shingles blisters. The area with pain is often sensitive to touch.

Is there a cure?

Typically, there are no cures for either TN or post-herpetic neuralgia. Healthcare providers and their patients focus on management of the chronic pain. Chronic pain management has two broad goals:

  • Reduce symptoms to the extent possible
  • Reduce the emotional distress and functional impairments that are associated with the symptoms

The first goal involves reducing pain and any other symptoms associated with either of the neuralgias. The second goal is two-fold: to reduce the fear, anger, anxiety, depression or sleep problems that tend to go along with living with neuralgia, and reducing the sense of disability that tends to occur with it. Overall, these goals amount to assisting the patient to live well, work, and be involved in life, despite having some chronic pain symptoms.

The healthcare system has different ways it pursues chronic pain management. Broadly speaking, there are three different types of pain clinics in our healthcare system:

  • Pain clinics that focus on surgical and/or interventional procedures (surgeries, injections, nerve-burning procedures, and the like)
  • Pain clinics that focus on long-term medication management (such as long-term use of narcotic pain medications)
  • Pain clinics that focus on chronic pain rehabilitation (such as interdisciplinary chronic pain rehabilitation programs)

All three types of clinics treat TN and post-herpetic neuralgia.

References

1. Hu, W. H., Zhang, K., & Zhang, J. G. (2010). Atypical trigeminal neuralgia: A consequence of central sensitization? Medical Hypotheses, 75, 65-66.

2. Watson, J. C. (2007). From paroxysmal to chronic pain in trigeminal neuralgia: Implications of central sensitization. Neurology, 69, 817-818.

 

Date of publication: April 27, 2012

Date of last modification: October 26, 2015

Murray J. McAllister, PsyD, is the executive director of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Its mission is to lead the field in making pain management more empirically supported. Additionally, the ICP provides Academic quality information on chronic pain that is approachable to patients and their families. Dr. McAllister is also the clinical director of pain services for Courage Kenny Rehabilitation Institute (CKRI), part of Allina Health, in Minneapolis, MN. Among other services, CKRI provides chronic pain rehabilitation services on a residential and outpatient basis.

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