Neuralgia
Nerve pain; Painful neuropathy; Neuropathic pain
Neuralgia is a sharp, shocking pain that follows the path of a nerve and is due to irritation or damage to the nerve.
Common neuralgias include:
- Postherpetic neuralgia (pain that continues after a bout of shingles)
- Trigeminal neuralgia (stabbing or electric-shock-like pain in parts of the face)
- Alcoholic neuropathy
- Peripheral neuropathy
The central nervous system comprises the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.
Causes
Causes of neuralgia include:
- Chemical irritation
- Chronic kidney disease
- Diabetes
- Infections, such as herpes zoster (shingles), HIV/AIDS, Lyme disease, and syphilis
- Medicines such as cisplatin, paclitaxel, or vincristine
- Porphyria (blood disorder)
- Pressure on nerves by nearby bones, ligaments, blood vessels, or tumors
- Trauma (including surgery)
In many cases, the cause is unknown.
Postherpetic neuralgia and trigeminal neuralgia are the two most common forms of neuralgia. A related but less common neuralgia affects the glossopharyngeal nerve, which provides feeling to the throat.
Neuralgia is more common in older people, but it may occur at any age.
Symptoms
Symptoms may include any of the following:
- Increased sensitivity of the skin along the path of the damaged nerve, so that any touch or pressure is felt as pain
- Pain along the path of the nerve that is sharp or stabbing, in the same location each episode, comes and goes (intermittent) or is constant and burning, and may get worse when the area is moved
- Weakness or complete paralysis of muscles supplied by the same nerve
Exams and Tests
The health care provider will perform a physical exam, and ask about your symptoms.
The exam may show:
- Abnormal sensation in the skin
- Reflex problems
- Loss of muscle mass
- Lack of sweating (sweating is controlled by nerves)
- Tenderness along a nerve
- Trigger points (areas where even a slight touch triggers pain)
You may also need to see a dentist if the pain is in your face or jaw. A dental exam can rule out dental disorders that may cause facial pain (such as a tooth abscess).
Other symptoms (such as redness or swelling) may help rule out conditions such as infections, bone fractures, or rheumatoid arthritis.
There are no specific tests for neuralgia. But, the following tests may be done to find the cause of the pain:
- Blood tests to check blood sugar, kidney function, and other possible causes of neuralgia
- Magnetic resonance imaging (MRI)
- Nerve conduction study with electromyography
- Ultrasound
- Spinal tap (lumbar puncture)
Treatment
Treatment depends on the cause, location, and severity of the pain.
Medicines to control pain may include:
- Antidepressants
- Antiseizure drugs
- Over-the-counter or prescription pain medicines
- Pain medicines in the form of skin patches or creams
Other treatments may include:
- Shots with pain-relieving (anesthetic) drugs
- Nerve blocks
- Physical therapy (for some types of neuralgia, especially postherpetic neuralgia)
- Procedures to reduce feeling in the nerve (such as nerve ablation using radiofrequency, heat, balloon compression, or injection of chemicals)
- Surgery to take pressure off a nerve
- Alternative therapy, such as acupuncture or biofeedback
Procedures may not improve symptoms and can cause loss of feeling or abnormal sensations.
When other treatments fail, doctors may try nerve or spinal cord stimulation. In rare cases, a procedure called motor cortex stimulation (MCS) is tried. An electrode is placed over part of nerve, spinal cord, or brain and is hooked to a pulse generator under the skin. This changes how your nerves signal and it may reduce pain.
Outlook (Prognosis)
Most neuralgias are not life threatening and are not signs of other life-threatening disorders. For severe pain that does not improve, see a pain specialist so that you can explore all treatment options.
Most neuralgias respond to treatment. Attacks of pain usually come and go. But, attacks may become more frequent in some people as they get older.
Sometimes, the condition may improve on its own or disappear with time, even when the cause is not found.
Possible Complications
Complications may include:
- Problems from surgery
- Disability caused by pain
- Side effects of drugs used to control pain
- Dental procedures that aren't needed before neuralgia is diagnosed
When to Contact a Medical Professional
Contact your provider if:
- You develop shingles
- You have symptoms of neuralgia, especially if over-the-counter pain medicines do not relieve your pain
- You have severe pain (see a pain specialist)
Prevention
Strict control of blood sugar may prevent nerve damage in people with diabetes. In the case of shingles, antiviral drugs and the herpes zoster virus vaccine may prevent neuralgia.
References
Katirji B. Disorders of peripheral nerves. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff’s Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 106.
Scadding JW, Koltzenburg M. Painful peripheral neuropathies. In: McMahon SB, Koltzenburg M, Tracey I, Turk DC, eds. Wall and Melzack's Textbook of Pain. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 65.
Smith G, Shy ME. Peripheral neuropathies. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 392.
Version Info
Last reviewed on: 5/2/2022
Reviewed by: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
