Neuralgia

Injury	Disease	Nutrition	Poison

Symptoms	Surgery	Test	Special Topic

Central nervous system

Neuralgia

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.

text continues below

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.

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 instance, antiseizure medications such as carbamazepine, gabapentin, lamotrigine or phenytoin may be helpful for pain associated with trigeminal neuralgia. The most common adverse effects of antiseizure drugs are drowsiness, tremor, and incoordination.

Antidepressant medications, such as amitryptiline, 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 (thermocoagulation), balloon compression, and injection of chemicals (such as glycerolysis).

Unfortunately, these procedures do not guarantee improvement and can cause sensory loss or abnormal sensory phenomena.

Another strategy sometimes used for resilient 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 postherpetic neuralgia, injections of anesthetics and steroids (potent anti-inflammatory drugs) in the subarachnoid space through a spinal tap may provide pain relief. For both trigeminal and glosso-pharyngeal neuralgias, a procedure called microvascular decompression, may result in symptom improvement. This surgical procedure consists of removing any possible compression exerted by neighboring blood vessels over the affected nerve.