Neuralgia

Every person in the entire world has experienced neuralgia at some point in their lives. The singeing sensation of a paper cut, a painful headache after a stressful day at work, and muscle cramps after a long-needed workout are all indicative of the very thing that every woman, man and child strives to avoid: pain.

Scientifically, neuralgia is classified as the pain that follows the path of a nerve. However, simply put, neuralgia is just pain. Neuralgia pain is over in an instant, that you’ll likely avoid the next time, and it also includes the pain that appears to be constant, not only interfering with emotions, but completely interrupting the flow of your life.

Pain can be distinguished into two different categories; acute and chronic, and as they differ greatly, it is useful to know the difference between the two.

• Acute Pain is clinically defined as pain that lasts over a relatively short time. It can be severe, resulting from surgery as well as other injuries and may be accompanied by emotional distress or anxiety. Acute pain usually comes on suddenly, and in most cases will fade with time.
• Chronic Pain is often much worse than acute pain, as it continues over an indefinite period of time and does not always respond to treatment. Chronic pain is often worsened by environmental and psychological factors, and chronic pain management is often extremely important in treating chronic pain.

Symptoms of Neuralgia

Pain is derived from a multitude of conditions, diseases, and syndromes. Physical pain is associated with many aspects of our lives; we have all experienced several varieties of pain, from the fleeting pain of a pinprick to the extreme pain of childbirth or severe trauma. Because there are so many different ways to experience neuralgia, an alphabetical list of common pain syndromes is listed below.

Arachnoiditis is a condition in which one of the three membranes covering the brain and spinal cord becomes inflamed because of infection or trauma. Arachnoiditis is an extremely severe condition which may produce disabling, progressive, and even permanent pain.

Arthritis generally covers many arthritic conditions including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and gout, which are characterized by extreme joint pain.

Back pain is a startlingly common cause of disability for much of the population, including both active and inactive people. A common type of back pain is associated with the spinal discs, which are the soft, spongy padding between the bones that form the spine. Discs protect the spine by absorbing shock, but they may sometimes rupture, as they tend to degenerate over time. Treatment for a damaged disc includes drugs such as painkillers, muscle relaxants, and steroids; exercise or rest, depending on the patient’s condition; adequate support, such as a brace or better mattress and physical therapy. In some cases, surgery may be required to remove the damaged portion of the disc and return it to its previous condition, especially when it is pressing a nerve root. Surgical procedures include discectomy, laminectomy, or spinal fusion.

Burn pain poses a challenge to the medical community, and though first-degree burns are the least severe, third-degree burns implicate extreme pain, as the burnt skin is lost. The pain that accompanies burns can be excruciating, depending on the severity and site of injury, as even after the wound has healed patients may experience chronic pain at the burn site.

Cancer pain accompanies the growth of a tumor, treatments of cancer, or chronic problems related to a cancer’s permanent effect on the body. Luckily, most cancer pain can be treated with medication and therapy to help minimize distress and trauma to the patient.

Headaches are particularly common among Americans. Headaches can be distinguished into three common types, which are migraines, cluster headaches, and tension headaches, and each one comes with its own specific symptoms of pain.

• Migraines are characterized by throbbing pain and sometimes by other symptoms, including nausea and visual disturbances. Migraines are more frequent in women than men. Stress can trigger a migraine headache, and migraines can also put the sufferer at risk for stroke.
• Cluster headaches are distinguished by excruciating, piercing pain on one side of the head; they occur more frequently in men than women.
• Tension Headaches are often described as a tight band around the head.
• Head and facial pain can be agonizing, whether it results from dental problems or from disorders such as trigeminal neuralgia, in which one of the nerves in the face, head, or neck is inflamed. Another condition, trigeminal neuralgia, affects the nerves within the face and is characterized by a stabbing, shooting facial pain.
• Muscle pain can range from an aching muscle, spasm, or strain, to the severe spasticity that accompanies paralysis. An additional disabling syndrome is fibromyalgia, a disorder which may be distinguished by fatigue, stiffness, joint tenderness, as well as widespread muscle pain. Other painful disorders characterized by muscle inflammation include, Polymyositis, dermatomyositis, and inclusion body myositis. These conditions, which induce muscle pain, are caused by infection or autoimmune dysfunction and can be associated with connective tissue disorders, including lupus and rheumatoid arthritis.
• Myofascial pain syndromes affect trigger points, which are sensitive areas, located within the body’s muscles. Myofascial pain syndromes may be misdiagnosed and can be debilitating. Fibromyalgia is a type of myofascial pain syndrome.
• Neuropathic pain is a type of pain that can result from an injury to the body’s nerves, within the peripheral or central nervous system. Neuropathic pain is frequently described as a hot, burning sensation, and can occur in any part of the body, which can be overwhelming for the affected individual. Neuropathic pain may result from diseases that affect nerves or from trauma, or alternatively, it can be a consequence of cancer treatment because chemotherapy drugs can affect nerves. Among the many neuropathic pain conditions are diabetic neuropathy (which results from nerve damage secondary to vascular problems that occur with diabetes); reflex sympathetic dystrophy syndrome (see below), which can follow injury; phantom limb and post-amputation pain, which can result from the surgical removal of a limb; postherpetic neuralgia, which can occur after an outbreak of shingles; and central pain syndrome, which can result from trauma to the brain or spinal cord.
• Reflex sympathetic dystrophy syndrome, or RSDS, is often triggered by trauma or nerve damage, and causes the skin of the affected area to become characteristically shiny. RSDS is accompanied by burning pain and hypersensitivity to temperature. RSDS is also called complex regional pain syndrome (CRPS) and causalgia.
• Repetitive stress injuries are muscular conditions resulting from repeated motions performed in the course of normal work or other daily activities, including:
  • Writer’s cramp, which affects musicians and writers and others
  • Compression or entrapment neuropathies, including carpal tunnel syndrome, caused by chronic overextension of the wrist
  • Tendonitis or tenosynovitis, which affects one or more tendons within the wrist.
• Sciatica is an excruciating condition, which is caused by pressure on the sciatic nerve, the main nerve that branches off the spinal cord and continues down into the thighs, legs, ankles, and feet. Sciatica is distinguished by pain in the buttocks and can be caused by a number of factors, including exertion, obesity, and poor posture. One common cause of sciatica is the wrong positioning of a spinal disc.
• Shingles and other painful disorders cause pain within the skin. Pain is a common symptom of many skin disorders, even the most common rashes. One of the most inconvenient neurological disorders is shingles or herpes zoster, an infection that often causes agonizing pain, which is resistant to treatment. Prompt treatment with antiviral agents is important to heal the infection, as it may result in an associated condition known as postherpetic neuralgia if it is prolonged. Other painful disorders affecting the skin include:
  • vasculitis, or inflammation of blood vessels
  • other infections, including herpes simplex
  • skin tumors and cysts
  • tumors associated with neurofibromatosis, a neurogenetic disorder
• Sports injuries are common. Sprains, strains, bruises, dislocations, and fractures are all well-known words in the language of sports. Pain is another. In extreme cases, sports injuries can take the form of costly and painful spinal cord and head injuries, which cause severe suffering and disability.
• Spinal stenosis happens when the canal surrounding the spinal cord begins to narrow. This condition occurs naturally with aging and causes weakness in the legs. The main symptom of spinal stenosis is pain that is felt while a person is standing up and relieved when they sit down.
• Surgical pain often requires regional or general anesthesia during the procedure and medications afterwards to control discomfort following the operation. The pain associated with surgery can easily be controlled by presurgical preparation and careful monitoring of the patient during and after the procedure.
• Temporomandibular disorders are conditions in which the jaw is damaged and, or the muscles used for chewing and talking become stressed. This condition may be the result of a number of factors, including an injury to the jaw or joint misalignment. People with temporomandibular disorders may experience a variety of symptoms, most commonly pain in the jaw, face, or neck muscles.

Trauma can occur after nearly any injury that happens within the home, at the workplace, during sports activities, or on the road. Any of these injuries can result in severe disability and chronic pain. Some patients who have had an injury to the spinal cord experience intense pain ranging from tingling to burning and additionally are sensitive to hot and cold temperatures and touch. For these individuals, a touch can be perceived as intense burning, indicating abnormal signals relayed to and from the brain. This condition is called central pain syndrome or, if the damage is in the thalamus (the brain’s center for processing bodily sensations), thalamic pain syndrome. Trauma affects many people with multiple sclerosis, Parkinson’s disease, amputated limbs, spinal cord injuries, and stroke, who experience severe pain, which is extremely difficult to treat effectively.

Vascular disease or injury, which includes vasculitis or inflammation of blood vessels, coronary artery disease, and circulatory problems all have the potential to cause pain. Vascular pain affects many people, and is caused by an interruption in the communication between blood vessels and nerves. Ruptures, spasms, constriction, or obstruction of blood vessels, as well as a condition called ischemia in which blood supply to organs, tissues, or limbs is cut off, can also result in pain.

Diagnosis of Neuralgia

Because the amount of pain that a person feels cannot be measured in any way, doctors may use alternative methods when diagnosing chronic and acute pain. Doctors often depend on patients for an accurate description of their pain to determine the appropriate treatment and diagnosis.

There are, however, certain tests that your physician may recommend to determine the cause of your pain. These technologies include:

• Electromyography (EMG) provides information that can help physicians tell precisely which muscle or nerve is affected by weakness or pain. Thin needles are inserted in muscles and a physician can view or listen to electrical signals displayed on an EMG machine.
• Nerve conduction studies the doctor uses two sets of electrodes (similar to those used during an electrocardiogram) that are placed on the skin over the muscles. The first set gives the patient a mild shock that stimulates the nerve that runs to that muscle. The second set of electrodes is used to make a recording of the nerve’s electrical signals, and from this information the doctor can determine if there is nerve damage.
• Evoked potential (EP) studies also involve two sets of electrodes-one set for stimulating a nerve, however these electrodes are attached to a limb, and another set on the scalp for recording the speed of nerve signal transmission to the brain.
• Magnetic resonance imaging or MRI, provides physicians with pictures of the body’s structures and tissues. MRI uses magnetic fields and radio waves to differentiate between healthy and diseased tissue.
• Neurological examination in which the physician tests movement, reflexes, sensation, balance, and coordination, that allows you physician to determine the cause of your pain.
• X-rays produce pictures of the body’s structures, such as bones and joints, and reveals any causes of pain related to your joints and bones.

Treatment of Neuralgia

As there are many different symptoms and causes for pain, it is only natural that there should be a multitude of available treatments as well.

Depending on the severity, cause and area of your pain your doctor may recommend any of the following treatments:

Acupuncture is an ancient method of treatment, which dates back 2,500 years and involves the application of needles to precise points on the body. Although acupuncture remains controversial, it is quite popular and has promise to one day prove to be useful for a variety of conditions in relieving pain.

Analgesic infers to the class of drugs that includes most painkillers, such as aspirin, acetaminophen, and ibuprofen. The word analgesic is derived from ancient Greek and means to reduce or stop pain. Analgesics include nonprescription or over-the-counter pain relievers that are generally used for mild to moderate pain as well as prescription pain relievers, which are sold through a pharmacy under the direction of a physician, and are used to relieve moderate to severe pain.

Anticonvulsants are mainly used for the treatment of seizure disorders, but may also be prescribed for the treatment of pain. Carbamazepine, for example, is used to treat a number of painful conditions, including trigeminal neuralgia.

Antidepressants are occasionally used for the treatment of pain. Anti-anxiety drugs called benzodiazepines also act as muscle relaxants and are additionally used as pain relievers. Physicians usually try to treat the condition first with analgesics before prescribing these drugs.

Antimigraine drugs include the triptans- sumatriptan (Imitrex®), naratriptan (Amerge®), and zolmitriptan (Zomig®), and are recommended specifically for migraine headaches. They can have serious side effects in some people and therefore, as with all prescription medicines, should only be used when recommended to by a physician.

Aspirin may be the most widely used pain-relief agent and has been sold over the counter since 1905 as a treatment for fever, headache, and muscle soreness.

Biofeedback is used for the treatment of many common pain problems, and is often prescribed for headache and back pain. Using a special electronic machine, the patient is trained to become aware of, to follow, and to gain control over certain bodily functions, including muscle tension, heart rate, and skin temperature. This process teaches the individual to learn to change his or her responses to pain by using relaxation techniques. Biofeedback generally induces few side effects and is often used in combination with other treatment methods. Similarly, the use of relaxation techniques in the treatment of pain can increase the patient’s feeling of well-being.

Capsaicin is a primary ingredient in pain-relieving creams, and is a chemical found in chili peppers.

Chemonucleolysis is a treatment in which an enzyme is injected directly into a spinal disc to dissolve material around the disc, thus reducing pressure and pain. The procedure’s use is extremely limited, in part because some patients may have a life-threatening allergic reaction to the specific enzyme that is used.

Chiropractic is a controversial method of pain relief, which is particularly popular among many people seeking relief from back disorders; thus, this method of hand manipulation of the spine is a treatment option that continues to grow. Chiropractic’s usefulness as a treatment for back pain is generally restricted to a select group of individuals with uncomplicated acute low back pain who may find relief from the massage component of the therapy.

Cognitive-behavioral therapy is used for postoperative pain, cancer pain, and the pain of childbirth and involves a wide variety of coping skills and relaxation methods to help prepare for and cope with pain.

Counseling can give a patient suffering from pain much needed support, whether it is derived from family, group, or individual counseling. Support groups can provide an important adjunct to drug or surgical treatment. Psychological treatment can also help patients learn about the physiological changes produced by pain.

COX-2 inhibitors (“superaspirins”) may be particularly effective for individuals with arthritis. For many years scientists have wanted to develop the ultimate drug-a drug that works as well as morphine but without its negative side effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking two enzymes, cyclooxygenase-1 and cyclooxygenase-2, both of which promote production of hormones called prostaglandins, which in turn cause inflammation, fever, and pain. Newer drugs, called COX-2 inhibitors, primarily block cyclooxygenase-2 and are less likely to have the gastrointestinal side effects sometimes produced by NSAIDs. However major concerns about cardiac adverse effects have forced the removal of VIOX off the shelves. Similar drugs such as Celebrex may follow the same path.

Electrical stimulation, including transcutaneous electrical stimulation (TENS), implanted electric nerve stimulation, and deep brain or spinal cord stimulation, is the modern-day extension of age-old practices in which the nerves of muscles are subjected to a variety of stimuli, including heat or massage. Electrical stimulation, no matter what form, involves a major surgical procedure and is not for everyone, nor is it 100 percent effective. The following techniques each require specialized equipment and personnel trained in the specific procedure being used:

TENS uses tiny electrical pulses, delivered through the skin to nerve fibers, to cause changes in muscles, such as numbness or contractions, producing temporary pain relief. There is also evidence that TENS can activate subsets of peripheral nerve fibers that can block pain transmission at the spinal cord level, in much the same way that shaking your hand can reduce pain.

Peripheral nerve stimulation uses electrodes placed surgically on a carefully selected area of the body. The patient is then able to deliver an electrical current as needed to the affected area, using an antenna and transmitter.

Spinal cord stimulation uses electrodes surgically inserted within the epidural space of the spinal cord. The patient is able to deliver a pulse of electricity to the spinal cord using a small box-like receiver and an antenna taped to the skin.

Deep brain or intracerebral stimulation is considered an extreme treatment and involves surgical stimulation of the brain. It is generally used for a limited number of conditions, including severe pain, central pain syndrome, cancer pain, phantom limb pain, and other neuropathic pains.

Exercise has come to be a prescribed part of some doctors’ treatment regimes for patients with pain because there is a known link between many types of chronic pain and tense, weak muscles. Exercise-even light to moderate exercise such as walking or swimming-can contribute to an overall sense of well-being by improving blood and oxygen flow to muscles. Exercise, sleep, and relaxation can all help reduce stress, thereby helping to alleviate pain. Exercise has been proven to help many people with low back pain. It is important, however, that patients carefully follow the routine laid out by their physicians.

Hypnosis is used to control physical function or response, or, the amount of pain an individual can withstand. How hypnosis works is not fully understood, and remains controversial within modern day medicine. Hypnosis may result in relief of pain by acting on chemicals in the nervous system, slowing impulses. Whether and how hypnosis works involves greater insight-and research-into the mechanisms underlying human consciousness.

Ibuprofen is a member of the aspirin family of analgesics, the so-called nonsteroidal anti-inflammatory drugs (see below). It is sold over the counter and also comes in prescription-strength preparations.

Low-power lasers have been used occasionally by some physical therapists as a treatment for pain, and are considered extremely controversial.

Magnets are usually worn as a collar or wristwatch, and in theory, effect changes in cells or body chemistry, thus producing pain relief. However, the use of magnets for pain relief is often dismissed as quackery and pseudoscience by skeptics.

Nerve blocks use drugs, chemical agents, or surgical techniques to interrupt the pain messages between specific areas of the body and the brain. There are many different names for this procedure, depending on the technique or agent used.

Nonsteroidal anti-inflammatory drugs (NSAIDs) (including aspirin and ibuprofen) are widely prescribed and are analgesics that work by reducing inflammatory responses in tissues. Many of these drugs irritate the stomach and for that reason are usually taken with food or beverage. Although acetaminophen may have some anti-inflammatory effects, it is generally distinguished from the traditional NSAIDs.

Opioids are derived from the poppy plant and are among the oldest drugs known to humankind. They include codeine and perhaps the most well-known narcotic of all, morphine. Morphine can be administered in a variety of forms, including a pump for patient self-administration. Opioids have a narcotic effect, that is, they induce sedation as well as pain relief, and some patients may become physically dependent upon them. For these reasons, patients given opioids should be monitored carefully; in some cases stimulants may be prescribed to counteract the sedative side effects. In addition to drowsiness, other common side effects include constipation, nausea, and vomiting.

Physical therapy and rehabilitation include using physical techniques and methods, such as heat, cold, exercise, massage, and manipulation, to treatment a variety of conditions. Any of these methods may be applied to increase function, control pain, and speed the patient toward full recovery.

Placebos offer some individuals pain relief, although whether and how they have an effect is mysterious and somewhat controversial. Placebos are inactive substances, such as sugar pills, or harmless procedures, such as saline injections or sham surgeries, generally used in clinical studies as control factors to help determine the efficacy of active treatments. Although placebos have no direct effect on the underlying causes of pain, evidence from clinical studies suggests that many pain conditions such as migraine headache, back pain, post-surgical pain, rheumatoid arthritis, angina, and depression sometimes respond well to them. This positive response is known as the placebo effect, which is defined as the observable or measurable change that can occur in patients after administration of a placebo. Some experts believe the effect is psychological and that placebos work because the patients believe or expect them to work, while others say placebos relieve pain by stimulating the brain’s own analgesics and setting the body’s self-healing forces in motion. A third theory suggests that the act of taking placebos relieves stress and anxiety-which are known to aggravate some painful conditions-and, thus, cause the patients to feel better. However, placebos are considered controversial because by definition they are inactive and have no actual curative value.

R.I.C.E.-Rest, Ice, Compression, and Elevation are four components prescribed by many orthopedists, coaches, trainers, nurses, and other professionals for temporary muscle or joint conditions, such as sprains or strains. While many common orthopedic problems, including sprained ankles, can be controlled with these four simple steps, especially when combined with over-the-counter pain relievers, more serious conditions may require surgery or physical therapy, including exercise, joint movement or manipulation, and stimulation of muscles.

Surgery, although not always an option, is occasionally required to relieve pain, especially pain which is caused by back problems or serious musculoskeletal injuries. Surgery may take the form of a nerve block or it may involve an operation to relieve pain from a ruptured spinal disc. Because surgery can result in scar tissue formation that may cause additional problems, patients are well advised to seek a second opinion before proceeding with surgery. In some cases, the results of an operation are remarkable; however it is important to assess all risks associated with surgery before making any decisions.

The goal of pain management is ultimately to improve function, and enable individuals to work, attend school, or participate in other day-to-day activities. Any of these methods can be powerful and effective, according to those who advocate their use. It is important to remember that no matter what treatment plan of your doctor has chosen for you, the pain that you are experiencing is always treatable.