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Overview:

Neuralgia/Neuropathy

Nearly 16% of Americans are diagnosed every year with pain that has a neuropathic component in it.

“Neuralgia” and “neuropathy” are both terms used to denote medical problems and conditions related to the nerves in the somatosensory system, a part of the sensory nervous system. Neuralgia or neuropathy are also referred to as “neurogenic pain” or “neuropathic pain”.

The terms neuralgia, neuropathy, and “neuritis” have often been used interchangeably due to the commonalities between them. However, there are multiple differences between them.

Neuritis refers to inflammation that is caused in one or more nerves due to an injury, infection, or any autoimmune disorder. Neuritis is characterized by tenderness, pain, impaired sensations, etc. In rare cases, neuritis can progress into neuropathy.

Neuropathy (or “nerve damage”) usually manifests as pain, numbness, and muscle weakness, swelling, or tingling in various parts of the body and is caused by degeneration, dysfunction, or other damage to the peripheral nerves, including the motor nerves and sensory nerves – not just inflammation. This condition results in a loss of the sensation of the nerve and/or wrong signals being sent by the nerves to the brain. Patients can experience a complete loss of sensation in parts of the body (usually beginning in the feet) or have sudden bouts of burning, stabbing pain. The most common types of neuropathy include peripheral, proximal, focal, and autonomic neuropathy, each affecting a different set of nerves in the body.

Neuralgia is type of nerve pain usually caused by inflammation, injury, or infection (neuritis) or by damage, degeneration, or dysfunction of the nerves (neuropathy). This pain can be experienced as an acute bout of burning, stabbing, or tingling sensations in varying degrees of intensity across a nerve(s) in the body.

Some common types of this condition are trigeminal neuralgia, postherpetic neuralgia, and glossopharyngeal neuralgia.

What are the causes of neuralgia and neuropathy?

Neuralgia is a condition that can occur at any age; however, it is more common in older people. The primary cause(s) of neuralgia remain undeterminable. In the case of primary neuralgia, there are no structural issues observed in the nerve(s). Neuralgia can also be caused by a lesion on a nerve. The most common causes of lesions (irritation or damage to the peripheral nerves) can include:

  • Trauma
  • Chemical irritations
  • Diabetes
  • Blood disorder or porphyria
  • Chronic kidney disease
  • Infections such as shingles, Lyme’s disease, and HIV/AIDS
  • Usage of specific medicines
  • Surgery
  • Multiple sclerosis
  • Trauma
  • Chemical irritations
  • Diabetes
  • Blood disorder or porphyria
  • Chronic kidney disease
  • Infections such as shingles, Lyme’s disease, and HIV/AIDS
  • Usage of specific medicines
  • Surgery
  • Multiple sclerosis

Neuropathy often starts in the feet or the hands but can be experienced in other parts of the body. This condition, commonly known as peripheral neuropathy, usually affects people above 55 and indicates problems in the network of nerves outside the brain and spinal cord.

Peripheral neuropathy can be classified as:

  • Mononeuropathy — one single peripheral nerve is affected (Carpal tunnel syndrome is a common example)
  • Multiple Mononeuropathy — single nerves in multiple spots are affected (examples include types of palsy such as ulnar nerve palsy and radial nerve palsy)
  • Polyneuropathy — multiple peripheral nerves malfunction simultaneously (Diabetic neuropathy and Guillain-Barre syndrome are examples of this condition)

Neuropathy can be caused by a variety of reasons. This condition can be acquired, hereditary, or idiopathic. The most common causes of acquired neuropathy (in its various manifestations) include:

  • Chemotherapy
  • Vitamin deficiency
  • Infections such as AIDS and Lyme’s disease
  • Autoimmune diseases such as rheumatoid arthritis
  • Vascular disorders
  • Tumors
  • Abnormal protein deposits in tissues and organs
  • Poor nutrition
  • Vitamin deficiency
  • Infections such as AIDS and Lyme’s disease
  • Autoimmune diseases such as rheumatoid arthritis
  • Vascular disorders
  • Tumors
  • Abnormal protein deposits in tissues and organs

“Hereditary neuropathy” can be caused by inherited diseases such as Charcot-Marie-Tooth disease, while “Idiopathic neuropathy” indicates that the underlying causes remain unknown.

What are the different types of neuralgia and neuropathy?

Some common types of neuralgia include:

  • Trigeminal Neuralgia — This type of nerve pain is caused in the head, specifically in the face, mouth, teeth, and nose regions. There are two subtypes of trigeminal neuralgia – a) TN which is experienced sporadic sensations that are like electric shocks and b) TN which is in the form of a dull and constant ache. This form of neuralgia can occur in anyone after puberty but is more common in those above 50. This is a progressive condition, with the duration between attacks getting shorter as the disease progresses. The attacks can even be induced by routine activities such as talking or eating.
  • Glossopharyngeal Neuralgia — This form of neuralgia or nerve pain affects the glossopharyngeal cranial nerve. Though rare, this form is characterized by extreme and recurring pain in the throat, back of the tongue, ear, and tonsils. This disease usually sets in after the age of 40 and is more common in men. Pain episodes last for brief periods of time and can be brought on by routine activities such as coughing, talking, or sneezing.
  • Occipital Neuralgia This type of nerve pain affects the occipital nerve. It originates as pain in the neck and radiates to the region behind the eyes and at the back of the head. This condition is experienced as throbbing or shooting pain. Apart from the typical causes of neuralgia, occipital neuralgia can also be caused by sudden movements of the neck, stiffness in the neck, etc. This is a common cause of chronic headache.
  • Postherpetic Neuralgia This form of neuralgia occurs as one of the most common complications arising post shingles, a viral infection. It is an extremely painful condition that affects the nerves in the skin.

Neuralgia can also occur as postoperative nerve pain or pelvic nerve pain.

Neuropathy can affect both sensory and motor nerves. In rare cases, neuropathy can also manifest in the internal organs. Based on the region affected, the types of neuropathy can be classified as:

  • Peripheral Neuropathy — This type of neuropathy includes peripheral diabetic neuropathy or distal polyneuropathy. As one of the most common forms of neuropathy, peripheral neuropathy is often caused by diabetes and can affect both the limbs and a large expanse of nerves. For this reason, this condition can cause severe damage in the form of deformities and ulcers. It is often associated with vascular insufficiency and should be treated aggressively to avoid complications.
  • Proximal Neuropathy — Also called as diabetic amyotrophy as it can cause severe muscle weakness. This type of neuropathy is usually characterized by radiating or sharp and shooting pain.
  • Autonomic Neuropathy — A rare form of neuropathy that affects the body’s internal organs (autonomic nervous system) and disrupts normal function. The impact of this specific condition can be immense as it can affect several different functions of the body simultaneously.
  • Focal Neuropathy — This is a form of mononeuropathy, which means that it affects only one nerve. Focal neuropathy can manifest in the nerves in the head, legs, or torso.
  • Cranial Neuropathy — This occurs when the cranial nerves are damaged and can result in severe pain and dysfunction of the head and neck.
What are the different types of neuralgia and neuropathy?

Neuralgia or nerve pain can manifest itself in different ways. Some of the most common symptoms of neuralgia include:

  • Sporadic pain that is similar to an electric shock
  • Atrophy or loss in muscle mass
  • Involuntary cramping or twitching of muscles
  • Dull aching sensation
  • Throbbing, shooting or radiating pain along a nerve path
  • Intense stabbing pain
  • Sensations of tingling or numbness
  • Sensations of tightness
  • Weakness in the muscles
  • Sporadic pain that is similar to an electric shock
  • Atrophy or loss in muscle mass
  • Involuntary cramping or twitching of muscles
  • Dull aching sensation
  • Throbbing, shooting or radiating pain along a nerve path
  • Intense stabbing pain
  • Sensations of tingling or numbness
  • Sensations of tightness
  • Weakness in the muscles

Neuropathy has some characteristic symptoms which include:

  • Loss of sensations
  • Hypersensitivity
  • Sudden onset of numbness or tingling
  • Loss of muscle mass or atrophy
  • Weakness in the muscles
  • Excessive sweating
  • Incontinence
  • Blurred vision
  • Intolerance to heat
  • Hypoglycemia
  • Loss in dexterity and coordination
  • Difficulty in managing motor tasks
  • Nausea, vomiting, or stomach bloating after meals
  • Loss of sensations
  • Hypersensitivity
  • Sudden onset of numbness or tingling
  • Loss of muscle mass or atrophy
  • Weakness in the muscles
  • Excessive sweating
  • Incontinence
  • Blurred vision
  • Intolerance to heat
  • Hypoglycemia
  • Loss in dexterity and coordination
  • Difficulty in managing motor tasks
  • Nausea, vomiting, or stomach bloating after meals
What are the risk factors associated with neuralgia and neuropathy?

The most common risk factors for neuralgia include:

Age (higher incidence in Adults 50+)

Tumors

Diabetes

Alcoholism

Shingles

Stress

Neuropathy can be associated with several risk factors such as:

Alcohol and/or substance abuse

Vitamin deficiency

Genetic diseases

Diabetes

Autoimmune diseases

Trauma or injury

Stress

Tumors

Infections

When should I see a doctor for neuralgia and neuropathy?

Nerve pain, be it neuralgia or neuropathy, can cause permanent damage if not treated early.

Pain is not the yardstick to measure if your condition is getting better, because both neuralgia and neuropathy can cause numbness and loss of sensation in various parts of the body.

If you are experiencing nerve pain, it is important to consult with a healthcare professional at Advanced Pain Care by calling at 512-244-4272 or visiting www.austinpaindoctor.com for schedule a same or next day appointment

There are also certain symptoms that clearly indicate a need to see a doctor immediately:

  • Increased numbness and loss of sensitivity
  • Uncontrollable or jerky body movements
  • Vision or hearing-related issues
  • Muscle weakness
  • Loss of control over bodily functions
  • Disorientation and/or loss of memory
  • Seizures
  • Sleep disturbances
  • Shingles
  • Increased numbness and loss of sensitivity
  • Uncontrollable or jerky body movements
  • Vision or hearing-related issues
  • Muscle weakness
  • Loss of control over bodily functions
  • Disorientation and/or loss of memory
  • Seizures
  • Sleep disturbances
  • Shingles

Neuropathy is a progressive disease with various stages of development.

  • Stage 1 expressed through numbness and pain
  • Stage 2 characterized by constant pain.
  • Stage 3 results in pain becoming extremely intense.
  • Stage 4 expresses with complete numbness and loss of sensations. If the condition is left untreated and reaches Stage 4, the risk of recurrent wounds and amputations is greatly increased.

Early intervention can prevent the possibility of permanent damage to the brain, spinal cord and/or specific nerves affected by the condition. Consulting your healthcare provider at Advanced Pain Care can also help in getting the right treatment to help minimize the pain and identify the underlying cause of the condition.

When should I see a doctor for neuralgia and neuropathy?

Diagnosing Neuralgia

The neurologists and pain care specialists at Advanced Pain Care approach the diagnosis of neuralgia in the following manner:

  • Past medical history and symptoms to identify the underlying cause of the pain
  • Measurement of the pain using assessment questionnaires such as the McGill pain questionnaire
  • Physical examination to check for the body’s response to varied stimuli – mechanical, thermal, and chemical factors
  • Tools such as laser evoked potentials (to assess damage to central and peripheral nervous systems) and quantitative sensory testing (response to external stimuli in a controlled setting)
  • Blood tests to check for any infections
  • X-rays and MRIs to check for nerve compression or lesions

Diagnosing Neuropathy

To diagnose a neuropathic condition, the neurosurgeons and pain care management doctors at Advanced Pain Care examine what types of symptoms are occurring and to what extent. All exams or tests are prescribed as needed. To aid in the diagnosis process, the following steps are taken:

  • Review of past medical history and symptoms to identify the underlying cause of the pain
  • Neurological examinations
  • Blood tests to check for any deficiencies or diseases
  • X-rays and MRIs to identify the source of the pressure on the nerves
  • Electromyography to measure the function of the nerves
  • Nerve conduction velocity test to measure the speed at which signals are transmitted through the nerves
  • Nerve, muscle, or skin biopsies in case of suspected malignancies
  • Tests such as QSART to check for the body’s ability to sweat
  • Genetic tests to check for hereditary factors
When should I see a doctor for neuralgia and neuropathy?

Treatment for Neuralgia

The treatment plan for neuralgia is heavily dependent on a proper diagnosis.

In case of primary neuralgia or idiopathic neuralgia, the neurosurgeons and pain management doctors at Advanced Pain Care take a pharmacological approach for the treatment. Depending on the location and severity of the pain, antiepileptic medications have proved to be effective. Here is a list of additional medications used to minimize pain incidence and treat the underlying causes of the condition:

  • Antiseizure medications
  • Antidepressant medications
  • Over-the-counter pain medications (such as aspirin, acetaminophen, or ibuprofen)
  • Prescription pain medications
  • Capsaicin or lidocaine medicated skin creams and patches
  • Muscle relaxants
  • Membrane-stabilizing medications
  • Physical therapy

Spinal stimulation at Advanced Pain Care is very effective for chronic pain due to neuralgia.

Treatment for Neuropathy

Treatment for neuropathy includes a plan to control and manage the symptoms while treating the underlying causes. Here are the possible treatment plans that may be offered by neurosurgeons based on the specifics of this type of condition:

  • Treating diabetes condition and taking measures to keep the blood sugar under control
  • Over-the-counter pain medications
  • Prescription pain medications, antiepileptic medicines, and
    antidepressants
  • Ergonomic casts or splints if the affected areas are the limbs
  • Cannabinoids
  • Botulinum neurotoxin injections
  • Immune suppressing or immune-modulating therapies
  • Physical therapy

Spinal stimulation is the most effective treatment for chronic pain due to neuropathy.

Is surgery required for neuralgia and neuropathy?

In some cases when pharmacological interventions and therapies are not providing the desired relief, surgical intervention may be advised. Some prescribed surgical interventions include:

  1. Neural augmentative surgeries to stimulate the affected nerves
  2. Thermocoagulation
  3. Balloon decompression
  4. Gamma-knife radiosurgery
  5. Nerve ablation
  6. Nerve blocks
  7. Peripheral neurolysis
  8. Microvascular decompression
  9. Stereotactic surgery
  10. Plasmapheresis
  11. Transcutaneous electronic nerve stimulation or TENS
  12. Neuromodulators
  13. Deep brain stimulation
  14. Motor cortex stimulation
  15. Spinal cord stimulation
  16. Intrathecal pumps for drug delivery
What precautions can be taken to prevent neuralgia and neuropathy?

While there are no specific ways to prevent neuralgia, identifying the triggers that cause the pain can go a long way in controlling the symptoms. Here are suggestions to reduce triggers, incidences of pain and other symptoms associated with this condition:

Keeping a check on blood pressure and blood sugar levels

Modify lifestyle choices toward healthier decisions

Incorporate ergonomics for repetitive activities

Limit the use of tobacco and alcohol

Constantly monitor health conditions

Avoid stress

If you have are experiencing nerve pain, relief is available at Advanced Pain Care. Visit us online at https://austinpaindoctor.com/ or call 512-244-4272 to schedule a same or next day appointment with a neurosurgeon or pain management doctor.

FREQUENTLY ASKED QUESTIONS

Q: What are the symptoms of neuralgia?

A: Neuralgia or “nerve pain” can express itself in different ways. Some common symptoms which indicate neuralgia include:

  • Dull aching sensation in a specific part(s) of the body
  • Throbbing, shooting, or radiating pain along a nerve path
  • Intense stabbing pain
  • Sporadic pain that is similar to an electric shock
  • Weakness in the muscles
  • Atrophy or loss in muscle mass
  • Involuntary cramping or twitching of muscles
  • Sensations of tingling or numbness
  • Sensations of tightness

Q: How do you treat neuralgia?

A: The treatment plan for neuralgia is dependent on the accuracy of the diagnosis.

In the case of primary neuralgia or idiopathic neuralgia, the neurosurgeons and pain management physicians at Advanced Pain Care take a pharmacological approach to treatment. Depending on the location and severity of the pain, antiepileptic medications have proved to be very effective. Here are some of additional medications used to minimize the pain and treat the underlying causes of this disease:

  • Antiseizure medications
  • Antidepressant medications
  • Over-the-counter pain medications, such as aspirin, acetaminophen or ibuprofen
  • Narcotic analgesics for short-term pain
  • Capsaicin or lidocaine medicated skin creams and patches
  • Muscle relaxants
  • Membrane-stabilizing medications
  • Physical therapy

Spinal stimulation is very effective in the treatment of chronic pain due to neuralgia.

If the diagnosis accurately identified the condition as a “secondary neuralgia”, neurosurgeons will treat the cause(s) of the pain (infections, tumors, etc.)

Q: Does neuralgia go away?

A: Neuralgia is not a condition that will go away on its own. In primary neuralgias, treatment will be required. In case of secondary neuralgia, nerve pain may be reduced if the underlying cause of the pain has been treated successfully.

Q: What is neuralgia in the face?

A: Trigeminal neuralgia is a type of nerve pain that is caused in the head (regions of the face, mouth, teeth, and nose). There are two subtypes of trigeminal neuralgia. 1 TN produces sporadic sensations in a facial nerve(s) that are like electric shocks while 2 TN is usually expressed in the form of a dull pain and/or constant ache. This form of neuralgia can occur in anyone after puberty but is more common in those above the age of 50. This is a progressive condition, with the duration between attacks getting shorter as the disease progresses.

Q: What causes neuropathy?

A: Neuropathy can be caused by various reasons. They can be acquired, hereditary, or idiopathic.

The most common causes of acquired neuropathy (across all types) include:

  • Physical injury or trauma
  • Prolonged pressure on the nerve (for a variety of reasons)
  • Systemic diseases (such as diabetes, kidney failure, thyroid, and cancer)
  • Alcohol and/or substance abuse
  • Poor nutrition
  • Chemotherapy
  • Vitamin deficiency
  • Infections (such as AIDS and Lyme’s disease)
  • Autoimmune diseases (such as rheumatoid arthritis)
  • Vascular disorders
  • Tumors
  • Abnormal protein deposits in tissues and organs

Hereditary neuropathy can be caused by inherited diseases such as Charcot-Marie-Tooth disease while the underlying causes of idiopathic neuropathy still remain unsolved by the healthcare community.

Q: Is neuropathy curable?

A: The damage caused by neuropathy cannot be reversed, although it can be controlled and treated. Most treatments aim at managing the symptoms and preventing further damage to the nerves.

Q: What is the best treatment for neuropathy?

A: Treatment for neuropathy includes a plan to control the pain,manage the symptoms while treating the underlying causes. Here are several possible treatment plans that neurosurgeons may recommend based on a particular diagnosis and condition:

  • Treating any diabetes condition and taking measures to keep the blood sugar under control
  • Over-the-counter pain medications
  • Prescription pain medications including narcotics, antiepileptic medicines, and antidepressants
  • Ergonomic casts or splints if the affected areas are the limbs
  • Cannabinoids
  • Botox injections
  • Immune suppressing or immune-modulating therapies
  • Physical therapy

In some cases, if there is no response to pharmacological interventions and therapies, surgical intervention may be advised.

Spinal stimulation is very effective in controlling chronic pain due to neuropathy or nerve damage.

Q: What is the best treatment for neuropathy?

A: Treatment for neuropathy includes a plan to control the pain,manage the symptoms while treating the underlying causes. Here are several possible treatment plans that neurosurgeons may recommend based on a particular diagnosis and condition:

  • Treating any diabetes condition and taking measures to keep the blood sugar under control
  • Over-the-counter pain medications
  • Prescription pain medications including narcotics, antiepileptic medicines, and antidepressants
  • Ergonomic casts or splints if the affected areas are the limbs
  • Cannabinoids
  • Botox injections
  • Immune suppressing or immune-modulating therapies
  • Physical therapy

In some cases, if there is no response to pharmacological interventions and therapies, surgical intervention may be advised.

Spinal stimulation is very effective in controlling chronic pain due to neuropathy or nerve damage.

Q: What are the types of neuropathy?

A: Neuropathy can affect both the sensory nerves and  motor nerves. In rare cases, neuropathy can express itself in internal organs. Based on the region(s) affected, the types of neuropathy can be classified as:

  • Peripheral Neuropathy — Type of neuropathy also called peripheral diabetic neuropathy or distal polyneuropathy. Peripheral neuropathy is one of the most common forms of neuropathy, and is caused by diabetes and affects the limbs. This condition also affects a large expanse of nerves, and can cause severe damage in the form of deformities, ulcers and amputation if left untreated.
  • Proximal Neuropathy — This is referred to as diabetic amyotrophy as it can cause severe muscle weakness. This condition can be characterized by radiating or sharp and shooting pain.
  • Autonomic Neuropathy — A rare form of neuropathy that affects the body’s internal organs (autonomic nervous system) and keeps them from functioning normally. The impact of this form of neuropathy can be significant as it usually affects several different functions of the body.
  • Focal Neuropathy — A form of mononeuropathy which affects only one nerve. Focal neuropathy can manifest in nerves in the head, legs, or torso.
  • Cranial Neuropathy — Occurs when cranial nerves are damaged resulting in chronic pain in the head, face and neck.

Neuralgia and neuropathy are forms of nerve damage. The bottom line for most patients is chronic pain. The doctors and nurses at Advanced Pain Care and Advanced Neurosurgery are leading experts in the diagnosis and treatment of all forms of nerve damage. We work to eliminate or minimize the cause of nerve damage and eliminate or minimize the chronic pain. We are world leaders in spinal stimulation – the ultimate treatment for nerve damage.

Neuralgia/Neuropathy

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We have a range of pain management treatment options available right from surgical interventions to non-invasive and minimally invasive treatment options. Our team will work with you to develop a pain management plan based on the severity of your condition.