Neuralgia

Neuralgia

Occipital neuralgia is a pain syndrome which may usually be induced by spasms of the cervical muscles or trauma to the greater or lesser occipital nerves. The initial cause of the neuralgia appears to be from inflammation, damage or irritation of these nerves. It is more common and is more problematic to treat in older people. Often, no physical cause can be found, although some forms of neuralgia may be triggered when nerves are compressed by injuries, arteries, tumors, or, in rare cases, as the result of nerve damage from multiple sclerosis. Neuralgia is an uncommon condition, with trigeminal neuralgia occuring most often. Microvascular compression is an accepted cause of classic TNG but little is known about the etiology of idiopathic ON and NIN, apart from two articles suggestive of microvascular compression. The cause is not known.

Most neuralgias appear suddenly, with no apparent physical basis for the pain, which can be severe. It is caused by reactivation of the Varicella-zoster virus that enters the body following a chickenpox infection that may have occurred years ago. Preferred using 5% lidocaine but found elderly more likely to get dizzy from injections I found using 5%, unlikely to have problems if stick to 2 mls for usual adults, and under 1-1.5 for elderly. This small amount of concentrated PRP is then injected into the joint or other body area, that needs regeneration, after local anesthetic is administered. The head pain can be anywhere from a nagging aching pain to an excruciating migraine headache type of pain, which can be debilitating. It is rare to occur on both sides of the face. The cause of Headaches varies depending on its source, it may arise from the network of nerve fibers in the tissues, muscles, and blood vessels located in the head and at the base of the skull.

Headaches can be caused by either a primary (within the head) or secondary source. The pain associated with TN is recognized as one of the most excruciating pains that can be experienced. Patients with migraines have a higher probability than the general population of demonstrating nonenhancing white matter lesions on magnetic resonance imaging (MRI). Occipital neuralgia is caused by pain from one of the two occipital nerves that supply the back of the head. Some patients experience muscle spasm, which led to the original term for TN of “Tic douloureau”, meaning painful, in French). Although most neuralgias have no known cause, one type, postherpetic neuralgia (PHN) is only seen following an outbreak of shingles, a painful, blistering rash caused by the Herpes zoster virus, the same virus that causes chicken pox. Nonprescription and prescription pain medicines sometimes work well for neuropathic pain.

Older people, especially those with weak immune systems, can suffer a relapse, with the rash appearing along the course of the nerve that is affected. It starts to work only after four days of application. PHN and TN are the most common types of neuralgia. The patient has attacks of pain in the face that last less than two minutes. So, it is INTENSE pain that is just anterior of center, to the left side maybe 1-1/2 inches. Trigeminal neuralgia may be numbed with radio frequency waves, gamma rays or glycerol injections if the patient does not respond to drug treatment. Pressure – compression of the nerve by surrounding structures in the body.

Lumbar neuralgia gives rise to pain in the lumbar region, along the crest of the ilium, in the inguinal and femoral regions, and in the spermatic cord, scrotum, or vulva. In many patients, TN can be positively diagnosed if the drug carbamazepine (Tegretol) diminishes the pain of an attack. It is a constant and severe nerve pain. Great site! Occipital neuralgia is caused by pain from one of the two occipital nerves that supply the back of the head. Sedation is often given at the time of injections to promote relaxation and comfort. X rays and CT scans can help indicate if the nerve is compressed; numbing the nerve with anesthetics can pinpoint the cause.
Neuralgia

Trigeminal neuralgia was identified almost 2,000 years ago. Capsaicin cream does work better than placebo creams, but the relief is not total. The patient was satisfied with the reduction in pain but commented on difficulty of possibility in its recurrence after 3 months when medical treatment and botox injection treatment done in 3 to 4 week intervals are executed. These include baclofen and amitryptyline (see following). A whole foods diet with adequate protein, carbohydrates, and fats that also includes yeast, liver, wheat germ, and foods that are high in B vitamins is important. Essential fatty acids, such as flax or fish oil, may also help reduce inflammation. Homeopathic treatment can also be tried.

There is no consensus on IHP treatment, but the most common approach is to initiate corticotherapy and then to add immunosuppressants. The pain of neuralgia may also be relieved by hydrotherapy (hot shower or bath), deep massage, reflexology (massaging reflex points in the feet relating affected painful areas in the body) or yoga exercises. In addition, guided imagery, biofeedback therapy, and hypnosis may be beneficial. Patients should also consider t’ai chi, qigong, and other movement therapy. Patients may also be helped by transcutaneous electrical nerve stimulation (TENS), in which a weak electrical current applied to the skin interferes with the nerve’s ability to send pain signals to the brain. Although somewhat controversial, initial results, especially for postherpetic neuralgia, are promising. Once a diagnosis of neuralgia has been established, physicians prescribe drugs to alleviate the pain.

The anti-convulsant drug carbamazepine (Tegretol) is often an effective treatment for TN, relieving or reducing the pain within a day or two. Unfortunately, it can also cause dizziness, drowsiness, nausea, and double vision, as well as other side effects. If Tegretol is not well tolerated, doctors can try another anitconvulsant, like gabapentin (Neurontin), antispasmodics like baclofen (Lioresal), or anti-anxiety drugs like clonazepam (Klonopin). These drugs are also frequently prescribed for other forms of neuralgia as well. Injecting local anesthetics into the nerve can stop the pain for a few hours, and for some patients this is effective for a much longer time. Lidocaine cream may be somewhat helpful in treating PHN, probably by temporarily desensitizing nerves just under the skin. Medications such sumatriptan (Imitrex) are used to treat it.

Pain is often worse when lying down. One particularly unpleasant, but evidently successful, method of treating neuralgia seems to be desensitization. This means that if a patient is bothered by the touch of clothing on the skin, the therapist may rub a towel briskly over the area for a few minutes. If the patient has trouble tolerating heat or cold, warm or cold water may be applied. De Moragas JM, Kierland RR. For PHN, the best treatment seems to be prevention. People with shingles should see a doctor as soon as the rash develops so they can receive treatment to ease the severity of the outbreak and minimize the risk of developing postherpetic neuralgia.

It is not clear, however, whether treatment can prevent subsequent neuralgia. A TN sufferer will sometimes seek the help of numerous clinicians before a firm diagnosis is made. It’s important to stress, though, that early attention to either a shingles outbreak or PHN episode will reduce the incidence and severity of future attacks. Some patients receive complete pain relief after treatment. Others are able only to reduce the pain (to greater or lesser degrees), while for a very few treatment is completely ineffective. Although superoxide is biologically quite toxic and is deployed by the immune system to kill invading microorganisms by utilizing the enzyme NADPH oxidase. In 2002, clinical trials showed that gabapentin (Neurontin) was effective in treating patients with PHN with relatively low adverse effects.

paroxysmal pain after brachial plexus avulsion. Most procedures try to reduce the nerve’s ability to send pain signals to the brain. One of the most promising is dorsal root entry zone (DREZ) lesioning, which uses radio frequency to disrupt the nerves that are causing pain. Some studies showed that as many as 80% of DREZ patients were helped. According to Acar et al (2008), C2 or C3 ganglionectomies are associated with short term pain relief (less than 3 months). PHN, in particular, tends to fade away on its own, and only 2–3% of patients have pain that lasts a year or longer. For those unfortunate few, however, PHN can become a lifelong, debilitating condition.

You may also like

Neuralgia

Neuralgia

Post-herpetic neuralgia is a very incapacitating pain which is usually very recalcitrant to therapy. It is useful as an anti-epileptic drug and as an analgesic, particularly for pain of the neuropathic or neurogenic type. I am asking these questions because there is another condition called SUNCT (Short-lasting Unilateral Neuralgiform Conjunctival Injection Tearing). Related conditions include inflammation of the nerve / nerves. Neuralgia is the term for nerve pain. Workers in paints and metal-workers are also quite likely to attacks of neuralgia, while rheumatism, gout, chronic nephritis, diabetes, and the infectious fevers favor neuralgia. Post-herpetic neuralgia is also common.

The pains usually come and go. Of course I am no medical professional, but have just listened and read so many stories about ON here that I am getting a good idea on how this all works. In older adults, as many as 50% develop neuralgia, one or more months after the rash. Pain limits function. Occipital neuralgia is usually due to trauma to the occipital nerve, often caused by a whiplasy type auto-accident. Here, there are paroxysms of severe occipital pain, that often resemble severe migraines. For example, you might feel like pins and needles are poking your skin or that your feet are swollen or very fat or that worms are crawling on your skin.

The condition of occipital neuralgia then was the sense of being squashed constantly. Zostrix works by depleting substance P from nerve endings. Usually non-narcotic pain killers are not strong enough to control neuralgia pain, but they are worth a try anyway. Rathore has nothing to disclose. However, it is clear that they are reasonably effective (Pappagallo and Campbell, 1994). However, the patient was still cortico-dependent (at 15 mg/day) at 2 years after starting therapy. It us used both for arthritis and post-herpetic neuralgia.

It is not used for trigeminal neuralgia. It starts to work only after four days of application. Zostrix works by depleting substance P from nerve endings. Xylocaine preparations, such as are used for sunburn, are also sometimes used. 5% lidocaine Gel has been studied and shown to have good results with no side effects (Rowbotham et al, 1995). Aspirin dissolved in chloroform is used in some countries for neuralgia. Acupuncture or acupressure have also been studied and don’t work very well.

According to Rubin (2001), there is conflicting evidence regarding Zostrix, and the aspirin preparation alluded to above is of “questionable value”. EMLA cream has also been used. A ketamine lotion has been reported effective for postherpetic neuralgia. Soybean lecithin granules (250g Spectrum LE 102) were mixed with 150 ml isopropyl palmitate and stirred at least 12 hours. A neuropathic pain which may follow an attack of shingles (herpes zoster). The pain is often more prolonged and throbbing than brief and stabbing. A lidocaine patch has been approved by the FDA for pain.

It has been our observation that this method is effective but extremely expensive. Anticonvulsants used for pain. In 1967, Wall and Sweet implanted electrodes on peripheral nerves (22), introducing a new era of neuromodulation whose applications continue to expand to and offer relief to patients with chronic intractable pain. Tegretol (carbamazepine), Dilantin (phenytoin), and Neurontin (gabapentin) are the most commonly used drugs (Robotham et al, 1998). The author of this review often uses Trileptal (oxcarbamazine). They are given in doses similar to used for epilepsy, but more leeway is given to the patient in adjusting the dose up and down, depending on the amount of activity of the neuralgia. The mechanisms as to why one feels no pain while they are asleep, or in a slumber state, even though a pillow may be in contact with a “trigger point” on one’s face, remains a mystery to physicians and dentists.

Recently, oxcarbazepine (Trileptal) has become available. Although it is not FDA approved for this indication, it behaves similarly to carbamazepine. Adjunctive agents may be used in this situation. C. Some authors feel that flareups of trigeminal neuralgia may be alleviated by use of acyclovir or better, closely related antiviral medications (e.g. Ann Intern Med 2012; 15: 1–10. This indication is not well established, although it is clear that better results can be obtained if shingles is treated initially with Acyclovir.

Neuralgia
There are persistent reports suggesting that post-herpetic neuralgia is associated with persistent active virus (e.g. Pavan-Langson et al, 1995). If a block works temporarily, it usually wears off as the anesthetic effect stops. These drugs are also frequently prescribed for other forms of neuralgia as well. While many physicians do use steroids, there is presently no evidence supporting less neuralgia in persons treated orally. (Calza et al, 1992). Epidural steroids have been reported to largely prevent post-herpetic neuralgia (1.6% vs.

22.2%, comparing epidural group to an intravenous group), but many persons might prefer not to be treated with medications administered in this somewhat invasive way, as ones chances are only about 1 in 5 of developing post-herpetic neuralgia. In a trial of intrathecal steroids (given into the spinal canal) for post-herpetic neuralgia, Kotani and others (2000) reported that 91% of the a group with intractable post-herpetic neuralgia treated with methylprednisoline plus lidocaine experienced good to excellent relief. Blocks and other procedures that aim to damage nerves. Blocks are injections of medication intended to temporarily deaden pain nerves. They are ordinarily done by anesthesiologists in a pain clinic. Sympathetic blocks (e.g. Stellate Ganglion Block) are advocated by some anesthesiologists as a treatment of post-herpetic neuralgia (Kageshima et al, 1992).

Narcotics should be avoided due to the risk of abuse and addiction. Over-the-counter analgesics can be used to relieve headache and neck pains. Rhizotomy may be used to convert a neuralgia into a numbness. While effective, rhizotomy has been replaced by several less invasive procedures. Radiofrequency ganglio-neurectomy involves killing a nerve by cooking it with microwaves. One problem with QST is that abnormalities may be observed in non- neuralgia pains, often making it inconclusive in diagnosis. In some cases, a TIA can mimic the symptoms of a migraine with aura.

This procedure is usually performed by pain physicians. Though available in only a few research centers, skin punch biopsy is an easy procedure and is minimally invasive. A middle age woman experienced an automobile accident, and thereafter developed severe headaches with pain behind her right ear, nose bleeds, and loss of smell and taste. There was tenderness and wincing on palpation of the area behind the right ear. A tentative diagnosis of Eagles syndrome was proposed, but X-rays did not bear this out. Diagnostic blocks of the occipital nerve abolished the pain. She subsequently had RF-ganglioneurectomy, with complete relief of headache for 6 months.

References: Ali NM. They hurt REALLY bad and will end up making me cry sometimes. Drugs and Aging 5:411-8, 1994 Calza et al. Dermatology 184(4) 314-6, 1992 Farna et al. Opthalmologica 209(5),267-9, 1995 Hoffman et al, Clinical J. Pain, 10(3),240-2, 1994 Hugler et al. Anaesthetist 41(12)772-8, 1992 Ikebe H and others.

Japanesr J. Anesthesiology 44: 428-33, 1995 Kageshima et al. Jap. Jnl Anes. 41(1) 106-10, 1992 King RB. Arch Neurol 50(10), 1046-53, 1993 Kotani N et al. Intrathecal methylprednisolone for intractable postherpetic neuralgia.

NEJM 2000. Max MB. Ann Neurol. 35:S50-3, 1994 Pappagallo and Campbell, Annals Neurology 35, Suppl S54-6, 1994 Pasqualucci A, Pasqualucci V, Galla F, De Angelis V, Marzocchi V, Colussi R, Paoletti F, Girardis M, Lugano M, Del Sindaco F. Prevention of post-herpetic neuralgia: acyclovir and prednisolone versus epidural local anesthetic and methylprednisolone. Acta Anaesthetiol Scand 2000:40:910-918 Pavan-Langston et al. Arch Ophthalmol 113(11):1381-5, 1995 Quan D and others.

Topical Ketamine treatment of postherpetic neuralgia. Neurology (2003), 60, 1391-1392 Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998 Dec 2;280(21):1837-42 Rowbotham MC et al. Annals of Neurology 37: 246-53, 1995 Rubin M. Relief for Postherpetic neuralgia. Neurology Alert, 19, 5, 2001, 33-40 Yalcin, I., N.

Choucair-Jaafar, et al. (2009). “beta(2)-adrenoceptors are critical for antidepressant treatment of neuropathic pain.” Ann Neurol 65(2): 218-25.

You may also like