Absolutely Nerve-wracking: Here’s How Neuralgias Affect Your Nerves

Nerve-related pains, or neuralgias, stand out for their severity, difficulty diagnosing, and tricky remedies. Neuralgias affect the areas along the nerve's distribution and can impact any part of the body. A 2024 study says that neuralgias affect 10% of the global population, and about 60% of the cases are related to stress, anxiety, and depression.

Neuralgia is sudden and intense pain experienced in the areas of the body related to a particular nerve. Neuralgias, neuropathic pain, or simply nerve pain is a symptom of neuropathy or a damaged nerve.

There are many types of neuralgias based on the distribution of the anatomical location of the nerve:

Trigeminal neuralgia 

This is the most common type of neuralgia, also called tic douloureux. It refers to the abrupt jolts of searing pain that typically affect different areas of the face, sometimes only on one side, along the pathway of the trigeminal nerve, which is also known as the 5th Cranial Nerve. This makes smiling, washing your face, brushing your teeth, etc., extremely difficult.

Trigeminal neuralgia occurs at a rate of 4 to 5 cases per 100,000 people in the Indian population.

Herpes-related neuralgia

This type of neuralgia occurs after shingles or a herpes infection that affects specific nerves, particularly those that run between the ribs. Shingles is highly contagious, so it’s crucial to avoid physical contact with the blisters when they are still active. Initially, blisters may form along one of these nerves between the ribs, and if nerve pain (neuralgia) develops afterwards, it will likely occur in the same area. Although it can affect any nerve, the herpes virus tends to stay inside the nerve cell body, which is called a ganglion and can reactivate later whenever there is reduced immunity. 

Occipital neuralgia

This affects the region of the eyes and the areas around it. The lancinating pain may radiate to the sides of the head.

Glossopharyngeal neuralgia

It is a sharp, stabbing, shooting, or lancinating pain in the tongue (mouth), throat, and ear region along the distribution of the glossopharyngeal nerve. 

Superior laryngeal neuralgia

These are sharp, piercing pain bursts lasting seconds to minutes in the front part of the neck on the sides. 

Nervus intermedius neuralgia

This pain occurs inside and around the ear due to abnormalities in the nervus intermedius, a branch of the facial nerve. It is also related to reduced saliva flow, tear production, and sensation of taste.

Auriculotemporal neuralgia

The pain is primarily felt in the temple, ear, front of the ear area, temporomandibular joint (the jaw joint), or parotid area.

Burning Mouth Syndrome

This condition can be idiopathic or secondary, resulting from nutritional deficiencies, hormonal changes, menopause-related hormonal changes, primary dryness of the mouth, hypersensitivity reactions, medications, and even sometimes precipitated by other stressors, leading to a burning sensation in the mouth.

Neck-tongue syndrome

Characteristically triggered by the turning of the head, the pain occurs in the neck and the back of the neck. It is associated with compression of the first vertebra region.

The typical cause of neuralgia is damage to the nerve or impingement of the nerve. The main causes of neuralgias are:

• Injuries to the brain, spine, or nerves
• Poor blood flow to the nerves
• Excessive alcohol consumption
• Phantom pain after an amputation of a body part
• Deficiencies of vitamins B12 or B1 
• Certain medications 
• Conditions such as infections like shingles and HIV/AIDS, multiple sclerosis, diabetes, stroke, and cancer (along with treatments like surgery, radiation, or chemotherapy) may lead to nerve pain. 
• Trapped nerves, such as carpal tunnel syndrome, are another common cause.

There are a few symptoms that are typical of neuralgias:

• Sudden episodes of shooting, stabbing, and excruciating pain
• The pain is episodic in nature and lasts for days to weeks
• The concerned areas are extremely sensitive to touch and pain is exacerbated by any movement, touch, or pressure
• You can experience related twitches, muscle spasms, and related muscle weakness

Trigeminal neuralgia, one of the most recognised forms of neuralgia, involves intense facial pain along the eye, cheek, or chin, triggered by simple actions like talking or chewing. This is usually caused by compression from an accompanying blood vessel along the course of a nerve.  Another type is occipital neuralgia, where the pain is along the back of the head to the scalp region, caused by various factors, such as previous head or neck injuries, pinched nerves in the neck (due to disc disease), and muscle tightness from long-term poor posture, although, occasionally, no specific cause is identified. Reactivation of a dormant varicella virus (chicken pox) in the elderly and diabetics, along with skin lesions (shingles), is another cause of severe pain, usually occurring along the chest or back, and is called post-herpetic neuralgia. 

“Though location and cause may vary, attacks of pain can be debilitating, affecting the quality of life of those affected. Seeking medical assistance and accurate diagnosis can help alleviate symptoms using medications, or in severe cases, interventional procedures to temporarily block the nerve involved or surgery to relieve compression,” says Dr George Abraham Ninan, Neurology, Christian Medical College Hospital Vellore.

Neuralgias are not diseases but symptoms of an underlying issue. If diagnosed early and correctly, they usually respond to treatment.

Neuralgia is triggered by underlying causes, such as tumours, nutritional deficiencies, infections, long-term medications, etc., that damage or impinge the nerve, initiating nerve-related pain.

Neuralgia may affect any age group; however, it typically occurs more commonly above the age of 50 and is twice as likely in women.

Neuralgias typically respond well to medications, therapy, and lifestyle modifications if diagnosed early and correctly.

The pain of neuralgias can be reduced with prescribed medicines, surgical intervention, and using a temporary nerve block.

Hot or cold compression therapy is known to be effective in treating neuralgia.