Neuralgia is basically a condition that leads to stabbing, burning, and often severe pain along the course of the nerve. This stabbing and unbearable pain make it very difficult to carry out basic daily activities. Also, since there is a glitch in the nerve conduction, the motor functions are also affected causing the movements to become difficult and tiring.

Pain Management, therefore, forms a very important aspect of treatment in Neuralgia as it is one of the most disabling symptoms in patients suffering from Neuralgia. All these consequences of Neuralgia can be dealt with well with the help of Physiotherapy.

Trigeminal Neuralgia (TN) is the most common among various types of Neuralgia. It is a chronic, debilitating condition, which can have a major impact on quality of life.

What is the treatment of Neuralgia?
A number of treatments can offer some relief from the pain caused by Neuralgia.

• Identifying triggers and avoiding them helps.
• Medication is most often prescribed to help control the pain
• Physiotherapy to ease the pain and manage related symptoms of Neuralgia
• Surgery may be considered for the longer term

How do you relieve Neuralgia pain?
Pain Management forms a very important aspect of treatment in Neuralgia. Following measures have been found to be very helpful in easing the patients suffering from Neuralgia:

1. Cryotherapy: One of the passive treatments given is cryotherapy, which is the use of cold packs or ice at the area of pain. This helps by sensitizing the area and hence blocking the sensation of pain.
2. Transcutaneous Electrical Nerve Stimulation (TENS) is also considered one of the electrotherapeutic ways of blocking pain signals to the brain and hence reduce pain, as well as the tingling sensation that is experienced by the patient.
3. Therapeutic massage therapy may be used to relieve pain in cases of Occipital Neuralgia, where the patient has a stabbing headache. Massaging the painful area can hit key spots of the nerve blood and oxygen flow. The increased blood and oxygen flow can help to heal damaged nerves.
4. Apart from pain control, a physiotherapist will consider the following as an important part of the treatment:
   • Muscle strengthening
   • Improving flexibility
   • Aerobic training

How does Physiotherapy help in Neuralgia symptoms?
Physiotherapy treatment for Neuralgia is focused on decreasing the symptoms of Neuralgia and improving muscle strength and overall quality of life. After a detailed assessment by a specialist neurological physiotherapist, your treatment may include:

• Muscle and nerve mobilization
• Soft tissue stretches
• Muscle strengthening exercises
• Sensory and proprioceptive stimulation
• Pain management
• Facilitation of activities of daily living
• Home exercise program
• Electrotherapy (TENS/Ultrasound)

Individuals with Neuralgia substantially benefit from treatment by a specialist neurological physiotherapist. The advantages include:

• Increased strength of muscles
• Return to the normal daily routine
• Decreased pain
• Maintain muscle length
• Maintain joint range of movement
• Decreased sensory changes
• Learn how to manage your pain
• Learn specific exercises to continue at home/work

What is the best treatment for Neuralgia?
Apart from medications, Neuralgia symptoms can be best treated by a physiotherapist using a combination of special techniques and exercises, which may include:

1. Flexibility exercises in the form of stretching to help in relieving the tension from the muscles and hence reducing the pressure on the nerves, thereby reducing the symptoms. Both passive and active stretching exercises are taught to the patient and also administered as a home program.
2. To begin with, various free exercises for the affected muscles are started to maintain the muscle properties and prevent any further consequences like disuse atrophy which may result from not using the muscle for a long time.
3. Once the basic exercise protocol has been started and the symptoms of pain reduction, strengthening exercises for the affected muscles can be commenced. The muscle-strengthening exercises offer multiple benefits including the following:
   1. Posture: Strengthening exercises for the neck and back in case of occipital Neuralgia prove very useful as they allow maintaining a better posture. Poor posture, specifically being hunched over and bending your neck down, can put pressure on your nerves and lead to headaches.
   2. Reduce the intensity of pain: The strengthened muscles then what is felt usually as the muscles are now able to work more and hence do not give up soon.
   3. Ease Pelvic muscles: In the case of Pudendal Neuralgia rehabilitation of the pelvic floor, abdominal, gluteal, lumbosacral and hip rotator muscles.
   4. Improve balance and stability: Strengthening of certain muscles may be done to improve core and lower extremity balance and stability.
4. Due to Neuralgia, the nerve is under a lot of stress due to factors like external pressure and entrapment, nerve mobilization proves very helpful in relieving them from the tension. Various nerve mobilization techniques are used to reduce the symptoms of the respective nerve being hampered.
5. Aerobic training with low impact exercises helps maintain the body functions and also induces relaxation.
6. Walking also helps keep the mind and body healthy and active.

What is Neuralgia?
Neuralgia is a Greek word where neuron means “nerve” and algos “pain”.

Neuralgia is an intense, stabbing, burning and sharp shooting pain caused along the path of a damaged nerve it. Generally, neuralgia isn’t an illness in its own right, but a symptom of injury or a particular disorder. In many cases, the cause of the pain is not known. Older people are most susceptible, but people of any age. The pain may be continuous/ intermittent or caused just by a triggering factor. Neuralgia can occur in different parts of the body and can have various causes. Neuralgia is classified on the basis of the nerve affected or the cause of affection.

Almost everyone will experience mild Neuralgia at some point, but these bouts are usually temporary and tend to ease by themselves within a few days. Some types of Neuralgia are longer-lasting, debilitating and so agonizing that a person’s quality of life is severely reduced.

Keep reading till the end to understand the common types of Neuralgia.

What are the symptoms of Neuralgia?
Neuralgia symptoms can be widespread, depending on the cause, location, and severity of the nerve pain. However, the most common symptoms that occur with a pinched nerve include:

• Sharp and acute pain is felt in the affected area
• Dull, throbbing, and chronic pain through the course
• Muscle weakness is often seen in such cases
• Patient experiences fatigue
• There can be stiffness and soreness of the joint and the muscle
• Patient experiences typical pain that radiates along the nerve

Which areas of my body can get affected by Neuralgia?
Depending upon the nerve affected different areas of the body can get involved. For eg; if it is trigeminal Neuralgia then one side of the face gets affected. If it is postherpetic Neuralgia, the area which is affected by herpes zoster is involved like face, back, sole, etc. in occipital Neuralgia back of the head and neck is affected.

Read more about the various types of Neuralgia further down this article.

How can I prevent Neuralgia?
Here are a few tips to manage the painful attacks and prevent Neuralgia:

• Avoid (mental and physical) stress such as anxiety, lack of sleep, long drives etc.
• Avoid low room temperature throughout the night; it may aggravate the pain at night or on waking up
• Identify and avoid the specific trigger factors such as cold water, gargling, certain facial movements while eating or shaving etc.
• Avoid missing your medicine as per the dosage
• Learn to avoid sudden, jerky movements, turning neck while driving, heavy lifting activities etc
• Eat nutritious fresh food high in protein, antioxidants and omega-3 fatty acids
• Maintain excellent oral hygiene to avoid dental caries
• Do not smoke
• Maintain proper posture
• Establish a regular sleep schedule
• Stay active – exercise in moderation with low-impact exercises that improve cardiovascular health while stretching and strengthening supporting muscles.

Who is affected by Neuralgia?
Trigeminal Neuralgia is rare and statistical data regarding it is limited. The estimated annual incidence of Trigeminal Neuralgia is 12.6 per 100000 persons per year (4) and its incidence increases with age.

• Trigeminal Neuralgia affects females slightly more often than males. Although the exact incidence is unknown, approximately 10,000-15,000 new cases occur each year in the United States as per a report.
• The disorder most frequently affects individuals more than 50 years of age.
• However, cases can occur in younger adults as well. In younger individuals, the cause is often idiopathic, but when compared to older adult cases is more likely to be caused by damage to the central nervous system as in individuals with multiple sclerosis.
• Although extremely rare, TN can occur in children.

How is Neuralgia diagnosed?
The diagnoses of different types of Neuralgia are difficult and could take time to reach the right diagnosis. This is due to the mixed picture that the symptoms give. A person suffering from trigeminal Neuralgia could first visit a dentist as he may suffer from jaw and tooth pain, similarly, patient developing shingles could visit a neurologist before a skin specialist.

• A Neuralgia diagnosis generally begins with the patient describing their pain to a physician.
• From there, the physician will rule out other causes of the pain by running tests, completing a physical exam, and looking at the patient’s medical history.
• When Neuralgia is suspected, the physician will recommend tests that will check for a tumor or multiple sclerosis.
• Depending on the results of those tests, the physician may order advanced MRI tests that can see if there is a blood vessel pressing against the nerve.

What causes Neuralgia ?
The underlying cause of any type of Neuralgia is damage to a nerve. Each nerve in your body is protected by a coating called the myelin sheath. When the myelin is damaged or wears away from the nerve, the stabbing, severe, shock-like pain of Neuralgia results.

There are many different factors, including old age, which can cause damage to the myelin. Unfortunately, in many cases of Neuralgia, a cause can never be found. The possible causes of Neuralgia are as follows:

• Infection: An infection can affect your nerves. For example, the cause of postherpetic Neuralgia is shingles, an infection caused by chickenpox The likelihood of having this infection increases with age. An infection in a specific part of the body may also affect a nearby nerve. For example, if you have an infection in a tooth, it may affect the nerve and cause pain.
• Multiple sclerosis: Multiple sclerosis(MS) is a disease caused by the degradation of myelin, the covering of nerves. Among the many symptoms that result from MS is Neuralgia, often in the face. Related reading: Neuro Rehabilitation: How it helps in recovery of the patient
  Pressure on nerves: The myelin on nerves can be worn away by pressure. The pressure may come from a bone, ligament, blood vessel, or a tumor that is pressing on the nerve. The pressure of a swollen blood vessel is a common cause of Trigeminal Neuralgia.
• Diabetes: Many people with diabetes have problems with their nerves, including Neuralgia. The excess glucose in the bloodstream may damage nerves. This damage is most common in the hands, arms, feet, and legs
• Entrapment of the nerve: The nerves may get entrapped between the muscles/ muscle tendons or because of the pressure caused by the bones. This leads to an interrupted transmission of signals along with increasing the wear and tear of the myelin sheath causing it to degenerate faster.
  Less common causes
  If the cause of Neuralgia isn’t an infection, MS, diabetes, or pressure on the nerves, it may be from one of many less-common factors. These include:
  • chronic kidney disease
  • medications prescribed for cancer
  • fluoroquinolone antibiotics used to treat some infections
  • trauma, such as from surgery
  • chemical irritation

No one in my family has Neuralgia. How did I get it?
Neuralgia is not necessarily an inherited disease. In some cases, we find evidence of a family history of Neuralgia. In many cases, there may not be such history. Some patients may also give a family history of multiple sclerosis, brain tumor, or another neurological disease.

I have Neuralgia. Does it mean my child will have it too?
No. It is not a rule.

Does Neuralgia go away?
There is no cure for Neuralgia, but treatment can help improve your symptoms. Some types of Neuralgia improve over time. More research is being done to develop better treatments for Neuralgia.

How long does it take to recover from Neuralgia?
It depends upon the cause of the condition. In postherpetic Neuralgia one may take 3 to 4 months to recover whereas three weeks into your trigeminal Neuralgia surgery recovery, you can expect to return to your normal activity level while continuing to avoid high-intensity activities and longer in case of conservative treatment.

What are the common types of Neuralgia?
A. Trigeminal Neuralgia:
This type of Neuralgia is associated with pain from the trigeminal nerve, which goes from the brain to the face. In the case of trigeminal Neuralgia, the affected nerves are responsible for sensing touch, temperature sensation, and pressure sensation in the facial area from the jaw to the forehead. The disorder generally causes short episodes of excruciating pain, usually for less than two minutes and usually only one side of the face. The pain can be described in a variety of ways such as “stabbing”, “sharp”, “like lightning”, “burning”, and even “itchy”. The pain associated with Trigeminal Neuralgia is recognized as one of the most excruciating pains that can be experienced.

Simple stimuli – such as eating, talking, making facial expressions, washing face, or any light touch or sensation – can trigger an attack (even the sensation of a cool breeze). Attacks may be lone occurrences, clusters of attacks, or constant episodes.

Some patients experience muscle spasms, which led to the original term for Trigeminal Neuralgia of “tic douloureux” (“tic”, meaning “spasm”, and “douloureux”, meaning “painful”, in French).

B. Postherpetic Neuralgia:
This type of Neuralgia occurs as a complication of shingles and may be anywhere on the body. Shingles is a viral infection characterized by a painful rash and blisters. Neuralgia can erupt wherever the outbreak of shingles occurred and can be mild or severe, persistent or intermittent, and can last for months or years. It will always occur along the path of a nerve, so it’s usually isolated to one side of the body.Here the underlying cause that is Shingles is treated to cure the symptoms of Neuralgia.

C. Occipital Neuralgia:
Irritation of the main nerve that runs from the back of the skull can cause occipital Neuralgia. Occipital Neuralgia can cause intense pain that feels like a sharp, jabbing, electric shock localized to the back of the head and neck. The pain can sometimes include the forehead. But treatments for those conditions are very different, so it’s important to see your doctor get the right diagnosis. Other symptoms include aching, burning, and throbbing pain that typically starts at the base of the head and goes to the scalp, Pain on one or both sides of the head, pain behind the eye, Sensitivity to light, Tender scalp and Pain when you move your neck. People can confuse it with a migraine or other types of headache because the symptoms can be similar.

D. Pudendal Neuralgia:
Irritation of the pudendal nerve (severe pain in the distribution of the nerve), i.e. pudendal Neuralgia, may result in sensory symptoms in any or all areas it supplies and spasms of the muscles supplied by it. The sensory symptoms could manifest as itching, burning, tingling, cold sensations, and/or burning and shooting pain. The sensory symptoms may extend into the groin, abdomen, legs, and buttocks. The pudendal nerve is the only peripheral nerve that has both somatic and autonomic fibers. Thus, a person can experience increased heart rate and blood pressure, decreased motility of the colon, decreased blood flow, and perspiration with pudendal nerve stimulation.

E. Glossopharyngeal Neuralgia :
Pain from the glossopharyngeal nerve, which is in the throat, is not very common. This type of Neuralgia produces pain in the neck and throat.

F. Sciatic Neuralgia:
Shooting pain in the lower back, buttocks, legs, feet, and/or toes; occurs as a result of compression of the sciatic nerve, the longest and widest nerve in the body.

RehabMax Physiotherapy helps develop an overall treatment plan for Neuralgia which not only helps in relieving pain but also helps cope up with the difficulties encountered in everyday life.