Neuralgia is a severe stabbing or burning pain that occurs due to damage to a nerve. Pain management for this type of pain is challenging as it affects not only physical attributes but behavioural aspects of the patient’s life as well. A thorough examination of patient with detailed history is must to find the cause of pain and then appropriate management is instituted. Anxiety has a very high association with neuropathic pain along with sleep disturbance and both these aspects must be simultaneously treated with neuralgic pain.
 

Common types of Neuralgic pain
 
  • Trigeminal neuralgia- A very severe pain in the face which the patient describes as electric shock like. It may affect cheek, side of nose and forehead. Affected patients avoid touching the face and exposure to cold which may bring about these pain attacks.
  • Post herpetic neuralgia- It’s a burning or stabbing pain in the region of face and neck most commonly. Patient avoids touching of affected area as it leads to severe pain episodes. A large majority of elderly patients who suffer from shingles develop post herpetic neuralgia.
  • Due to alcoholic neuropathy- A very distressing pain in those who consume large amount of alcohol for a very long time. As alcohol can damage the nerves, it can cause very severe painful episodes in some of them.
  • Deficiency of vitamin B 12.
  • Diabetic – Tingling and burning sensation which may develop in a large majority of patients suffering from diabetes. Though it can affect any part of the body, usually it affects feet and hands. Patients often have severe interruption of sleep because the pain is typically worse at night time.

Common causes of nerve pain

  • Infections, such as herpes zoster (shingles), HIV/AIDS, Lyme disease, and syphilis
  • Certain cancer medicines such as cisplatin, paclitaxel, or vincristine
  • Pressure on nerves by nearby bones, ligaments, blood vessels, or tumor.
  • Trauma (including surgery) may also cause damage to nerves.

Management

  • Medications like Carbamazepine, Gabapentin
  • Topical analgesic like 5% Lidocaine 
  • Cognitive behavioural therapy
  • Nerve blocks can offer substantial relief especially in those not responding to medications. Both stellate ganglion block and other sympathetic nerve block can offer substantial relief for these patients. 
  • Physical therapy like myofascial release is also helpful.
  • Nutritional counselling- A diet rich in fruits and vegetables is desirable.
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