What is neuralgia? What are the symptoms and treatment methods?

Pain is defined as an unpleasant feeling that occurs anywhere in the body. Chronic pain can be examined under two headings as nociceptive pain and neuropathic pain. Nociceptive pain develops due to organ or tissue damage and is caused by pain receptors in the peripheral nervous system. Neuropathic pain, on the other hand, is a type of pain that operates through completely different mechanisms resulting from the damage of nerves in the peripheral and central nervous system.

What is neuralgia?
Neuralgias are chronic, flammable, stinging or cold, sometimes steady, sometimes lightning striking and transient pain in the neuropathic pain character that usually occurs in the head and neck region.
What are the causes of neuralgia?
The causes of neuralgia are not fully understood. Neuralgia may develop due to the nerve's own damage, pressure on the nerve, or changes in nerve function. Another situation to keep in mind is that in some cases the cause of neuralgia may not be found.
Infections
Previous infections can also affect nerves. For example, postherpetic neuralgia is a complication that occurs after shingles caused by chickenpox virus. Flammable, stinging pain that continues after itching and rashes after shingles are defined as postherpetic neuralgia. The rate of development of postherpetic neuralgia increases with age. The incidence is higher in the elderly.
Demyelinating diseases
In diseases such as Encephalomyelitis (ADEM) Multiple Sclerosis (MS), myelin envelopes surrounding the nerves are lost. This is called demyelination. Since the protective substance around the nerve is removed, neuralgias are more common in these diseases.
Press
A pressure on the nerve can also cause neuralgia. Bones, ligaments called ligaments, blood vessels and tumors can put pressure on the nerves, causing neuralgia. In trigeminal neuralgia, the cause is usually a vascular compression where the nerve exits the brain stem.
Diabetes
High blood sugar levels circulating in the blood damage both capillaries and nerves themselves. Diabetic peripheral polyneuropathy develops due to this damage. Numbness and burning occur in the hands and feet. This type of neuralgia is more common in the hands, feet, legs, and arms. Less frequently, chronic kidney failure can be seen due to the side effects of cancer drugs, fluroquinolone antibiotics, traumas and chemical stimuli.
What are the symptoms of neuralgia?
These are pain that can occur locally at certain points of the body depending on the neuralgia type, in the form of flammable, stinging, sometimes electric or lightning strikes, often not accompanied by loss of function.
What are the types of neuralgia?
The most common types of specific neuralgia are: Trigeminal Neuralgia, Postherpetic Neuralgia, Occipital Neuralgia, and Glosopharyngeal Neuralgia. When they occur in certain areas of the body due to nerve damage, they can also be named by that area. For example, in extremely rare intercostal neuralgia, flammable stinging pain may occur between the ribs. But this situation is very rare.
Trigeminal neuralgia
Trigeminal neuralgia is the type that we see most frequently among neuralgias. The trigeminal nerve is the fifth of the head nerves and provides sensory innervation of the face and the work of the chewing muscles. It has 3 branches. Take the first branch, feed the eyebrow and the upper part of the eye, the cheek area with the second branch up to the edge of the upper lip, and the chin branch that starts from the lower lip edge of the third branch. Sudden, paroxysmal (intermittent), lightning-like severe pain in the area where the trigeminal nerve is distributed in a single half of the face is called trigeminal neuralgia. It is very rarely seen bilaterally. Generally a single branch; most often it holds the second branch.
Patients may experience pain when touching the face, eating, shaving, drinking something, brushing teeth, putting on makeup, talking, washing the face, laughing and sometimes even talking. These patients usually apply to dentists with these pains; many patients even have their teeth pulled on the pain side before the diagnosis is made.
Postherpetic neuralgia
Shingles disease is a disease caused by Herpes Zoster virus. The virus that settles in the nerve is defined by pain, itching along the dermatoma (propagation path) innervated by the nerve and cittle chicken pox-like skin lesions are seen. When appropriate treatment is applied, skin lesions and acute severe pain pass in 2-4 weeks. In some cases, pain may not disappear at all or may start again after a period of rashes. The generally accepted opinion is that post-painful neuralgia (PHN) is still present for 3 months after the skin rashes have passed. There are some risk factors in developing postherpetic neuralgia after shingles. The incidence of PHN is higher in elderly patients. Excessive skin rash or acute pain during acute illness are considered as risk factors for the development of PHN.
Occipital neuralgia
Occipital nerves provide the sensation in the region from the back of the neck to the top on the back of the head. Flammable, persistent pain in this lightning-like lightning pattern suggests occipital neuralgia.
Glossopharengeal neuralgia
This situation is very rare, but it is very important in terms of the symptoms it creates. It is a paroxysmal painful disease of the 9th pair of glosopharyngus nerve. Pain is felt in the tongue and neck. In advanced cases, patients cannot swallow and their saliva flows through the mouth. Sometimes attacks of pain can be accompanied by attacks of cardiovascular syncope (fainting).
How is neuralgia diagnosed?
Diagnosis of neuralgia is made by anamnesis, that is, the story told by the patient. Physicians should suspect the diagnosis based on the patient's complaints and ask the right questions to the patient. In cases where trigeminal neuralgia is suspected, a tumor or other pathology that will compress the trigeminal nerve should be excluded by removing the brain MRI.
What are neuralgia treatment methods?
Drugs are primarily used in the treatment of neuralgias. Carbamazepic, an epilepsy drug, is the first drug to be used in the treatment of trigeminal neuralgia. Many patients can have a painless life for this treatment for many years. In some patients, there is no response to drug treatment or resistance to the drug may develop rapidly. In this case, it is necessary to switch to other drugs. In cases where drugs do not benefit or in young patients who do not want to use drugs, the surgical method applied to remove the vein pressing on the place where the 5th nerve called microvascular decompression comes out of the brain stem can be easily applied with very few complications. In cases where it is thought that it can not support the brain surgery, the operation of killing the sensory component of the nerve with radiofrequency can be performed by being located in the hole where the nerve leaves the skull.
Central effective neuropathic pain medications, antidepressants, nonstereoid anti-inflammatory drugs can be used in postherpetic neuralgia. Sympathetic nerve blockade or radiofrequency can be applied to patients who cannot get results with pharmacotherapy.
Occipital neuralgia is found in the occipital nerve and application of a mixture of corticosteroids and local anesthetic agents gives very good results. The treatment times of these injections are temporary, but since the application is simple, it can be administered repeatedly.
Surgical treatment is the most effective treatment method in glosopharyngeal neuralgia today. Microvascular decompression in the trigeminal nerve treatment can be applied this time to remove the pressure on the 9th nerve.
As can be seen, neuralgias are diseases that have serious psychosocial extensions that make patient's life seriously difficult. But there are many treatment methods. If you experience similar pain, do not forget to make an appointment with a specialist doctor and get information about treatment methods.

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