Neuralgia is associated with painful migraines and pain in the face. What is it exactly, how is it treated and what are it’s methods for diagnosis? Read on.
Neuralgia is a condition where a nerve pathway starts hurting, sometimes unbearably. This can be a stabbing or burning pain, the onset of which can be linked to either nerve damage or a number of diseases or infections. These include Shingles, Diabetes, Multiple sclerosis, as well as the onset of old age. There are different kinds of neuralgia that each have specific characteristics.
This variation of neuralgia occurs when the trigeminal nerve associated with the occurrence of this disease is damaged. It mainly affects the face, cheek and jaw because the trigeminal nerve is located in the different areas of the face. The pain from trigeminal neuralgia can be severe enough to cause convulsions. The pain that is associated with this condition only occurs on one side of the face. If there is pain experienced in both the sides of the face then it will be one at a time.
Trigeminal neuralgia can be very easily confused with other illnesses because the pain that is experienced is in such an area, with different parts like the ears, teeth and temple all being affected so diagnosis has to be determined by a complete discussion of the symptoms the affected individual is experiencing with a doctor.
Neuralgia is a painful condition to begin with, but trigeminal neuralgia is the condition where the pain is most severe of all the variations. The pain can be in different areas at the same time, concentrated in a particular general location as the trigeminal nerve has three branches. Therefore, the pain can be experienced in the ears, teeth, and jaw, pain around the eye sockets, forehead and cheeks. Sometimes the pain can also be felt in the neck and back of the scalp. One can also feel a fullness in the sinuses and small shocks as if struck by an electric current. Aside from all of this is the underlying migraine pain that remains in the background. The pain is usually for about two or three minutes and is said to be excruciating. The episode may be an isolated incident, part of a cluster of attacks or an extended problem.
There are actions that can increase the pain being felt including: moving the face during talking and making any sort of expression or chewing. At times, the pain can be so severe that a slight breeze can also trigger an uncomfortable or painful reaction.
This is a less severe version of trigeminal neuralgia but still causes plenty of discomfort, particularly in the back of the skull. Sometimes the pain, described as throbbing and dull, can travel forward to the forehead. The reason for occipital neuralgia occurring is ligaments or stretched muscles pressing against the nerve being affected. Causes of this disease can also be head trauma, bad posture and viral infection.
The glossopharyngeal nerve carries signals from the throat, tonsils and tongue to the brain. In this variation of traditional neuralgia, there are repeated stabbing pain in the back of the throat. The glossopharyngeal malfunctioning causes this pain and occurs in people that are older than 40. It is not known how this condition manifests, but in a few cases it has been caused by a tumor in the neck or brain that pushes down on on the nerve being affected. In other cases it can be caused by a genetic defect of an abnormally positioned artery.
Neuralgia is a difficult affliction to diagnose since its effects can neither be seen, nor is the body part it is affecting a unique area. Usually the area is better defined within the general proximity of where the pain is occurring. This means that nerve conduction tests have to be done to isolate missing motor or sensory function. A micron urography is done on the nerve to stimulate the condition of the pathway to understand if it is damaged.
Patient doctor communication is very important when diagnosing for any form of neuralgia. This is because the patient has to accurately pinpoint the nature of the pain that he or she is feeling. A pain assessment scale has to be used to understand when the pain is most excruciating, in what area and the level of discomfort. This can give the medical professional a better idea of the area that needs to be focused on for examination.
Different stimuli have to also be used to see what kind of a reaction they cause in the patient. Neuralgia has been seen to cause particular reactions in external stimuli such as mechanical, chemical or thermal. The patient also has to undergo a series of tests to see which stimuli he or she reacts to and in what way.
Neuralgia does not show up in brain scans so the only option is to see how the patient will react to different procedures and medication.
Quantitative sensory testing:
By doing a Quantitative Sensory Testing (QST) the proper functioning of the nerve is tested by seeing the patient’s response to various stimuli. The tests works by introducing the stimuli, like a pin prick, to the area that is thought to be affected. The stimuli is applied in increasing and decreasing magnitudes. This procedure is not usually used because it is quite expensive and time-consuming in its delivery of results.
Laser evoked potentials
By using Laser Evoked Potentials (LEP) lasers are used to induce heat stimuli on an area. By analyzing the data on how the nerves reacted to the heat from the laser even miniscule lesions in the spinothalamic pathways can be detected. Neuropathic discomfort is usually caused by lesions in this pathways. LEPs are extremely sensitive and accurate in assessing damage to the peripheral, as well as central nervous systems.
A new method of discovering neuralgia is to do a skin biopsy and examine the structure of a sample of skin. Low density of intra-epidural nerve fibers has been associated with neuropathic pain and a skin biopsy will be able to provide adequate information on the condition of mechanoreceptors within the skin.
There are different methods that neuralgia is treated, mostly according to where it is prevalent. A variety of treatments are done at the same time to tackle each symptom individually. For the pain, painkillers such as aspirin or codeine are prescribed. Antidepressants can also be prescribed for this very purpose. If the neuralgia is located inside the mouth, dental work might need to be done. Sometimes neuralgia can be caused by a bone pressing against the nerve or a tooth abscess. In these cases there needs to be an intake of antibiotics, as well as surgery.
For muscle spasms and convulsions that are associated with trigeminal neuralgia anticonvulsant medications are usually prescribed. In certain cases surgery needs to be done to permanently block the pain messages from an area. Physical therapy is also important to keep the body healthy and in fighting shape.
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