Neuralgia - Causes, symptoms and treatment. MF.
Jun 01, 2018
- Causes and Diagnosis neuralgia
- Trigeminal neuralgia
- Neuralgia pterygopalatine node
- neuralgia glossopharyngeal nerve
- herpetic neuralgia
- intercostal neuralgia
- Neuralgia femoral nerve
- Treatment of neuralgia
Neuralgia - the defeat of the peripheral nerve, is an acute, severe, burning, piercing pain inzone of innervation of the affected nerve.
If neuropathy( neuritis) is characterized by symptoms of loss of nerve function, neuralgia is characterized by irritation symptoms. There are neuralgia of the cranial( trigeminal, glossopharyngeal) and spinal( intercostal) nerves, as well as of the femoral nerves
Causes of neuralgia
Subcooling, inflammatory diseases, trauma, tumors, intoxications, stress, demyelinating processes can cause neuralgia.
Diagnosis of neuralgia
Neurologist deals with differential diagnosis. Diagnosis of neuralgia begins with a neurological examination of the patient with typical complaints for this disease. The listed causes of neuralgia require a more complete examination to identify or exclude the underlying disease.
In some cases, additional instrumental examination( electroneurography) may be required if the cause of neuralgia was a trauma in the nerve projection. It may be necessary to perform a MRI of the spine or any of the nerve plexuses in case of any voluminous effect on the nerve structures, as is the case with a hernia or protrusion of the intervertebral disc or soft tissue tumors.
Neuralgia of the trigeminal nerve
Or, as patients are called - "neuralgia of the facial nerve".The triple nerve is a V pair of cranial nerves that provides a sensory and partially motor innervation of the face and oral cavity. The glandular and maxillary branches of the nerve are purely sensitive; in the third, the mandibular branch, there are motor fibers that innervate the chewing musculature. The triadic nerve is the main nerve, providing the sensitivity of the face - superficial - painful and tactile, deep - proprioceptive. A powerful sensory innervation is provided by the Gasser's node( trigeminal ganglion), the connection of the nerve to the thalamus - the center of sensitivity, the medial loop, the spinal cord.
Neuralgia of the trigeminal nerve has so-called central and peripherally caused causative factors.
- The central genesis of is a pain paroxysm of the cortical-subcortical genesis - hypothalamic paroxysms, epileptic, dysphoria. Paroxysm is a manifestation of a disease that occurs suddenly, is sharply different, contrasting with the usual condition, lasts briefly - a few seconds or minutes, spontaneously abruptly stops. Neuralgia of the trigeminal nerve can be considered as the equivalent of epilepsy - since it is a short-term paroxysm, during which EEG bursts of slow wave activity and the effect of anticonvulsant therapy.
- Peripheral genesis - primary neuralgia is a pain syndrome that occurs primarily in infections, viral( herpetic) and toxic lesions, toxic-allergic and vascular irritation, compression of the trigeminal nerve by aneurysmal vessels, malformation, pathologically convoluted vessels. .. Secondary neuralgia- This is a pain syndrome in diseases of the ENT organs, teeth, upper cervical spine, multiple sclerosis, BAS, traumas, tumors of the cerebrospinal junction.
Symptoms of trigeminal neuralgia:
is pain - a short-term, may be of different nature, but always very strong "incompatible with life," one-sided, local - in the innervation zone of the affected nerve branch.
Areas of pain in trigeminal neuralgia
Pain is accompanied by vegetative reactions - lacrimation, hypersalivation( uncontrolled drooling), flushing( redness).Pain can be provoked by touching the horn points, chewing, talking, shaving. When the mandibular branch of the trigeminal nerve is affected, motor disorders in the chewing muscles are possible - twitching, spasms, atrophy.
The course of idiopathic neuralgia is long-term, with periods of remission and exacerbations. The duration of remissions and the frequency of exacerbations are individual, associated with provocative moments. A persistent and prolonged remission is possible. The course of secondary neuralgia depends on the underlying disease.
Neuralgia of the pterygoid node
The pterygoid node is a parasympathetic nerve formation that unites the 2nd branch of the trigeminal nerve, the parasympathetic part of the facial nerve, sympathetic from the intertwining of the internal carotid artery and having connections( anastomoses) with upper sympathetic nodes.
Neuralgia of the pterygoid ganglion( Slouder's neuralgia) often occurs with inflammatory processes in ENT organs.
unilateral pain acute, penetrating in the eye, nose, upper jaw, teeth, pain, accruing with possible irradiation in the temple, tongue and neck. The pain is accompanied by pronounced unilateral vegetative disorders - reddening of the eyes, lacrimation, drooling, blepharospasm, edema. Paroxysm of pain often occurs at night and can be from minutes to hours and days. The disease lasts for a long time with periods of exacerbations and remissions. Overwork, cold, strong emotions, alcohol consumption can provoke an exacerbation of the disease.
Neuralgia of the glossopharyngeal nerve
The glossopharyngeal nerve is the IX pair of cranial nerves that provides the sensitivity of tonsils, soft palate, the tympanic cavity, taste sensitivity of the posterior third of the tongue, secretory function of the parotid gland, motor innervation of the pharyngeal muscles.
The primary neuralgia, idiopathic and secondary, is symptomatic for infectious diseases( tonsillitis, tonsillitis, influenza), tonsil lumbar injuries, tumors of the bridge-cerebellar angle, tumors of the larynx, fracture of the base of the skull, as a complication in operations of tonsillectomy, tracheotomy, ventilation.
Neuralgia of the glossopharyngeal nerve is pain, paroxysmal, one-sided in the tongue, root of the tongue, throat, soft palate, in the ear. Pain occurs when eating, swallowing, yawning, coughing, taking very hot or cold food. The pain is accompanied by a vegetative reaction - hypersalivation or dryness in the throat, perhaps a change in taste - everything seems bitter or the taste sensations may be lost. An attack can be provoked by swallowing, talking.
Herpetic neuralgia is the most common complication of herpetic infection, especially in the elderly and in patients with impaired immunity. Herpetic neuralgia arises in the defeat of ganglia and the development of ganglionitis and as postherpetic neuralgia.
The basis of pain in postherpetic neuralgia is inflammatory changes in the ganglia of the posterior roots of the spinal cord and peripheral nerves in the affected areas. Severe pain syndrome can last up to 6 months. There are various painful sensations - constant, deep, dull, pressing or burning pain;spontaneous, periodic, stitching, shooting, similar to "electric shock";pain when dressing or touching lightly.
Intercostal neuralgia is an acute pain along the intercostal nerve, which increases with movements, bends of the trunk, and inspiration. It is impossible, because of acute pain, to breathe in full breast - a man holds his breath, is afraid and breathe and move. When palpation is determined by sharp tenderness along the intercostal space. Coughing and sneezing cause acute pain.
Causes of intercostal neuralgia can be hypothermia, severe stress, sudden movement, prolonged uncomfortable posture, physical loading, inflammatory diseases, severe cough, rib injury, pathology of the thoracic spine.
For intercostal neuralgia, a chest examination is necessary to detect / exclude pneumonia, pleurisy, pneumothorax. With left-sided localization of pains - a cardiac examination is absolutely necessary - an electrocardiogram to exclude cardiac pathology - angina pectoris, myocardial infarction .You will also need a general blood test, possibly a chest X-ray.
Neuralgia of the external cutaneous nerve of the thigh
Neuralgia of the external cutaneous nerve of the thigh( Roth's disease) is pain, burning, paresthesia( tingling, crawling sensations in the skin), numbness in the nerve innervation zone - anterior-external surface of the thigh. The pain can be paroxysmal and persistent, acute and aching, prolonged.
Neuralgia of the femoral nerve
Neuralgia of the femoral nerve can occur with metabolic disgemic disorders - diabetes, alcohol intoxication, vascular diseases of the lower limbs, with compression of the nerve at the exit site under the inguinal fold - bandage, during pregnancy, with trauma.
Treatment of neuralgia
Treatment for neuralgia is prescribed by a neurologist.
Anticonvulsants are used - gabapentines - gabbatin, tebantin, gabagamma;finlepsin, carbamazepine;vitamins of group B - cocarnite, milgamma, neurovitan, neurorubine;muscle relaxants - midocals, sirdalud, baclofen;locally ointments and gels - dipryliphil, apizartron, fastum gel. .., individually - physiotherapy, acupuncture, sanatorium treatment.
It has been proved by researches that the reception of a complex of vitamins B1, B6, B12 has a positive effect on the nervous tissue in such diseases as neuritis, radiculitis and various neuralgia. For the analgesic effect and restoration of the structure of the nerve, it is recommended to use Neuromultivitis - a drug containing a combination of vitamins B1( 100 mg), B6 (200 mg) and B12( 200 mg) in dosages higher than in standard multivitamin preparations. The use of a complex agent is more effective than the use of analgesics: the drug not only relieves unpleasant symptoms, but also eliminates the cause of pain. The drug is available in the form of tablets, which is especially convenient for use at home and at work, and the economical packing of 60 tablets is enough for a full course of treatment.
If neuralgia is secondary, treat the underlying disease with the appropriate specialist. Such neuralgia passes after curing the underlying disease or achieving its remission. The course of neuralgia in this case depends on the underlying disease.
In the absence of contraindications to physiotherapy, it is possible to use:
- in acute period of neuralgia of the trigeminal nerve irradiation with a lamp Solyu, ufo, infra-red rays in a lowthermal dosage - patient half of the face, CMT or DDT on the zone of innervation or half mask on the face, cervical spine,electrophoresis with novocaine, salicylates, vitamin B1, and possibly an intranosal technique of administration, ultrasound with hydrocortisone to trigger zones, electrosleep, laser therapy, acupuncture;
- uses the massage of the collar zone and face, ultrasound, mud and paraffin applications on the collar zone and half of the face, hydrogen sulphide and sea baths, acupuncture.
With frequent and prolonged exacerbations of the trigeminal neuralgia of , in the case of an accurate cause( magnetic resonance imaging) - compression of the trigeminal nerve with - surgical treatment is performed - microvascular decompression. The separation of the nerve and the vessels that squeeze it is carried out. Operation - open craniotomy .Anesthesia is common. Possible complications - numbness of the face, doubling, hearing loss, complications associated with anesthesia, infectious. ..
Chemical and electrical destruction of the nerve is practically not applied.
In the pharmacoresistant course of neuralgia, with ineffectiveness of surgical treatment, stereotactic radiosurgery is applied if the patient chooses to use the device - Gamma Knife , for example, in neurinemia of the trigeminal nerve, compression by arteriovenous malformation is a progressive method of treatment that does not require anesthesia, hospitalizationduration of intervention from minutes to hours) and heals the patient completely( possibly a decrease in sensitivity in the zone of innervation of the trigeminal nerve).
With , the glossopharyngeal nerve of uses CMT on the cervical sympathetic area, ultrasound analgin, novocaine euphyllinic paravertebral, DMV on the collar area, laser puncture, acupuncture, neck-and-neck massage. In acute pain, dication is applied to the root of the tongue.
With intercostal neuralgia use UFO segmental zones, electrophoresis of novocaine, lidocaine on the pain zones of intercostal spaces, darsonvalization. Outside the exacerbation - paraffin, mud and ozocerite applications, radon and hydrogen sulphide baths, massage.
With , the neuralgia of the femoral nerve uses DDT, CMT is paravertebral and on the innervation zone of the external cutaneous nerve of the thigh, electrophoresis of salicylates, novocain, darsonvalization, magnetotherapy, massage of the lumbar spine and legs, acupuncture. In the period of remission - sanatorium treatment with a full arsenal of rehabilitation measures.
Physiotherapeutic procedures relieve pain syndrome, have miorelaksiruyuschim, anti-inflammatory, sedative effect, improve blood circulation and trophicity, stimulate biologically active points, transport medicinal substances.
In neuralgia associated with degenerative-dystrophic processes in the spine, therapeutic exercises, swimming, aqua aerobics, training on simulators are shown.
Prevention of neuralgia
For preventive purposes, it makes sense to avoid hypothermia, drafts, injuries. Healthy lifestyle, treatment of chronic diseases, intake of B vitamins, therapeutic exercise are encouraged.
Doctor neurologist Kobzeva S.V.