Neurologists Herzliya Medical Center use highly effective treatments for neuralgia. The introduction of modern medicines and innovative methods to combat pain allows specialists to successfully manage patients’ pain of neurogenic origin.
What is neuralgia?
Neuralgia – pain of neurogenic origin due to nerve irritation or damage, it is not a disease, but rather a symptom resulting from injury or a symptom of particular disorders. Pain along a damaged nerve of the face or neck region, which can be severe and often debilitating. It most affects older people, but people of other age groups can also be susceptible. Comprehensive treatment involving medications, physical therapy and/ or surgery help manage the symptoms.
Symptoms vary according to the type and severity of neuralgia, but generally include:
- Pain (localized) – main symptom, usually severe, burning or stabbing sensation
- Skin sensitivity along the damaged nerve, results in pain in response to touch or pressure
- Numbness – intermittent or constant
- Weak or paralyzed muscles (of the damaged nerve)
Damaged nerves occur due to the destruction of its protective coat (myelin sheath), when this happens it leads to the symptoms experienced in neuralgia, caused not just by aging, but other factors may be responsible:
- Mechanical pressure on the nerve – blood vessel, tumor, ligaments or bone may be causing pressure, trigeminal neuralgia is caused by a swollen blood vessel
- Secondary neuralgia may develop in patients suffering from multiple sclerosis (MS), diabetes mellitus, chronic renal failure and infectious diseases – shingles (causes postherpetic neuralgia), Lyme disease and syphilis. A tooth abscess (untreated) could also cause neuralgia
- Side effects of certain medicines or the medicine itself
- Surgical trauma
- Chemical irritation
- Postherpetic neuralgia - Associated with shingles, can occur anywhere within the body. Shingles is a viral infection causing a rash and blisters. Neuralgia develops within regions of where shingles occurred. Symptoms range both in intensity and duration
- Trigeminal neuralgia (prosopalgia) – pain originating from the trigeminal nerve (from the brain to the face). Pain believed to be caused by pressure on the trigeminal nerve at the point of the brainstem. This type of neuralgia results in pain along one side of the face, and common in the elderly
- Occipital neuralgia – originating from the nerve found at the back of the skull, a dul throbbing pain results
- Glossopharyngeal Neuralgia – pain originating from the glossopharyngeal nerve (in the throat), is a rare form of neuralgia, causing pain in the neck and throat region
- Sciatic neuralgia (sciatica) – compression of the sciatic nerve (one of the longest and widest nerves) starting from the lower back through the buttocks and legs causing pain along these regions, including the feet and/ or toes. Depending on the location of compression, a burning pain or tingling or numbness down the leg
- Intercostal neuralgia (chest wall pain) - common type of neurogenic pain of the abdominal area, which is caused by compression of the intercostal nerves (between the ribcage); shingles (herpes zoster virus) can cause intercostal neuralgia. The pain is localized in the ribs and increases with breathing and movement. Violent attacks are marked by coughing and deep breathing. Often there is a need for differential diagnosis of intercostal neuralgia with diseases of the heart, lungs, abdomen, and damage to the nervous ganglion
Neuralgia Diagnosis at HMC
Diagnosis of neuralgia is based on a thorough neurological examination of the patient taking into account the symptoms described by the patient. Neurologists at Herzliya Medical Center, using the latest advances in laboratory and instrumental diagnosis, exclude other suspected conditions (rheumatoid arthritis, for example) by observing signs and symptoms, such as redness or swelling. Blood tests determine kidney function, blood sugar and more. Visualization of nerve pathways conducted using MRI, ultrasound or CT scanning help determine the presence and nature of mechanical pressure. An important method is also a study of nerve conduction velocity (NCV) through electromyography.
A comprehensive approach in the treatment of neuralgia allows Israeli experts at HMC to achieve stable effect and prevent relapse. A detailed description of the patient's symptoms of neuralgia will help determine the most effective treatment method, which depends on the type, location, cause and severity of neuralgia. The main methods of treatment include:
- The use of corticosteroids and non-hormonal anti-inflammatory drugs that have a pronounced analgesic effect. Anti-inflammatory effect reduces the swelling of the tissues surrounding the nerve, thereby reducing the pressure exerted on it
- Drugs that lower the pain threshold. These properties have a number of antidepressants (Amitriptyline, Nortriptyline, Duloxetine) and anticonvulsants (Carbamazepine, Gabapentin, Lamotrigine, Phenytoin, Pregabalin).
- Medication (injection or percutaneous) blockade of the affected nerve
- Narcotic analgesics – short term pain
- Physiotherapy with medical lasers, electrophoresis of drugs (anesthetics and anti-inflammatory drugs), as well as the use of percutaneous techniques electroneurostimulation
- Alternative medicine - acupuncture, massage therapy and meditation
- Surgical treatment is aimed at eliminating mechanical pressure on the nerve endings (performed by collaboration among the orthopedics and neurosurgery departments at Herzliya Medical Center
Neurologists at Herzliya Medical Center aim to eliminate or at the very least provide pain relief to patients with neuralgia. A team of specialists at HMC's neurology department work together to plan an effective treatment in order for the patient to lead the best quality of life, with minimal symptoms. People are recommended to contact their doctor if shingles is suspected or if the over-the-counter medication for pain relief is ineffective, or the pain is severe.