From the Guidelines
Neuralgia and neuritis are distinct neurological conditions that require a comprehensive treatment approach to manage symptoms and address the underlying cause, with a focus on improving quality of life and reducing morbidity and mortality. Neuralgia refers to severe, shooting or stabbing pain that occurs along the path of a nerve, often coming in episodes or triggered by specific stimuli, as seen in trigeminal neuralgia, which is defined by the IASP as ‘a sudden usually unilateral severe brief stabbing recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve’ 1. Common examples include trigeminal neuralgia (affecting the face) and postherpetic neuralgia (following shingles). Neuritis, on the other hand, is actual inflammation of a nerve that causes pain along with other symptoms like numbness, tingling, weakness, or reduced function in the affected area.
Key Characteristics
- Neuralgia: severe, shooting or stabbing pain along a nerve's path
- Neuritis: inflammation of a nerve causing pain, numbness, tingling, weakness, or reduced function
Treatment Approach
Treatment typically involves addressing the underlying cause while managing symptoms, with pain medications such as anticonvulsants (gabapentin, pregabalin, carbamazepine) and tricyclic antidepressants (amitriptyline) often prescribed at gradually increasing doses until pain relief is achieved, as suggested by international guidelines and Cochrane reviews that recommend carbamazepine as the primary drug of choice, with oxcarbazepine being equally effective with fewer side effects 1.
Additional Therapies
- Anti-inflammatory medications for neuritis
- Physical therapy
- Topical treatments
- Nerve blocks
- Surgical interventions in severe cases These conditions result from nerve damage or irritation caused by various factors including infections, physical trauma, systemic diseases like diabetes, or vitamin deficiencies, which explains why treatment must address both symptom management and the underlying cause, and a multidisciplinary approach may be necessary, involving multiple specialties, such as ophthalmologists, pain specialists, neurologists, and mental health professionals, to manage the condition holistically 1.
From the Research
Definition and Characteristics
- Neuralgia is characterized by pain in the distribution of a cranial or cervical nerve 2, 3
- Typically, neuralgias are brief, paroxysmal, painful attacks, although continuous neuropathic pain may occur 2, 3
- The most commonly encountered conditions are trigeminal, postherpetic, and occipital neuralgia 2
Types of Neuralgia
- Less common neuralgias include glossopharyngeal, superior laryngeal, auriculotemporal, and nervus intermedius neuralgia, among others 2
- Trigeminal neuralgia is a highly disabling disorder characterized by very severe, brief, and electric shock-like recurrent episodes of facial pain 4
Diagnosis and Treatment
- Patients who present with neuralgias should have imaging studies to investigate for structural abnormalities unless the etiology is apparent 2
- Management of both common and rare neuralgias can be challenging and is best guided by the most recent available evidence 2
- Carbamazepine and oxcarbazepine are drugs of first choice for trigeminal neuralgia, while lamotrigine, gabapentin, pregabalin, botulinum toxin type A, and baclofen can be used either alone or as add-on therapy 4
Treatment Algorithm
- A comprehensive algorithm for management of neuropathic pain includes assessment, multidisciplinary conservative care, nonopioid pharmacological management, interventional therapies, neurostimulation, low-dose opioid treatment, and targeted drug delivery therapy 5
- Multidisciplinary conservative care and nonopioid medications are recommended as first-line therapy, while combination therapy and tramadol and tapentadol are recommended as second-line 5