Neuralgia vs. Neuropathic Pain: Key Distinctions
Neuralgia is a specific subtype of neuropathic pain characterized by brief, paroxysmal, severe stabbing attacks in the distribution of a specific nerve, whereas neuropathic pain is the broader umbrella term encompassing all pain initiated by nervous system lesions or dysfunction, which can be continuous, burning, or shooting in nature. 1
Defining Neuropathic Pain
Neuropathic pain is defined by the International Association for the Study of Pain as "pain initiated or caused by a primary lesion or dysfunction of the nervous system." 1 This requires confirmation of injury or disease affecting somatosensory pathways of peripheral and/or central nervous systems. 1
Key Characteristics of Neuropathic Pain:
- Can present as continuous burning, tingling, aching, or intermittent shooting pain 1
- May include allodynia (pain from non-noxious stimuli) or hyperalgesia (enhanced pain response to noxious stimuli) 1
- Results from peripheral nerve injury or systemic etiologies 1
- Examples include painful diabetic neuropathy, post-herpetic neuralgia, post-traumatic nerve pain, and burning mouth syndrome 1, 2
Defining Neuralgia
Neuralgias are characterized by sudden, unilateral, severe, brief stabbing recurrent episodes of pain in the distribution of a specific cranial or cervical nerve. 3, 4 The pain is typically paroxysmal (occurring in discrete attacks) rather than continuous. 4
Key Characteristics of Neuralgias:
- Brief, electric shock-like paroxysmal attacks 3
- Pain follows the anatomical distribution of a specific nerve 3, 4
- Often triggered by specific stimuli (touch, eating, talking) 3
- Examples include trigeminal neuralgia, glossopharyngeal neuralgia, and occipital neuralgia 3, 4
The Relationship Between Terms
Neuralgia is essentially a subset within the broader category of neuropathic pain. 1 The term "neuralgia" is sometimes used interchangeably with "neuropathic pain" in specific contexts (e.g., "corneal neuralgia" vs. "neuropathic corneal pain"), but this represents imprecise terminology. 1
Important Clinical Distinction:
- Trigeminal neuralgia presents with paroxysmal stabbing pain, while trigeminal neuropathic pain (post-traumatic) presents with more continuous burning or aching pain 1
- Post-herpetic neuralgia presents with continuous burning pain rather than paroxysmal attacks, making the term "neuralgia" somewhat of a misnomer in this condition 1, 3
Clinical Implications
The distinction matters because treatment approaches differ:
- Classic neuralgias (like trigeminal neuralgia) respond best to carbamazepine or oxcarbazepine as first-line therapy 3
- Broader neuropathic pain conditions typically require tricyclic antidepressants, gabapentin, or pregabalin as first-line agents 1, 5
Common Pitfall:
Do not assume all nerve-related facial pain is "neuralgia"—continuous burning pain in a nerve distribution is neuropathic pain but not true neuralgia, and requires different management. 1