What are neuralgias (nerve pains)?

From the Guidelines

Neuralgias are painful conditions characterized by intense, stabbing pain along the pathway of a nerve, with trigeminal neuralgia being the most frequent diagnosis proposed for unilateral episodic pain, profoundly affecting quality of life. They occur when a nerve becomes irritated or damaged, causing it to send pain signals to the brain. Common types include trigeminal neuralgia (affecting the face), postherpetic neuralgia (following shingles), and occipital neuralgia (affecting the back of the head). According to the International Association for the Study of Pain (IASP), trigeminal neuralgia is defined 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.

Treatment typically involves medications such as anticonvulsants (like carbamazepine 200-400mg twice daily or gabapentin 300-1200mg three times daily), antidepressants (such as amitriptyline 10-75mg at bedtime), and sometimes opioids for severe cases. Carbamazepine remains the primary drug of choice, but oxcarbazepine is equally effective with fewer side effects 1. For immediate relief, patients can try applying heat or cold packs to the affected area, practicing relaxation techniques, and avoiding triggers that worsen pain. In persistent cases, nerve blocks, surgery, or neuromodulation therapies may be necessary.

Some key points to consider in the management of neuralgias include:

• The clinical features of trigeminal neuralgia, which are characterized by sudden, severe, brief, stabbing, and recurrent pain in the distribution of one or more branches of the trigeminal nerve 1
• The importance of early neurosurgical opinion in cases where medical management is ineffective or intolerable 1
• The availability of surgical interventions, including microvascular decompression, which can provide long-term complete pain relief and preservation of facial sensation, but also carries risks such as hearing loss and mortality 1
• The use of stereotactic radiosurgery as an ablative procedure, which can provide effective pain relief, but also has its own set of risks and complications 1

Overall, the management of neuralgias requires a comprehensive approach that takes into account the underlying causes, clinical features, and treatment options, with the goal of improving quality of life and reducing morbidity and mortality.

From the FDA Drug Label

Neuralgias are not explicitly defined in the provided drug labels, but they are mentioned in the context of specific conditions, such as:

• Postherpetic neuralgia (PHN), which is described as neuralgia persisting for at least 3 months following healing of herpes zoster rash 2, 3
• Trigeminal neuralgia, which is described as a condition characterized by pain associated with true trigeminal neuralgia, and glossopharyngeal neuralgia 4
• Neuralgias are also mentioned in the context of painful distal symmetrical sensorimotor polyneuropathy, which is a type of neuropathic pain 3

Key points:

• Neuralgias are a type of neuropathic pain
• Postherpetic neuralgia (PHN) is a specific type of neuralgia that occurs after herpes zoster rash
• Trigeminal neuralgia is a specific type of neuralgia characterized by pain in the face
• Neuralgias can be associated with various conditions, including neuropathic pain and epilepsy

From the Research

Definition and Characteristics of Neuralgias

• Neuralgias are characterized by pain in the distribution of a cranial or cervical nerve 5
• They are typically brief, paroxysmal, painful attacks, although continuous neuropathic pain may occur 5
• The most commonly encountered conditions are trigeminal, postherpetic, and occipital neuralgia 6, 5, 7

Types of Neuralgias

• Trigeminal neuralgia: a severe orofacial neuropathic pain condition characterized by unilateral, brief but recurrent, lancinating paroxysmal pain confined to the distribution of one or more of the branches of the trigeminal nerve 7
• Postherpetic neuralgia: an unpredictable complication of varicella zoster virus-induced herpes zoster, which can induce psychosocial dysfunction and negatively impact quality of life 7
• Occipital neuralgia: a condition characterized by pain in the distribution of the occipital nerve 6, 5
• Other less common neuralgias include glossopharyngeal, superior laryngeal, auriculotemporal, and nervus intermedius neuralgia 5

Treatment and Management of Neuralgias

• Treatment of neuralgias can be challenging and is best guided by the most recent available evidence 5
• Pharmacologic and surgical approaches can be used to manage neuralgias, including anticonvulsive agents, microvascular decompression, and ablative procedures 6, 7
• Interventional pain management options, such as nerve blocks and spinal cord stimulators, can provide effective and long-lasting pain relief 8
• Topical treatments, such as capsaicin 8% patch, can also be effective in managing neuralgias 9