Neuralgia

Causes of neuralgia include:

• Chemical irritation
• Chronic kidney disease
• Diabetes
• Infections, such as herpes zoster (shingles), HIV/AIDS, Lyme disease, and syphilis
• Chemotherapy medicines such as cisplatin, paclitaxel, or vincristine
• Porphyria (blood disorder)
• Pressure on nerves by nearby bones, ligaments, blood vessels, or tumors
• Trauma (including surgery)
• Underlying nervous system disorder (such as multiple sclerosis)

In many cases, the cause is unknown.

Postherpetic neuralgia and trigeminal neuralgia are the two most common forms of neuralgia. A related but less common neuralgia affects the glossopharyngeal nerve, which provides feeling to the throat.

Neuralgia is more common in older people, but it may occur at any age.

Symptoms may include any of the following:

• Increased sensitivity of the skin along the path of the damaged nerve, so that any touch or pressure is felt as pain
• Pain along the path of the nerve that is sharp or stabbing, in the same location each episode, comes and goes (intermittent) or is constant and burning, and may get worse when the area is moved
• Weakness or complete paralysis of muscles supplied by the same nerve

Your health care provider will perform a physical exam, and ask about your symptoms.

The exam may show:

• Abnormal sensation in the skin
• Reflex problems
• Loss of muscle mass
• Lack of sweating (sweating is controlled by nerves)
• Tenderness along a nerve
• Trigger points (areas where even a slight touch triggers pain)

You may also need to see a dentist if the pain is in your face or jaw. A dental exam can check for dental disorders that may cause facial pain (such as a tooth abscess).

Other symptoms (such as redness or swelling) may indicate other conditions such as infections, bone fractures, or rheumatoid arthritis.

There are no specific tests for neuralgia. But, the following tests may be done to find the cause of the pain:

• Blood tests to check blood sugar, kidney function, and other possible causes of neuralgia
• Magnetic resonance imaging (MRI)
• Nerve conduction study with electromyography
• Ultrasound
• Spinal tap (lumbar puncture)

Treatment depends on the cause, location, and severity of the pain.

Medicines to control pain may include:

• Antidepressants
• Antiseizure medicines
• Over-the-counter or prescription pain medicines
• Pain medicines in the form of skin patches or creams

Other treatments may include:

• Shots with pain-relieving (anesthetic) medicines
• Nerve blocks
• Physical therapy (for some types of neuralgia, especially postherpetic neuralgia)
• Procedures to reduce feeling in the nerve (such as nerve ablation using radiofrequency, heat, balloon compression, or injection of chemicals)
• Surgery to take pressure off a nerve
• Alternative therapy, such as acupuncture or biofeedback

Procedures may not improve symptoms and can cause loss of feeling or abnormal sensations.

When other treatments fail, providers may try nerve or spinal cord stimulation. In rare cases, a procedure called motor cortex stimulation (MCS) is tried. An electrode is placed over part of a nerve, spinal cord, or brain and is hooked to a pulse generator under the skin. This changes how your nerves signal and it may reduce pain.

Most neuralgias are not life threatening and are not signs of other life-threatening disorders. For severe pain that does not improve, see a pain specialist so that you can explore all treatment options.

Most neuralgias respond to treatment. Attacks of pain usually come and go. But, attacks may become more frequent in some people as they get older.

Sometimes, the condition may improve on its own or disappear with time, even when the cause is not found.

Complications may include:

• Problems from surgery
• Disability caused by pain
• Side effects of medicines used to control pain

Contact your provider if:

• You develop shingles
• You have symptoms of neuralgia, especially if over-the-counter pain medicines do not relieve your pain
• You have severe pain (see a pain specialist)

Strict control of blood sugar may prevent nerve damage in people with diabetes. In the case of shingles, antiviral medicines and the herpes zoster virus vaccine may prevent neuralgia.

Nerve pain; Painful neuropathy; Neuropathic pain

Cohen SP. Pain. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 388.

Katirji B. Disorders of peripheral nerves. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 106.

Smith AG, Shy ME. Peripheral neuropathies. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 388.

Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.