Neuralgia (also called painful neuropathy) feels like an electrical shock, burning or stabbing pain and is is caused by irritation, inflammation or damage to a nerve. The three most common forms of neuralgia are postherpetic, occipital and trigeminal.

Postherpetic neuralgia occurs throughout the body as a complication of herpes zoster (shingles), an infection caused by the chickenpox virus that results in a painful rash and blisters. People with this form of neuralgia typically experience a burning, sharp, stabbing or deep and aching pain; sensitivity even to light touch (including clothing); itching and numbness; and in rare cases, muscle weakness or mild paralysis.

Occipital neuralgia concerns the nerves running from the top of the spine at the base of the neck up through the scalp. Although many times no ultimate cause is found, medical conditions associated with occipital neuralgia include tension or tumors in the neck, injury to the back of the head, osteoarthritis, gout, diabetes or blood-vessel inflammation. Occipital neuralgia may initially be confused with a severe headache or migraine.

Trigeminal neuralgia , the cause of which is not fully understood, affects a nerve in the cheek area. It is linked to excruciating facial pain that can last days or even months.

Diagnosis of Neuralgia
No specific tests exist to diagnose neuralgia directly. Postherpetic neuralgia can be diagnosed in an office visit without further testing. Occipital neuralgia can be diagnosed by applying an occipital nerve block (a mixture of anesthetic and steroids injected to numb the occipital nerve), which in alleviating the pain may also act as a temporary treatment. Other forms of neuralgia may be diagnosed indirectly through testing to rule out similar potential conditions.

Treatment Options for Neuralgia
Administering the herpes zoster vaccine within 72 hours of the first signs of shingles can cut the risk in half of it developing into postherpetic neuralgia. For other types of neuralgia, the treatment depends on whether the doctor is able to pinpoint the underlying cause, but may potentially include any of the following:

  • Physical therapy 
  • Blood sugar regulation (where diabetes is the known cause) 
  • Medications 
  • Surgery to cut or relieve pressure on the nerve 
  • Cutting, heating or blocking the nerve 
  • Implanting a nerve stimulator

Medications prescribed may include the following:

  • Over-the-counter pain relievers (aspirin, ibuprofen, naproxen)
  • Topical creams with lidocaine or capsaicin
  • Antidepressants (amitriptyline, nortriptyline, duloxetine)
  • Anticonvulsants (carbamazepine)
  • Opioids (morphine, oxycodone, tramadol)

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