Neuralgia is one of the common symptoms in neurology, and such pain is pain felt without external stimulation, also known as spontaneous pain. There are many types of spontaneous pain, which can be divided into peripheral neuropathic pain and central neuropathic pain according to the location of the lesion. Those with unknown cause are called primary neuralgia, and those with clear cause are called secondary neuralgia.
The lesion may be located in the nerve root, plexus or nerve trunk. It is often named after the peripheral nerve involved in the lesion. Local pain caused by stimulation of peripheral receptors by other local lesions and somatic pain caused by lesions of sensory transmission pathways of the central nervous system are generally not included in the category of neuralgia.
Clinical symptoms
Neuralgia and neuropathy occurring after limb trauma, pain, nociceptive hypersensitivity, sensory hypersensitivity occurring after limb trauma; pain initially limited to the site of trauma or the distribution area of the injured nerve, and then may extend to the entire limb; in addition to pain there may also be vasodilator disorders (starting with vasodilated skin becoming warm and dry, later becoming vasoconstricted skin edema, cyanosis, and becoming cold) and excessive or excessive sweating. Skin, subcutaneous tissue and muscle nutritional changes, osteoporosis, etc. Should go to the hospital for consultation and treatment, may be radioactive sympathetic dystrophy.
I. Two common causes.
1. Peripheral neuralgia
(1) Trigeminal neuralgia: commonly caused by inflammatory infiltration, atherosclerotic compression and tumors of the pontocerebellar angle, nasopharyngeal carcinoma, trigeminal ganglion tumors, chordoma, multiple sclerosis, etc.
(2) Pterygopalatine ganglion pain, pterygoid neuralgia, geniculate ganglion pain: seen in paranasal sinusitis, pterygoid sinusitis, septal sinusitis, deformation of nasal cavity structure, nasal septum curvature due to mechanical compression of middle turbinate, skull base fracture, metastatic cancer, herpes zoster virus infection, etc.
(3) Occipital neuralgia : Commonly caused by neuritis, upper respiratory tract infection, influenza, malaria, rheumatism, diabetes mellitus, thyroid disease, alcohol and lead poisoning, occipital and cervical trauma, cervical spondylosis, rheumatoid spondylitis or metastatic cancer, skull base recess, foramen magnum stenosis, atlanto-occipital fusion, atlanto-axial dislocation, incomplete separation of upper cervical vertebrae, submicrocephalic tonsillar herniation, intravertebral canal tumor, tumor of the foramen magnum area, and adhesion spinal arachnoiditis, spinal cord cavitation, suboccipital joint ligament injury, anterior and posterior atlantoaxial arch fracture, atlantoaxial subluxation, cervical muscle injury, etc.
(4) Intercostal neuralgia: common in infectious and toxic radiculitis, pleurisy, chronic pneumonia, aortic aneurysm, mitral stenosis, thoracic organ lesions, thoracic spinal tuberculosis, tumors, ankylosing spondylitis, myeloma, spinal inflammation and other spinal lesions, rib osteoma, rib fracture, bone scab, herpes zoster.
(5) Cervical-shoulder brachial neuralgia, brachial plexus neuritis: common in cervical osteoarthrosis, neck swelling, tumor, herpes zoster, infections such as influenza, typhus flu and malaria, exposure to cold, vaccination with heterologous serum.
(6) Ulnar neuralgia, median neuralgia and lateral femoral cutaneous neuralgia: seen in neuritis, trauma, local inflammation and compressive lesions.
(7) Femoral neuralgia and sciatica: seen in nerve root lesions such as mass compression, lumbar disc herniation, tumor, inflammation and other diseases.
(8) Caudalgia: seen in trauma, fracture, etc.
(9) Burning neuralgia: seen in trauma such as knife cuts, crush injuries, heavy blows, especially firearm injuries, chemical injuries, infections, etc.
(10) Herpes zoster: the cause is caused by varicella-zoster virus.
2.Central pain
(1), spinal pain.
①Posterior horn pain is mostly seen in trauma, tumor, spinal cord cavernous disease, etc.
②Posterior cord pain is seen in multiple sclerosis, spinal cord consumption, etc.
(3) Spinal cord thalamic tract pain is more common in spinal cord cavernous disease.
(2) Thalamic pain: thalamic pain is more common with cerebrovascular lesions and tumors.
(3) Pontocerebral and medullary pain: seen in cerebrovascular disease, tumor, multiple sclerosis, etc.
(4) Cerebral cortical pain: cerebral cortical pain is rare, usually for tumors, vascular disease, etc.
II. Common neuralgia
In some people, when washing face, brushing teeth or eating, they will suddenly feel intense flashing pain on one side of the face, which lasts for about several seconds and is difficult to suffer. In some people, when swallowing, talking or turning the neck, one or both sides of the neck pain is induced, which lasts for several days or weeks and then relieves, and the pain may also radiate backward from the pharynx. Both of the above conditions are due to pain caused by peripheral neuropathy, also called neuralgia. Sciatica, trigeminal neuralgia, and intercostal neuralgia are all included in neuralgia.
Neuralgia is one of the common neurological symptoms. It is pain caused by a peripheral nerve lesion that radiates to the innervation area of that nerve, and the lesion can be in the nerve root, plexus or nerve trunk. Some neuralgia can be triggered or aggravated by coughing, sneezing, or exertion, and can even be aggravated by persisting in a certain posture or position. Sometimes, radicular neuralgia caused by structural lesions of the spine (e.g., herniated discs) can limit spinal movement or increase pain with activity. The common neuralgia are trigeminal neuralgia, sciatica, intercostal neuralgia, etc.
1.Trigeminal neuralgia
Trigeminal neuralgia, with pain in the 2nd branch, is more common at the age of 40 to 50. Patients present with sudden onset of flashing pain on one side of the face, lasting for several seconds to more than ten seconds. The pain is self-reported as burning-like and unbearable. The patient often rubs the painful side of the face with his hands during the attack time in order to relieve the pain. As a result of frequent rubbing, the skin of the face becomes rough and sometimes the eyebrows may fall off. There are intermittent episodes of varying lengths, and the milder ones may occur once every few days or weeks, with longer intervals. The pain can be triggered by actions such as washing the face, brushing teeth, and eating. Treatment is usually with vitamin intramuscular injection of camp nerve, or surgery to cut the nerve, etc.
2.Sciatic nerve pain
Sciatic nerve is the largest peripheral nerve in the human body. It starts from the spinal cord in the lumbosacral region, passes through the pelvis, and penetrates the sciatic foramen to reach the buttocks, and then travels down the back of the thigh to the foot.
Sciatica, its painful episodes can be radiating along the hip, posterior femur, lateral calf, dorsum of the foot, etc., and is accompanied by varying degrees of sensory impairment, lower extremity muscle weakness, reduced or absent Achilles tendon reflexes, reduced lumbar and affected extremity movement when the bunion bends backward to the side of the body, or point and click ring jump.
Sciatica is a common disease. There are many causes of its onset. The most common one is lumbar disc herniation. Others such as spinal tuberculosis, arachnoiditis, and intravertebral metastatic cancer. In addition, sciatica can be caused by sacral arthritis and tumor compression in the pelvic cavity.
Sciatica is pain in the area where the sciatic nerve passes through (i.e., the lower back, buttocks, back of the thigh, outer calf, and foot). The pain increases when the sciatic nerve is pulled, so the patient’s affected lower extremity is often flexed to relieve the pain. Sometimes the pain is aggravated by coughing, sneezing, and straining to defecate.
Sciatica can be treated with B vitamins, herbal medicines to relax the tendons and blood, as well as acupuncture and physical therapy. However, the fundamental solution is to treat the original cause of sciatica. Chinese herbal medicine can be used for treatment. In clinical treatment, Chinese herbal medicine, such as the Chinese medicine Hua Tuo Pulse Tong developed by the Chinese Medical University, has increasingly shown its advantages of treating both the symptoms and the root cause of sciatica, and is increasingly being widely used by major hospitals.
3.Intercostal neuralgia
Intercostal neuralgia can be caused by rib fractures, metastatic carcinoma of the thoracic spine, and herpetic rash. Those caused by band rash can be seen as skin damage within this painful area with heaps of clustered rash, normal skin between the rash, or oozing or redness in severe cases. Therefore, when treating intercostal neuralgia, the main focus should be to treat its primary lesion, and secondly, the pain can be treated to reduce local symptoms.
Clinical treatment
There are many treatment methods for neuralgia, which can be roughly divided into non-invasive and invasive treatment methods. Non-invasive treatment methods include drug therapy, Chinese herbal medicine, acupuncture therapy, physiotherapy and so on. They are suitable for patients with short duration of disease and mild pain. It can also be used as a complementary treatment to invasive treatment methods. Invasive treatment methods include surgical therapy, injection therapy and radiofrequency thermal coagulation therapy.
Acupuncture and physiotherapy are still effective in the treatment of neuralgia, and if the pain is severe, usually 5 to 10 acupuncture sessions may be effective.
IV. Family treatment measures
1. Active prevention
Learning how to sit, stand and carry things properly is the best way to prevent all kinds of neuralgia. Some different physical therapy methods can know how to act correctly to prevent pain attacks, and you can discuss treatment methods with a trained therapist.
2.Massage with an ice pack
Massage with an ice pack can interrupt the signal transmission along the nerve pathway and be replaced by a temperature signal, which can relieve the pain.