Neuralgia

Neuralgia is a sharp, severe, and often burning pain that follows a nerve pathway and results from nerve irritation or damage. It can occur anywhere in the body and is usually a symptom of an underlying condition.  

There are several types of neuralgia, each with its own characteristics: 

• Trigeminal neuralgia is the most common type of neuralgia, causing sudden jolts of shooting pain primarily on one side of the face. Everyday activities like toothbrushing can trigger severe pain. This type of neuralgia is often linked to causes like multiple sclerosis or nerve compression. 
• Occipital neuralgia involves irritation of the nerve at the back of the skull that results in dull, throbbing pain, usually in the back of the head. Tense muscles, ligaments, or infections may be contributing factors. 
• Postherpetic neuralgia is associated with the reactivation of the varicella-zoster virus (chickenpox and shingles). This type of neuralgia causes pain and nerve damage after a shingles infection. The pain often persists even after the infection subsides. 
• Peripheral neuralgia (peripheral neuropathy) results from nerve damage in the peripheral nervous system, affecting areas like the hands, feet, arms, and legs. It can lead to pain, numbness, muscle twitching, coordination difficulties, and other symptoms. 
• Intercostal neuralgia is caused by factors like chest injuries, nerve pressure, or viral infections that affect the nerves beneath the ribs, causing sharp, burning chest and upper abdominal pain. Movements like breathing, coughing, or laughing may worsen the pain. 

Neuralgia typically manifests with specific symptoms, including: 

• Increased sensitivity of the skin along the affected nerve’s path, making touch or pressure painful  
• Localized pain that may be extremely sensitive to touch 
• Muscle weakness or spasms 
• Sharp or stabbing pain along the pathway of a damaged nerve, which may be intermittent or constant and burning 
• Tingling, numbness, or involuntary muscle twitching 

The exact location and nature of the symptoms may vary depending on the specific type of neuralgia you have. 

Neuralgia pain arises due to disruptions in a nerve’s structure or function due to nerve damage, compression, or changes in nerve function. Neuralgia can be caused by various factors including: 

• Blood disorders like porphyria  
• Chronic kidney disease 
• Diabetes 
• Infections like herpes zoster (shingles), HIV/AIDS, Lyme disease, and syphilis 
• Medications 
• Pressure on nerves from nearby structures such as bones, ligaments, blood vessels, or tumors 
• Trauma or surgery 

In many cases, the cause of neuralgia remains unknown. 

While there are no specific tests for neuralgia, there are a series of tests and exams your doctor may use to identify the cause and location of your pain. At Penn Medicine, your doctor may perform a combination of exams, including:

• A blood test, to check for infections or other conditions linked to the pain
• A dental exam, to rule out dental causes if the pain is occurring in the facial region
• Imaging, x-rays, and CT or MRI scans, to assess whether any nerves are being compressed or to detect conditions like multiple sclerosis or tumors
• A neurological exam, to pinpoint the location of the pain and assess the affected nerves
• A physical exam, to check for abnormal sensations in the skin, reflex problems, muscle loss, tenderness along nerves, and trigger points where slight touch causes pain

It’s helpful to keep detailed notes about your symptoms, including where they occur in the body, to help your doctor arrive at an accurate diagnosis.