Neuralgia

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Central nervous system

Nerve pain; Postherpetic neuralgia

Treatment of neuralgia is aimed at reversing or controlling the cause of the nerve problem (if identified), as well as providing pain relief. Therefore, the treatment varies depending on the cause, location, and severity of the pain, and other factors. Even if the cause of the neuralgia is never identified, the condition may improve spontaneously or disappear with time.

The cause (if known) should be treated. This may include surgical removal of tumors, or surgical separation of the nerve from blood vessels or other structures that compress it. This can be the approach taken for certain cases of carpal tunnel syndrome and trigeminal neuralgia.

Strict control of blood sugar may accelerate recovery in people with diabetes who develop neuralgia.

Mild over-the-counter analgesics such as aspirin, acetaminophen, or ibuprofen may be helpful for mild pain. Narcotic analgesics such as codeine may be needed for a short time to control severe pain. These traditional pain-killers, however, often have disappointing results.

Other types of medications work in different parts of the nervous system and often provide better symptom control. For example, antiseizure medications such as carbamazepine, gabapentin, lamotrigine or phenytoin may be helpful for pain associated with trigeminal neuralgia. The most common side effects of antiseizure drugs are drowsiness, tremor, and incoordination.

Antidepressant medications, such as amitriptyline, may be helpful to control pain in some cases. The topical (local) application of creams containing capsaicin also may help to control pain.

Other treatments may include nerve blocks, local injections of anesthetic agents, or surgical procedures to decrease sensitivity of the nerve. Some procedures involve the ablation (surgical destruction) of the affected nerve using different methods, such as local radiofrequency, heat, balloon compression, and injection of chemicals (such as glycerolysis).

Unfortunately, these procedures do not guarantee improvement and can cause loss of sensation or abnormal sensations.