neuralgia
Meaning of neuralgia: Pain with no injury underneath it, which is why ordinary painkillers disappoint and drugs built for epilepsy and depression do not.
Definition of neuralgia
Neuralgia is pain felt along the course of a nerve, arising from the nerve itself rather than from injury to the tissue where the pain seems to sit. It is typically sharp, stabbing, burning or electric, comes in bursts, and can be set off by light touch that would not normally hurt. The skin supplied by that nerve may also feel numb or oversensitive.
How is nerve pain different from ordinary pain?
Ordinary pain is an accurate alarm. Tissue is damaged, nerve endings in it fire, and the brain locates the trouble. Neuralgia inverts that arrangement. The alarm wire itself is faulty, whether from compression by a blood vessel, damage left behind by a virus, scarring, diabetes, surgery or pressure from a nearby structure, and it fires with nothing happening at the place the pain appears to come from. Two consequences make it recognizable. Light touch that should not hurt at all becomes painful, a state called allodynia, so a breeze, a razor or a shirt collar can set off an attack. A pinprick that should hurt slightly hurts a great deal, called hyperalgesia. The same patch of skin can feel numb and exquisitely tender at once, a combination that sounds contradictory and is characteristic.
What are the common forms?
Neuralgia is named for the nerve involved rather than for a cause, and a handful of patterns recur often enough to carry their own names.
| Form | Nerve involved | Typical pattern |
|---|---|---|
| Trigeminal neuralgia | Main sensory nerve of the face | Brief one-sided stabs set off by chewing or a breeze |
| Postherpetic neuralgia | A nerve scarred by shingles | Burning in the band of skin where the rash sat |
| Occipital neuralgia | Nerves running up the back of the head | Shooting pain from the skull base toward the scalp |
| Intercostal neuralgia | Nerves running between the ribs | A band of pain around one side of the chest |
Why do standard painkillers help so little?
An analgesic bought off the shelf works by damping the chemistry of inflamed tissue, and in neuralgia there is no inflamed tissue to damp, which is why those drugs disappoint so consistently. Treatment borrows from other fields instead. Pregabalin and gabapentin were developed for epilepsy and quiet overactive nerve firing by acting on calcium channels. Amitriptyline and duloxetine came from psychiatry and strengthen the spinal cord's own damping of pain signals, amitriptyline at doses well below those used for depression. Local anesthetic patches, injections around the nerve, and procedures that interrupt or decompress it are used where medicines fail.
Also known as
Used in a sentence
Postherpetic neuralgia persisted in the affected dermatome after the rash had cleared.
Good to know
Neuralgia names where the pain arises rather than what caused it, and trigeminal neuralgia appearing at a young age or accompanied by facial numbness is associated with an underlying cause such as multiple sclerosis or a growth pressing on the nerve.
Word origin
Where “neuralgia” comes from
Neuralgia joins the Greek neuron, meaning nerve or sinew, with algos, meaning pain.