Neuralgia means “nerve pain”, and can encompass shooting pains like sciatica, or hypersensitivity. Shooting pains often come with pins and needles, numbness, or weakness. Hypersensitivity can either be an increased sensitivity to usually painful stimuli, or the perception of pain in response to non-painful stimuli; like bedsheets moving over skin.
Examples of Neuralgia
Technically, sciatica is a neuralgia, but the term is more commonly used for the examples below.
Trigeminal Neuralgia
The diagram above shows the three branches of the trigeminal nerve. Any of these three can be affected by trigeminal neuralgia, which is characterised by agonising facial pain in the area supplied by the affected branch.
Most nerves in the body come from the spinal cord, but the trigeminal nerve is a cranial nerve, meaning it comes directly from the brain. So it doesn’t leave via the spine, but through a small opening in the skull, near the ear. It may be a problem in this area that causes the symptoms, but there are many other potential causes too.
Symptoms manifest as episodes of extreme pain in response to triggers. High or low temperatures, vibration, or touch can be triggers, so things like shaving your face and using cold water might cause an attack. Between attacks, symptoms completely disappear. Understanding your triggers is a key part of managing symptoms.
Post-Herpetic Neuralgia
This is a complication of shingles, which is caused by a herpes virus (hence the name, post-herpetic). The nerve that was affected by the shingles can become sensitised. If the shingles rash is out of sight, such as when it sits between the back of the ribs, you may assume that your pain is caused by residual blisters- but the pain persists once the blisters have started to heal.
For most people, the pain is self limiting, but sometimes the symptoms continue for over a year. Unlike some cases of trigeminal neuralgia, symptoms are not caused by compression of the nerve.
Osteopathic Management
Although there is likely no mechanical factor in either case, your osteopath may still be able to help. Beyond helping you to identify and mitigate aggravating factors, we can help with desensitising the nerve.
Desensitisation Techniques
Whether the pain is a magnified response to normally painful stimuli, or a pain response to something that is normally innocuous, desensitisation can help. Techniques like graded exposure to stimuli, like gently brushing cotton wool over the affected area, have been well researched. We can perform these techniques in clinic, and teach them to you so you can continue the progress at home.
Pain science is complicated, but in the simplest terms, neuralgia causes the nervous system to misinterpret pain. Desensitisation techniques give the brain a gentle reminder that these stimuli are not dangerous, and over time the body reduces its reaction to them. Results may be slow, especially if there are a number of factors maintaining the neuralgia in the first place, but we will aim to find the most appropriate treatment plan for you. This may involve medication from your GP to help make things more manageable in the short term, or a referral to a pain clinic in more severe cases.
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