Neuropathic Pain (29)
(ĐTĐ) - You might think that as an adult you’re safe from the chicken pox, but there’s a grown-up version of everything. Shingles is a viral infection of the nerves that is caused by the same virus as the chicken pox; people who had that itchy illness as a child sometimes get shingles later in life as the virus reactivates.
(ĐTĐ) - The definition of a headache is pain that is arising from the upper neck or head. This pain comes from the tissues and other structures surrounding the brain because the brain actually has no nerves that the sensation of pain can come from.
(ĐTĐ) - The myofascial pain syndrome is a medical condition that is as real as it is mysterious. Although it is acknowledged as a medical condition in its full rights, the harsh truth is that no research has been able to reveal precisely what its causes are.
(ĐTĐ) - Carpal tunnel syndrome is caused by the compression of the median nerve which runs through the carpal tunnel in the wrist. Its causes are uncertain, but it’s generally assumed that any position that causes stress on the nerve can be a cause. It is often worse from flexing the wrist. The syndrome causes a feeling of numbness and pain in the thumb, pointer finger, long finger and parts of the ring finger. The only digit unaffected is the pinkie finger.
Carpal tunnel syndrome is diagnosed largely from the presence of suspect symptoms, like pain and numbness in the hand. To increase certainty, the syndrome does not have a blood test, but there are physical tests that a doctor will ask you to perform. The doctor actually also has some electrical tests that he or she can use as well.
Given our modern dependence on typing, carpal tunnel syndrome has become a more common issue.
Nerve Conduction velocity test
This isn’t a test specifically for carpal tunnel syndrome, but it is used to check for abnormalities in nerve responses that might indicate the presence of the syndrome. In this test, an electrical current is introduced to the nervous system and the speed with which it reaches nerves “downstream” is measured. A slow response is indicative of some kind of issue with the nervous system. The electrical stimulus is generally introduced through electrodes placed on the patient’s skin.
This is often conducted at the same time as the Nerve Conduction Velocity test. It is a test specifically designed to find any muscular conditions that may be mimicking nervous conditions. Muscles also produce electrical signals when they are active, and so electrical abnormalities might also point to muscular issues rather than nervous conditions like carpal tunnel syndrome.
While, as mentioned, there isn’t a specific blood test to test for carpal tunnel, there are tests to check related issues. There is something thyroid hormone levels, a test to check blood sugar and protein analysis. As stated, none of these will be definitive of carpal tunnel, but they can point to it being more or less likely.
Again, because carpal tunnel syndrome is a nervous condition, X-rays will not be able to find it specifically. However, they can find bone and joint abnormalities in the bones of your wrist and therefore are able to give an indication that the syndrome exists.
However, the main indication that is used for diagnosis of carpal tunnel syndrome is the existence and medical examination of physical symptoms. This will include a general examination of the area as well as more specific physical tests.
A physical exam with a focus on your neck, arms, wrists, and hands is done if there is tingling, numbness, weakness, or pain of the fingers, thumb, or hand. The exam is to help find out whether your symptoms are caused by compression of the median nerve as it passes through the carpal tunnel in the wrist.
During this examination, a doctor will also examine your wrists and hands to compare the strength and appearance of both sides. You will then be asked to pinch an object so your doctor can see and check your thumb for strength and movement during this movement.
Not only is it important to isolate issues you are having in your hand from muscular or other physiological problems, it is also necessary to ensure that your pain is being caused by the median nerve rather than a different nerve in another part of your body. The neck, especially, can mimic carpal tunnel issues, so if your doctor suspects neck-related problems, he or she will also check your neck for possible nerve compression.
Tinel’s sign test
This test dates back to the early 1900s when physiologist Paul Hoffman found that mild percussion of an injured nerve could illicit the sensation of “pins and needles,” or a feeling like an electrical shock.
Your doctor taps on the inside of your wrist over the median nerve. If you feel tingling, numbness, “pins and needles,” or a mild “electrical shock” sensation in your hand when tapped on the wrist, you may have carpal tunnel syndrome.
Phalen’s sign test
This test dates to the 1950s when physiologist George S. Phalen describe a new method for diagnosing carpal tunnel syndrome. The sensations caused by Tinel’s test might be caused by different nerves and not necessarily the median nerve which is affected by carpal tunnel syndrome. Therefore, by using Phalen’s test as well, you could be more specific with your diagnosis.
In the test, you will hold your arms out in front of you and then flex your wrists, letting your hands hang down for about 60 seconds. If you feel tingling, numbness, or pain in the fingers within 60 seconds, you may have carpal tunnel syndrome.
Two-point discrimination test
This test is used when severe carpal tunnel syndrome is suspected. It is not very accurate for mild carpal tunnel syndrome. To do the test, your doctor has you close your eyes and then uses small instruments, such as the tips of two opened paper clips, to touch two points (fairly close together) on your hand or finger. Typically, you would feel separate touches if the two points are at least 0.5 cm (0.2 in.) apart. In severe carpal tunnel syndrome, you may not be able to tell the difference between the two touches, so it may feel as though only one place is being touched.
Given our modern dependence on typing, carpal tunnel syndrome has become a more common issue. While treatment may be as straightforward as simply stopping the activity which causes the syndrome, sometimes more serious measures are required. These can include surgery to alleviate your symptoms, so it is good to be aware and catch the syndrome early, before it becomes severe enough to require more drastic measures to treat.
(ĐTĐ) - Sciatica is the largest nerve is your body. This nerve that runs from nerve root of the spinal cord, down the lower lumbar region of your back, across your buttocks. From there it travels down the backside of your legs, branching off into the feet and toes. When this large nerve’s pinched, it causes excruciating pain that can radiate down the length of the nerve.
Sometimes the pain is a burning, numbness or tingling that is felt in the buttocks, hips and legs but not the lower back. These pains seem too intense when a person is walking, bending, lifting, stooping over, coughing, standing, straining or sitting for a long time. This pain can become so severe that even the slightest movement’s painful.
What are the causes of this type of nerve pain? What are some the treatment options available? You will find the answers to all your questions in the following paragraphs.
What’s Causing Me to have so Much Pain?
- An injury can cause this type of pain. It doesn’t have to be a major accident, just enough that the nerve becomes pinched which causes irritation and inflammation.
- Sciatica nerve pain can also occur if you’re pregnant and the extra weight’s compromised the nerve.
- An infection, muscle, bone, or tumor pressing on the nerve might cause inflammation, swelling which will cause this type of pain.
- Some other causes include herniated disk, at the lumbar region that’s pressed and irritated the nerve, and as radiculppathy which is an abnormal intervertebral disk
How will the Doctor Know?
The doctor will first get a medical history, and then he will do his exam. With the symptoms you are experiencing, and his finding, he will make a diagnoses. Once completed, he will order some type of imaging like MRI, x ray or CT scan to the cause.
What Medicines Will Relieve My Pain?
The doctor will first prescribe bed rest. 70 % of patient’s improves with resting. He might advise you to try over the counter non-steroid anti-inflammatory medicines like, Motrin, Aleve and naproxen. These will reduce the irritation and swelling, which reduces the pain. He might suggest topical NSAID sports creams. If your pain’s real severe, he might prescribe muscle relaxers, or a stronger pain medicine. Some even prescribed a combination of anti-convulsing anti-depressant. This combination has been shown to work well to alleviate pain. The doctor may put you on a central nervous system depressant. This decreases the neuron pain signals to the brain.
Top 10 Remedies For Pain Relief
Some people use ice packs on the inflamed nerve. Never apply ice directly to the skin. Leave it on for 20 minutes, then remove for a half hour. Warm, moist heat works well. There are several ways to accomplish this. Soaking in a nice warm tub of water relieves soreness. You can also apply warm, moist heat with a hot water bottle.
Be sure it isn’t too hot and the lid is secure. Never apply the water bottle directly to the skin. A damp towel warmed up in the microwave will work just as well. Be sure not to get it too hot. Rice packs warmed in a microwave is effective. The rice socks stay warmer, longer than a towel.
Some use biofeedback to relieve stress and pain. Biofeedback is where a physical therapist attaches electrodes to different areas of a person’s body and then to a device. This device to get \measures your body’s response to different stimuli by recording heart rate, blood pressure, respirations, tension in your muscles, temperature and brain waves.
The machine will then make different noises as these things change. With the physical therapist’s help, you will be able to learn how to control these body functions, which will help control your pain.
Many people find that massaging the deep tissue helps relieve their pain. Using a nice warmed stress relieving herbal oil will enhance the massage. I suggest Rosemary, Jasmine, Rose or lavender. Others use a deep pressure massage. This applies pressure to specific areas to relieve the pain. Tennis balls work well with this type of massage.
Be sure not to apply too much pressure and don’t overwork the muscle afterwards. Some say a warm bath before this type of massage works best to alleviate some of the possible bruising, while others say a bath afterwards helps to relieve any of the remaining pain.
Some people find that acupuncture helps with their sciatica nerve pain. What happens is a chiropractor places tiny needles in varying pressure point areas of your body. Many believe this will overload the nerve receptors, which will decrease the pain signals. While other people believe it works because it stimulates your body into releasing different chemicals in your body and that relieves the pain. Although the exact reason why this therapy works is unknown, studies show it does relieve pain and helps with a lot of other aliments as well. Sometimes when a person stretches, this will move the obstruction that is pinching the nerve, which will help with pain relief.
The 10 Best Herbs to Relieve Sciatica Pain
Sometimes the best cure is found in Mother Nature herself. If fact Herbal medicines was once the only source of treatment, but as penicillin and other medicines was introduced the herbs were forgotten. Now with all the drug recalls, many are turning to alternative, holistic medicines. I’ve listed the ten best herbs to help relieve sciatica pain.
- Rue is well known for its relief of sciatica pain.
- Wild lettuce helps relieve pain and it helps with insomnia.
- Willow it’s an anti-inflammatory herb.
- Skullcap it helps with stress, anxiety, fatigue pain and insomnia.
- Meadow sweet alienates pain.
- Black pepper helps relieve pain.
- Mullein root is used for nerve pain, for muscle spasms.
- Black birch is a pain reliever and it helps with digestive issues.
- St Johns wart helps with nervousness, anxiety, fatigue and pain.
- Wintergreen massage into the affected area to help relieve pain and swelling.
(ĐTĐ) - The sural nerve runs down through the center of the calf muscle and is one of five nerves that provide sensation to the foot. It travels down the back of the leg, over the Achilles tendon, and then along the outside of the foot to the end of the little toe. Comparatively, it is a fairly minor nerve, since it only provides sensation on the outside of the foot and areas between the 4th and 5th toes.
Sural Nerve Pain Causes
While the nerve may be minor in scope, it is capable of creating a fair amount of pain and discomfort when it is irritated. Though anyone can develop this condition, it is often related to surgery in the area. When it isn’t caused by surgery, it will often be athletes who will develop it, since they regularly put stress on the area. Luckily, they are also on the look-out for foot related nerve conditions, and see doctors familiar with athletic issues on a regular basis.
Because the nerve is just under the skin, it is particularly susceptible to compression from tight shoes that put stress on the Achilles tendon. The sural nerve can be compressed between the tendon and the shoe, and the pressure can then cause something called neuritis.
Sural neuritis can also be caused by something called “entrapment.” What this refers to is when the nerve becomes tangled in scar tissue which then puts pressure on the nerve and creates pulling. This is, in fact, more serious than pressure created by a shoe. For one thing, this is a great deal more difficult to relieve. For another, the scar tissue involved is often the result of surgery in the area, so the sural neuritis can actually be conceived of as a negative side effect of surgery.
There are several likely surgical culprits that might cause sural neuritis. The most common are Achilles tendon lengthening surgery, Achilles tendon surgical repair after a torn tendon, ankle fracture surgery for a broken ankle, flatfoot surgery and fifth metatarsal fracture surgery. This list isn’t exhaustive, but it’s reasonably well known that neuritis is a risk when these surgeries are conducted.
Sural Nerve Pain Symptoms
The symptoms of sural nerve entrapment are fairly straight-forward. Generally, the symptoms are pain, and/or a numb or tingling feeling on the outside of the foot. This will only rarely have an effect on your gait, but it can definitely cause a great deal of discomfort.
Unfortunately, this can develop over time, and so people may not feel motivated to get this treated right away. In addition, this may present in combination with other pain from foot exertions, so people may just see this as a standard part of the achiness that comes with being on your feet too much.
Sural Nerve Pain Diagnosis
Because this is such a specific kind of irritation in such a small area, the diagnosis of this condition is not necessarily that difficult. That said, there still isn’t a positive test for neuritis, and your doctor will need to engage in a process of elimination. What that means is that they will investigate your symptoms and then use tests to rule out other causes. Also, because of the nerve’s location, problems with the sural nerve may easily be confused with Achilles tendon issues instead.
Especially confusing is that sural neuritis can often present as Achilles tendinitis. However, this is more to do with pronation or supination of the ankle, rather than nerve issues. So, at least, there are physical symptoms that one might be able to observe.
One of the tests that is done, is called the Tinel’s test. What this involves is percussion at the site of the nerve, in this case, the ankle. If the percussion results in tingling, pins and needles or electric shock sensations in the area, then the test is positive. A positive test is a sign of neuritis.
More technical measures might include radiography. This will rule out problems with the bones in the area. It may pick up evidence of arthritis or stress fractures that are causing you pain, and are more serious conditions.
It might be required for you to get a magnetic resonance imaging test as well. These will be used to eliminate the soft tissues in the area as the source of your issues.
Finally, your doctor may also decide to use diagnostic nerve blocks on the area. The nerve block will do just that, blocking sensations of pain and discomfort from being transmitted to the brain. The nerve is anaesthetized and then the remaining pain is assessed. If your pain is ultimately relieved by putting the sural nerve to sleep, there is a very good chance that the sural nerve is the source of your problems.
Sural Nerve Pain Treatment
Treatment can involve self-care measures, medication and also more radical measures, like surgery might be required. Like a regular type of injury, the sural nerve will respond to cold temperatures. The first thing to do is to apply ice to the area to ease irritation and inflammation of the nerve.
Make sure your shoes aren’t responsible for the compression. If your footwear has straps or seams that press on the Achilles tendon, then it’s time to replace them.
You can also start taking non-steroidal anti-inflammatory drugs like ibuprofen. These drugs are not only pain relievers, they also act to reduce inflammation, which will relieve both the irritation and pressure on your sural nerve.
Your doctor may also decide that steroid injections as well. These are done to relieve inflammation, so it will relieve the stress on the nerve.
Finally, if there are no other options left, then it is possible that surgery may be used to release the nerve from entrapment. As in most conditions, surgery is a last resort, undertaken when there don’t seem to be other measures that will be helpful.
(ĐTĐ) - Paresthesia is a term referring to a burning or prickling sensation that people may experience within their legs, arms, hands or feet. It may also occur in other parts of their body. The sensation, sometimes, occurs without warning and is a mostly painless sensation. It’s best described by its tingling, numbness and distinct skin crawling feeling.
Most people actually experience a temporary form of paresthesia when they sit with their legs crossed or sleep with their arm underneath their head for too long. That’s why many people feel a brief ‘pins and needles’ sensation when they constrict the blood flow, muscles and even nerves of their limbs in that way.
People also feel ‘pins and needles’ when they place prolonged pressure on any of their nerves. The sensation, however, does fade away once the pressure gets relieved. Though, paresthesia is a condition that doesn’t fade away like its temporary version. The chronic version of paresthesia doesn’t fade away as fast, and it’s often a symptom of an underlying neurological condition or even traumatic nerve damage.
A look at chronic paresthesia
Chronic paresthesia, also known as intermittent paresthesia, may originate from disorders that affect the central nervous system, such as transient ischemic attacks or strokes, multiple sclerosis or encephalitis. Vascular lesions or tumor-like growths may press against a person’s spinal cord or brain and cause paresthesia to develop. However, the development of paresthesia from those conditions is considered rare. In most cases, paresthesia develops after a person experiences nerve damage from infections, trauma, inflammation or other conditions. To fully understand how paresthesia develops in people, we invites our readers to take a look at the causes of the condition in the next section.
The causes and symptoms of paresthesia
Paresthesia is an interesting condition in that its symptoms originate from a wide range of possibilities. In other words, paresthesia may have many potential causes. In the last section, we mentioned some of paresthesia’s potential causes. Here’s a brief look at more potential causes:
- Nerve irritation
- Multiple sclerosis
Some rare causes of paresthesia may include:
- Fabry disease
- Lyme disease infection
- Beta-alanine ingestion
- Heavy metal poisoning
- Lidocaine poisoning
- Guillain-Barre Syndrome
Paresthesia also has orthopedic causes, typically originating from conditions that may injure and/or damage the nerves. Those causes include back or neck injuries, bone fractures, herniated discs, osteoporosis, nerve pressure or entrapment and degenerative disc disease. Many of the aforementioned causes make people with paresthesia develop symptoms. While paresthesia is considered a symptom of many conditions, the condition itself makes people experience symptoms. When paresthesia is caused by another condition, people with paresthesia may experience symptoms related to that aforementioned condition; in rare cases, those symptoms might worsen their paresthesia symptoms.
Common symptoms of paresthesia typically include:
- Itching, numbness and tingling
- Foot drop
- Crawling sensation within the skin
- ‘Sleeping’ limbs, including the arms and legs
- Restless leg syndrome
- Muscular atrophy
- Ocular dysmetria
Doctors typically diagnose paresthesia based on a person’s medical history, a complete physical examination and/or laboratory testing. This typically helps them find the suspected cause of the condition. Paresthesia may cause complications. Since it often develops from diseases affecting the nervous system or nerve damage, people with paresthesia need to seek immediate treatment to prevent themselves from experiencing any complications that might lead to permanent damage.
Some of those complications may include permanent or chronic pain, disabilities (involving mobility), paralysis, an inability to independently breathe and a permanent loss of sensation. Of course, treatment for paresthesia helps people avoid contracting permanent or chronic complications from the condition. In the next section, we’re going to review some of those treatments.
A look at treatments for paresthesia
Treatment for paresthesia is based on the diagnosis of the condition, meaning people with different diagnoses relating to paresthesia will have different recommended treatments for their symptoms. People with limbs that fall asleep, due to paresthesia, may be recommended stretching, exercising or massaging for their affected limbs. This helps eliminate their tingling sensations and feelings of numbness. People who have paresthesia originating from another chronic disease may be recommended treatments aimed at providing relief for their symptoms.
Anti-inflammatory medications, such as ibuprofen or aspirin, are commonly recommended for people with mild paresthesia. Severe cases of paresthesia require stronger medications. Antidepressants, such as amitriptyline, are typically given to patients with the aforementioned form of paresthesia. They’re typically administered at lower doses than what they’d be administered for depression relief. That’s because the low dosages affect how people perceive pain within their body, providing potential relief to the parts of their body affected by paresthesia. Those with worsening paresthesia may be given opium derivatives like codeine to relieve pain.
Human nerve growth factor and paresthesia?
Human nerve growth factor, a small secreted protein, may play a role in paresthesia treatment in the future. This small secreted protein is important for the survival, growth and maintenance of specific neurons or nerve cells, while also functioning as a signaling molecule. As of now, it’s known to prevent or reduce neural degeneration from neruodegenerative diseases in animal models.
Due to those results, many medical researchers are exploring the possibility of human nerve growth factor playing a role in helping heal nerve degradation and restore damaged nerves. It may be a key element in paresthesia treatment in the future, in addition to treatment for conditions like depression, dementia, depression, schizophrenia and autism.
Several alternative treatments for paresthesia also exist. They mainly help with relieving the immediate symptoms of the condition.
Nutritional therapy involves the use of vitamin supplements. Vitamin supplements, like B-complex vitamins, can help restore the nervous system’s normal functions. Interestingly enough, B-complex vitamins like B6 should be used as directed, since an overdose of B6 is known to cause paresthesia.
Acupuncture and massages also help relief paresthesia in different ways. It’s suggested to find a massage therapist or acupuncture specialists who are trained in performing their corresponding treatments on people with paresthesia.
Self-massages also provide short term relief. Massages with aromatic oils have a soothing effect, especially when using essential oils with an active effect that soothes the skin and underlying tissue. Some essential oils that may provide relief for paresthesia and other types of nerve pain include peppermint, sandalwood, chamomile, lavender and marjoram.
(ĐTĐ) - The sciatic nerve is a large nerve in both humans and animals. It’s so large that it stretches throughout several portions of the body. It begins in the lower back, and then runs through the buttocks and right down the lower legs and feet.
Even though it’s a large nerve, the sciatic nerve is still susceptible to inflammation and outright injury. And, when that nerve gets injured or inflamed, it affects the parts that it influences. The skin of the leg, the muscles of the back of our thighs and the rest of the legs and feet are all affected by this large nerve. When the sciatic nerve becomes injured or inflamed, people feel what’s known as sciatic nerve pain. At our Online Guide for Chronic Body Pain, we’re going to take a closer look at how you can relieve sciatic nerve pain—with the guidance of yoga.
How sciatic nerve pain develops
Sciatic nerve pain is best described as sciatica, since it describes all of the symptoms that occur when the sciatic nerve gets injured or inflamed. Most people feel a shooting, sharp pain down their buttocks, legs and, sometimes, to their feet when they first develop this condition. That pain originates from several sources, interestingly enough including yoga itself. That’s because activities like yoga may end up compressing, overstretching, spraining or even outright damaging the area around the sciatic nerve.
Any pressure resulting from the damage may bear down on the sciatic nerve, sometimes even pinching the nerve, to cause the characteristic shooting or stinging pain many experience. In the medical community, however, many experts agree that most sciatic nerve pain originates from the spine, particularly the spinal discs in cases where they become misaligned, damaged or have worn down. Even genetics might play a role in causing sciatic nerve pain, in addition to other conditions like infections and trauma.
Yoga and sciatic nerve pain
So, you’re probably wondering how yoga might make sciatic nerve pain feel worse. It’s pretty simple to explain. When we perform yoga stretches, we’re stretching our muscles, ligaments and the underlying nerves. Sometimes, the nerves become stuck if they’re moving around, stretching the nerve past its capabilities. That’s what causes nerve pain in many people. The sciatic nerve is actually a network of spinal nerve roots that form from the spinal cord (between the lower lumbar vertebrae and the sacrum. When sciatica develops, it’s usually because these nerve roots have been compressed in some way.
The main culprit of that is the Piriformis muscle, since the fibers of the muscles more or less cushion part of the sciatic nerve. When there’s tension in the muscle, it compresses the nerve, which might lead to its characteristic sciatic nerve pain. Interestingly enough, only 15 percent of people are affected by the Piriformis muscle causing sciatic nerve pain. Other people may experience sciatic nerve pain originating from issues with their sacroiliac joints.
Yoga might also cause sciatic nerve pain by:
- Compressing the nerve roots, if a person performs extreme back bending
- Stretching and/or damaging the sciatic nerve through holding asanas (like Kurmasana) for long periods of time
- Practicing too many leg strengthening postures, causing the hip muscles to over stretch
Even though yoga might cause a lot of damage to the sciatic nerve, that doesn’t mean you should rule out yoga entirely. Yoga is actually an alternative treatment for sciatic nerve pain. Though, in order to use it right, you need a great licensed practitioner to show you how to perform yoga right.
Yoga for sciatic nerve pain
Yoga helps relieve sciatic nerve pain mainly through helps strengthen the area surrounding the sciatic nerve without causing any pain or, rather, causing as little pain as possible. Hamstring stretches also play a large role in using yoga for relieving sciatic nerve pain. These stretches safely stretch the hamstrings or the muscles of the back of the thigh. Let’s look at two distinct ways yoga stretches help relieve sciatic nerve pain.
If the sciatic nerve pain originates from a herniated or bulging disc, yoga using gentle poses that progress to foundational asanas like standing poses or downward-facing ‘dogs’ are used for treatment. These poses help align, lengthen and eventually strengthen the lower back.
If the sciatic nerve pain originates from pressure bothering the nerve, it’s usually due to the Piriformis muscle. So, in order to treat it, yoga stretches that target that muscles are used. Before performing the exercises themselves, most people start off with deep breathing (ujjayi breathing). Deep breathing allows the muscles within the lower back to relax and allow people to better connect with their yoga for sciatic nerve pain.
Yoga poses for sciatic nerve pain
We’ve talked about how yoga can help people relieve their sciatic nerve pain, but we haven’t yet looked at any poses. Well, now’s the time for that. Here’s a look at three yoga poses for sciatic nerve pain:
Locust Pose ~ Salabhasana
This is considered one of the gentlest back bends around. It helps strengthen the area surrounding the sciatic nerve. It also opens the area to better blood circulation, more or less helping the area heal better. The pose starts us off on our stomachs. Then, rest your arms to your sides with your palms facing up. When you inhale, lift your chest and arms; when you’re comfortable, lift your legs. Hold to five breaths and repeat twice when you’re ready.
Half ‘Lord of the Fishes’ Pose ~ Ardha Matsyendrasana
This pose benefits people with a distinct tightness within the Piriformis muscle. It might, however, benefit people who do feel the same tightness, but don’t necessarily have a malformed Piriformis muscle. Start in a comfortable seated position. Bend your knees, and then (on your inhale) cross your left leg over your right knee. Cross your right elbow over your left knee, coming to a twist. When you do this, you should feel a stretch run through your left buttocks and into your thigh. Hold the position for 10 breaths and then switch sides. If you feel too uncomfortable, fold a blanket and place it underneath your seat for support.
Cobra Pose ~ Bhujangasana
This pose also helps strength the muscles around the sciatic nerve, while helping boost blood circulation within the lower back area. Start on your stomach, keeping your pubic bone and upper thighs pressed to the mat. When you inhale, lift your chest and straighten your arms. Bring your shoulder blades together (to the back) and open your heart. Hold your pose for 10 breaths.
(ĐTĐ) - The sciatic nerve, also known as the ischiadic nerve, is a large nerve in both humans and animals. In fact, it’s the longest and widest nerve in the human body. This particular nerve starts in the lower back and runs through to the buttocks and down the lower limbs.
As the longest nerve in the human body, it affects the legs’ skin, in addition to the muscles on the back of the thigh and the foot and leg. The nerve essentially controls how people feel different types of sensations and move the muscles within their legs.
Even though our sciatic nerve is the largest nerve in the body, it isn’t immune to contracting ailments. One of the most common ailments of the sciatic nerve is best known as sciatica, otherwise known as sciatic nerve pain.
About sciatic nerve pain
Sciatica describes the symptoms affecting the sciatic nerve when it’s inflamed in some way. It mainly occurs when pressure from the back or inflammation makes the sciatic nerve feel painful. For most people, sciatic nerve pain is caused by a ruptured or bulging (also known as herniated disc) within the spine. The pain develops when the damaged disc bears down onto the sciatic nerve roots.
Sciatica is also considered a symptom originating from other spinal conditions, including spinal stenosis, small bone growths (spurs) from arthritis or compressed/pinched nerve roots. Sometimes, sciatic nerve pain may develop from conditions that might not involve the spine. Those conditions include pregnancy (for women) and tumor growths.
Sciatic nerve pain in pregnancy
Although sciatic nerve pain develops in pregnant women, women aren’t more likely to develop sciatic nerve pain if they’re pregnant. Most cases of pregnancy-induced aches develop in the back and pelvis, not particularly around the sciatic nerve. Some women, however, do experience pain originating around their sciatic nerve. The sciatic nerve runs underneath the uterus and throughout a woman’s legs. Due to this placement, many believe sciatic nerve pain may be associated with the pressure that the womb places on the nerve throughout pregnancy.
How sciatic nerve pain develops in pregnant women
In women, sciatic nerve pain often develops when their baby’s head presses against their sciatic nerve region. This causes pressure to build in that particular region, eventually leading to sciatic nerve pain. Sciatic nerve pain often occurs throughout a pregnancy, though most instances happen during the second and third trimesters. It usually happens in those trimesters, since the baby is larger and often in a much lower position within the abdomen.
Symptoms of sciatic nerve pain in pregnancy
Pregnant women who have sciatic nerve pain may feel a shooting, often burning pain affecting their lower back or buttocks area. Sometimes, women feel the pain affect just one side of their body, while others often feel the pain affect both sides. Women with sciatic nerve pain are known to feel pain in their lower back, down the back of their legs, their feet and the back of their thigh.
Some feel a burning and/or tingling sensation within their leg, numbness and/or ‘pins and needles’ within the legs or feet. While the pain manifests in the aforementioned places of the body, it’s also known to appear ‘patchy’ on occasion.
Sciatic nerve pain is also known ‘wear down’ people with the constant pain, especially pregnant women. The pain completely limits their mobility, in some cases, since the baby’s positioning can’t be moved until their baby is born.
Sciatic nerve pain and labor
Sciatic nerve pain may affect how women position themselves during labor. To accommodate their situation, their physiotherapist, midwife or other health care provider may provide suggestions (like a birth pool) to make the birthing process much easier on women with sciatic nerve pain.
Women also have to make accommodations after labor to manage their sciatic nerve pain. They’re advised to look after their posture, meaning they should be careful about how they position themselves with or without their child.
If breastfeeding, to provide an example, they should sit on a straight-backed chair, keeping their baby raised to their breast with a pillow or cushion. They should also keep their feet flat to the floor. If lifting their baby, they should keep their back straight, bend their knees and avoid making any sudden twisting movements.
After birth, it’s also recommended for women to ask their health care providers for advice about managing and recovering from sciatic nerve pain.
Treating sciatic nerve pain during pregnancy
Pregnant women with sciatic nerve pain are advised to lie on their side, the side opposite of the one in pain. This is likely to help relieve any additional pressure that might be placed on the nerve.
They should also avoid any heavy lifting and standing for prolonged periods of time. If they do feel any pain when they stand for long periods of time, they should elevate one of their feet by resting it on something.
Hot and cold compresses (like ice packs or heating pads) help relieve some pain. Painkillers like acetaminophen may be recommended to help subside some of the pain. Other anti-inflammatory drugs, including ibuprofen, also help alleviate symptoms from sciatic nerve pain. Most pregnant women, however, will be suggested alternative pain-killing medications that won’t harm their pregnancy by their doctor.
Most women with sciatic nerve pain in pregnancy end up recovering within 6 weeks of having the condition. As much as 90 percent of all pregnant women with sciatic nerve pain end up recovering within 12 weeks. In uncommon and, sometimes, rare cases, some women end up having sciatic nerve pain for longer than 12 weeks.
Women with prolonged sciatic nerve pain from their pregnancy should seek immediate medical attention if it increases in frequency or severity. Physical therapy, such as chiropractic and osteopathy may be recommended for pregnant women with sciatic nerve pain, especially if they have long term pain.
(ĐTĐ) - Peripheral Neuropathy is a disorder that results from damage to the peripheral nerves. The nerves other than the ones found in your brain and spinal cord. This set of nerves receives electrical impulses from the brain and spinal cord, the central nervous system and sends them to other parts of your body.
In addition, it’s responsible for relaying messages from other body parts, back to the central nervous system. This communication is how your body knows what to do, when problems occur. Damage to the peripheral nervous makes it difficult to send and receive messages, this causes complications to arise.
Symptoms of Peripheral Neuropathy
Some of these symptoms include numbness, prickling or tingling feeling.You can have a burning feeling that seems to worsen at night. The slightest touch might be painful. You can have muscle twitches.Neuropathycan affect the sense of touch, which makes it difficult to tell the difference between hot and cold.
You may have difficulty with zipping and buttoning. Sometimes the damage is so severe, that a person might have muscle weakness, which leads to difficulty with mobility, balance and possible atrophy. They could have bone loss and organ dysfunctions, like digestion issues, incontinence, and erectile dysfunction.
Types of Peripheral Neuropathy
There are two types of neuropathy, chronic and acute. Acute is usually caused by a disease. The symptoms and progression is generally sudden. It takes a while to recover. With chronic neuropathy the symptoms and progression is slow. Sometimes their symptoms will remain the same for a while and usually decrease before an attack. Unless enhanced by a disease, chromic neuropathy is seldom fatal.
12 Causes of Peripheral Neuropathy
Why do I have Peripheral Neuropathy?
There are several ways Peripheral neuropathy occurs. I will explain a little about each in the paragraphs below.
1- Injury is the most common cause of nerve damage. This can be from sports, falls, car or motorcycle accident. The damage can be minor like a pinched nerve, or so severe that the nerve’s completely severed.
2- Diseases can cause this disorder to occur. This is especially true when it affects the endocrine system. In fact, over half the people with diabetes have some form. Making diabetes the number one reason for peripheral neuropathy.
- Liver and Kidney disease. If the toxins in our blood become extremely high this can cause nerve damage.
- Autoimmune disease are where the immune system attacks and destroys its own tissue. Sometimes this destruction can lead to nerve damage.
- Lyme disease can cause nerve damage. This disease occurs when a person is bitten by an infected tick. Neuropathy generally occurs within the first couple of weeks after the initial bite.
3- Hormonal changes can cause nerve pain. Our hormones affect how our body functions so a decrease in thyroxin can cause fluid overload which could compromise nerves. The overabundance of the growth hormone causes a person’s bones to grow larger than they should and this increase in bone structure, can pinch nerves.
4- Vitamin depletion our body needs all the B vitamins, Vitamin E and niacin, in order to function properly. A lack of these vitamins causes disruption in the nerve impulses which creates neuropathy.
5- Alcoholism because of their poor eating habits, lack of thiamine and the alcohol consumption, they can have what’s known as alcohol neuropathy.
6- Damage to the blood vessels can decrease the oxygen and other essential nutrients to specific areas and this can cause neuropathy to occur. These blood vessels could be blocked from plaque buildup, or they can become hard, stiff.
7- Inflammation when an area becomes inflamed swelling occurs and this compresses the nerve causing damage. Sometimes the inflamed tissue causes nerves to become inflamed, which can lead to injury, infection and nerve damage.
8- Tumors sometimes benign tumors can grow on the nerve which can cause extreme pain. These tumors can spread to surrounding nerves, causing pain to increase. Diseases and injuries causes tumor to develop.
9- Muscle Tendon and Ligament Damage overworking a specific body area will cause injury. This injury can cause pain and swelling, which causes the surrounding nerves to become compromised.
10- Toxic substance,exposure to harmful chemicals can cause nerve damage. This is why it is so important to wear protective gear when you have to be around them.
11- Infections certain infections can cause nerve damage some of them include the herpes virus like Epstein-Barr, cytomegalo virus and HIV.
12- Genetics Sometimes genetics cause neuropathy to occur. Some can begin in infancy while others start until early adulthood.
The doctor will first get your medical history. He will then ask you about your work, extracurricular activities and alcohol consumption. He’ll ask about risk factors like HIV, toxin exposure and exposure to other infections. He will ask about your family medical history. He’ll do aphysical, neurological exam and order blood work. He might order an MRI, CT scan to determine the extent of the damage, and a spinal tap to confirm the diagnosis. A doctor may do a biopsy of the skin or nerve.
He could order an EMGto determine if it’s muscle or nerve‘s that’s causing the pain. This involves inserting tiny needles into muscles to measure electrical impulses. He might do a NVE nerve conduction test. This will determine the extent of the damage and what’s causing the symptoms to occur. What happens is a probe sends electrical impulses in the body. The doctor will measureresponse time and the impulse speed.
The doctor will want to treat the cause of the neuropathy. This will prevent further damage from occurring while the nerves repair. The doctor will treat the symptoms. This could include things like pain medicines, muscle relaxers, Immunosuppressive medicine, immunoglobulin’s, antiepileptic drugs, antidepressants, anticonvulsant, and local analgesic, He might prescribe assistive devices. The doctor will suggest you start eating a well-balanced diet and take a multivitamin daily. He will recommend an exercise program, perhaps advise you to see a physical therapist. He’ll suggest you stop smoking andlimit alcohol intake.
Living with nerve pain can be a long-term proposition. Some neuropathic pain gets better with treatment or on its own, but that can take months or years. Other nerve pain stays the same for years or worsens slowly. Some nerve pain can't be reversed.
Your doctor can help you identify and treat your neuropathic pain with the best available therapies. But there are also plenty of things you can do on your own to take care of yourself and your pain.
What Causes Nerve Pain?
Neuropathic pain comes from nerve damage. Most commonly, this is caused by medical conditions such as diabetes, side effects from drugs or chemotherapy, or injuries.
Damaged nerves are more likely to misfire, sending pain signals when there is no cause for pain. They can also put you at risk for more serious problems such as foot infections.
All the causes of nerve pain are still largely a medical mystery. Researchers have identified several different ways nerves can misfire, and this has led to treatments that help many people.
Still, in surveys of people with nerve pain, most say they still have pain despite the best efforts of their doctors. If you're one of them, you may want to look beyond conventional medicine for relief. Almost half of those with nerve pain report trying complementary or alternative approaches to improve their pain.
Self-Care Strategies for Easing Nerve Pain
In addition to relieving pain, many self-care and home treatments can help prevent more serious problems and protect your overall health. And some of these strategies may even trigger the body's natural painkillers, having the added benefit of making you feel good.
Keep on top of diabetes. If you have diabetes, keep your blood sugar under control. Normal blood sugar levels are the best possible treatment for diabetic nerve pain.
Walk it off. Exercise releases natural painkillers called endorphins. Exercise also promotes blood flow to the nerves in the legs and feet. Researchers believe that regular exercise may create a long-lasting expansion in blood vessels in the feet, nourishing damaged nerves back to health. Start with a daily walk, gradually increasing your pace and distance.
Pamper your feet. If your feet are affected by nerve pain, it's time to focus on good foot care. Nerve pain usually means impaired sensation, making injuries and infections more likely. Reduce your risk by examining your feet daily, wearing comfortable shoes, and seeing a podiatrist regularly. No wound or injury to your feet is too minor for a consultation with your doctor.
Soak it away. A warm bath might be the easiest -- and least expensive -- home treatment for nerve pain. Warm water temporarily increases blood flow to the legs and can help ease stress as well. Avoid burns by measuring water temperature with your arm before stepping in.
Skip happy hour. Heavy alcohol use is toxic to nerves and can worsen nerve pain. There's no magic number for how many alcoholic beverages you can have and still avoid nerve pain, but some experts advise four drinks or less per week.
Sleep on it. Nerve pain can worsen at night, disrupting sleep and making it more difficult to cope with pain. Help break the cycle with good sleep habits. Limit afternoon caffeine intake, keep a consistent bedtime that allows for eight hours of sleep, and reserve the bedroom for sleep and sex.
Burn it out. Capsaicin cream, made from hot chili peppers, causes an uncomfortable burning sensation when initially applied. Some individuals find the burning sensation they experience when using capsaicin cream to be intolerable, especially when they are already suffering from a painful condition. But those who stick with it for weeks often report improvement in nerve pain (and less burning over time).
Numb it up. The anesthetic lidocaine -- in gel, ointment, or patches -- is available in prescription and over-the-counter preparations. The relief from lidocaine is satisfying, although temporary.
Rub it out. Some studies have shown that applying botanical oils such as geranium oil can reduce the pain of postherpetic neuralgia. Other oils, such as lavender oil, have been shown to help relax people, which may also help take the mind off nerve pain.
Meditate on it. Techniques such as guided imagery, meditation, biofeedback, and hypnosis help some people with nerve pain live better. Finding the right professional at a reasonable price can be challenging. Do your homework and ask for a referral from your doctor or someone whose advice you trust.
Neuropathy, also called peripheral neuropathy, is a condition caused by nerve damage. Neuropathy can affect movement, sensation (e.g., temperature, pain, touch), and functions, such as breathing and digestion.
Peripheral neuropathy can occur with no known cause, but the disorder often is associated with diabetes (called diabetic neuropathy) and other medical conditions. Neuropathy can result in neuropathic pain and chronic numbness, tingling, and weakness.
Here are some questions to ask your doctor (e.g., neurologist) about peripheral neuropathy. Print this page, mark the questions you would like to have answered, and bring it with you to your next appointment. The more you know about neuropathy, the better you will be able to make informed decisions about your condition.
- What do you suspect is the underlying reason for my neuropathy?
- Might my peripheral neuropathy be related to an undiagnosed condition, such as diabetes?
- What are other common risk factors for developing neuropathy?
- What are the most common signs and symptoms of neuropathy?
- What should I do if my condition worsens or I experience new symptoms?
- How will you determine for sure if I have peripheral neuropathy?
- What types of diagnostic tests will be performed?
- How should I prepare for these tests?
- Is the underlying cause for my neuropathy curable? Is it treatable?
- How will my condition be treated?
- What are the benefits, risks, and possible complications of this treatment?
- Will my neuropathy be treated with prescription medications? If so, how will these medicines be administered?
- What are the side effects of these drugs?
- What should I do if I experience severe medication side effects?
- If left untreated, what are the possible complications of peripheral neuropathy?
- If prescription medicines are ineffective, what other treatment options are available?
- Might any alternative treatments be effective? If so, what do these treatments involve?
- Can you recommend any resources for support or additional information for people who have neuropathy?
Sciatica is a common type of pain affecting the sciatic nerve, a large nerve extending from the lower back down the back of each leg.
What Are the Symptoms of Sciatica?
Common symptoms of sciatica include:
- Pain in the rear or leg that is worse when sitting
- Burning or tingling down the leg
- Weakness, numbness, or difficulty moving the leg or foot
- A constant pain on one side of the rear
- A shooting pain that makes it difficult to stand up
Sciatica usually affects only one side of the lower body. Often, the pain extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes.
For some people, the pain from sciatica can be severe and debilitating. For others, the pain from sciatica might be infrequent and irritating, but has the potential to get worse.
Seek immediate medical attention with any symptoms of progressive lower extremity weakness and/or loss of bladder or bowel control.
What Causes Sciatica?
Sciatica is caused by irritation of the root(s) of the lower lumbar and lumbosacral spine.
Additional common causes of sciatica include:
- Lumbar spinal stenosis (narrowing of the spinal canal in the lower back)
- Degenerative disc disease (breakdown of discs, which act as cushions between the vertebrae)
- Spondylolisthesis (a condition in which one vertebra slips forward over another one)
Other things that may make your back pain worse include being overweight, not exercising regularly, wearing high heels, or sleeping on a mattress that is too soft.
Neuralgia is pain in one or more nerves that occurs without stimulation of pain receptor (nociceptor) cells. Neuralgia pain is produced by a change in neurological structure or function rather than by the excitation of pain receptors that causes nociceptive pain. Neuralgia falls into two categories: central neuralgia and peripheral neuralgia. This unusual pain is thought to be linked to four possible mechanisms: ion gate malfunctions; the nerve becomes mechanically sensitive and creates an ectopic signal; cross signals between large and small fibers; and malfunction due to damage in the central processor.
Neuralgia was first recognized by Silas Weir Mitchell, a neurologist in the American Civil War, who noticed hyperalgesia and chronic pain in patients who had nerve lesions in the extremities and also some cases where no lesion was observed: These causalgias were certainly major by the importance of the symptoms, but stemmed from minor neurological lesions". Mitchell termed the condition “causalgia” which has since become known as “Complex Regional Pain Syndrome Type 1 and Type 2” (CRPS). CRPS Type I is a syndrome that develops after an initiating noxious event ., and Type 2 describes a case when nerve damage is clear.
Neuralgia is often difficult to diagnose, and most treatments show little or no effectiveness. Diagnosis typically involves locating the damaged nerve by identifying missing sensory or motor function. This may involve tests such as an EMG test or a nerve conduction test. Neuralgia is more difficult to treat than other types of pain because it does not respond well to normal pain medications. Special medications have become more specific to neuralgia and typically fall under the category of membrane stabilizing drugs or antidepressants such as Cymbalta. The antiepileptic medication(AED) Lyrica was developed specifically for neuralgia and other neuropathic pain as a successor to Neurontin (gabapentin).
Under the general heading of neuralgia are trigeminal neuralgia (TN), atypical trigeminal neuralgia (ATN), and postherpetic neuralgia (caused by shingles or herpes). Neuralgia is also involved in disorders such as sciatica and brachial plexopathy with neuropathia. Neuralgias that do not involve the trigeminal nerve are occipital neuralgia and glossopharyngeal neuralgia.
In the case of trigeminal neuralgia the affected nerves are responsible for sensing touch, temperature sensation and pressure sensation in the facial area from the jaw to the forehead. The disorder generally causes short episodes of excruciating pain, usually for less than two minutes and usually only one side of the face. The pain can be described in a variety of ways such as "stabbing," "sharp," "like lightning," "burning," and even "itchy". In the atypical form of TN, the pain presents itself as severe constant aching along the nerve. The pain associated with TN is recognized as one of the most excruciating pains that can be experienced.
Simple stimuli such as eating, talking, making facial expressions, washing the face, or any light touch or sensation can trigger an attack (even the sensation of a cool breeze). The attacks can occur in clusters, as an isolated attack, or be completely constant. Some patients will have a muscle spasm which led to the original term for TN of "tic douloureux" ("tic", meaning 'spasm', and "douloureux", meaning 'painful', in French).
Neuralgia is a form of chronic pain and can be extremely difficult to diagnose. Postherpetic neuralgia is the easiest to diagnose because it follows an obvious cause (shingles). Neuralgia is a rare disease. Women are more likely to be affected than men, and those over 50 are at the greatest risk. In some cases, multiple sclerosis is related to nerve damage, causing the pain, so doctors will likely ask about family history to help diagnose. Nothing unusual can be seen in brain scans, so diagnosis is usually based on the description of the symptoms and the response to the medication or procedures.
By understanding the neuroplastic changes following nerve damage, researchers may be able to better understand the mechanism of hyperexcitability in the nervous system that is believed to cause neuropathic pain.
A neuron’s response to trauma can often be determined by the severity of the injury, classified by Seddon's classification. In Seddon’s Classification, nerve injury is described as either neurapraxia, axonotmesis, or neurotmesis. Following trauma to the nerve, a short onset of afferent impulses, termed “injury discharge”, occurs. While lasting only minutes, this occurrence has been linked to the onset of neuropathic pain.
When an axon is severed, the segment of the axon distal to the cut degenerates and is absorbed by Schwann cells. The proximal segment fuses, retracts, and swells, forming a “retraction bulb.” The synaptic terminal function is lost, as axoplasmic transport ceases and no neurotransmitters are created. The nucleus of the damaged axon undergoes chromatolysis in preparation for axon regeneration. Schwann cells in the distal stump of the nerve and basal lamina components secreted by Schwann cells guide and help stimulate regeneration. The regenerating axon must make connections with the appropriate receptors in order to make an effective regeneration. If proper connections to the appropriate receptors are not established, aberrant reinnervation may occur. If the regenerating axon is halted by damaged tissue, neurofibrils may create a mass known as a neuroma.
In the event that an injured neuron degenerates or does not regenerate properly, the neuron loses its function or may not function properly. Neuron trauma is not an isolated event and may cause degenerative changes in surrounding neurons. When one or more neurons lose their function or begin to malfunction, abnormal signals sent to the brain may be translated as painful signals.
Neuronal injury in the central nervous system (CNS) typically leads to local degeneration of the nerve axon and myelin sheath. Axonal debris in the CNS is eliminated by macrophages. Trauma to neurons in the CNS also causes a proliferation of glial cells that form a glial scar. Development of the glial scar is thought to inhibit regeneration of central neural connectionscitation needed. The damaged nerve terminal begins to swell and glial cells push the defective terminal away from connections to other neurons. Often, aberrant sprouting of damaged CNS neurons, specifically sensory neurons, results in neuralgia.
Diagnosis of neuralgia is difficult, and misdiagnosis is common. Diagnosis typically involves locating the damaged nerve by stimulation of the specific damaged pathway or by identifying missing sensory function. The most common test for neuralgia is a nerve conduction study, such as using microneurography in which a peripheral nerve is stimulated and recordings are taken from a purely-sensory portion of the nerve.
When assessing neuralgia to find the underlying mechanism, a history of the pain, description of pain, clinical examination, and experimental examination are required. Since pain is subjective to the patient, it is important to use a pain assessment scale, such as the McGill Pain Questionnaire. Qualifying the severity of the pain is essential in diagnosis and in evaluating the effectiveness of the treatment. Clinical examinations usually involve testing responses to stimuli such as touch, temperature, and vibration. Neuralgia can be further classified by the type of stimuli that elicits a response: mechanical, thermal, or chemical. Response to the course of treatment is the final tool used to determine the mechanism of the pain. Future research must focus on the relationships between all of these categories.
Neuropathic pain is often the result of a lesion in spinothalamic pathways. Laser evoked potentials (LEPs) are measurements of cortical responses using lasers to selectively stimulate thermonociceptors in the skin. Lasers can emit a radiant-heat pulse stimulus to selectively activate A-delta and C free nerve endings. By specifically targeting pain and temperature pathways and measuring cortical responses, clinicians can identify even minute lesions in the spinothalamic pathways. LEP abnormalities are strongly indicative of neuropathic pain, while a normal LEP is often more ambiguous. LEPs have high sensitivity and are very reliable in assessing damage to both central and peripheral nervous systems.
Another method for testing the proper function of a nerve is Quantitative sensory testing (QST). QST relies on analysis of a patient’s response to external stimuli of controlled intensity. A stimulus is applied to the skin of the nerve area being tested in ascending and descending orders of magnitude. Clinicians can quantify the mechanical sensitivity of the tactile stimulus using von Frey hairs or Semmes-Weinstein monofilaments. Also, weighted needles can be used to measure pin-prick sensation, and an electronic vibrameter is used to measure vibration sensitivity. Thermal stimuli are quantified by using a probe that operates on the Peltier principle.
One problem with QST is that abnormalities may be observed in non-neuralgia pains, often making it inconclusive in diagnosis. Also, QST is very time consuming and relies on expensive equipment.
Recently, skin biopsy has been used to investigate mechanoreceptors and their myelinated afferents. Though available in only a few research centers, skin punch biopsy is an easy procedure and is minimally invasive. Punch skin biopsy is used to quantify nerve fibers C fibers and A-delta nerve fibers through measurement of the density of intra-epidermal nerve fibers (IENF). Loss of IENF has been observed in several cases of neuropathic pain.
Atypical trigeminal neuralgia (ATN) is a rare form of neuralgia and may also be the most misdiagnosed form. The symptoms can be mistaken for migraines, dental problems such as TMJ, musculoskeletal issues, and hypochondriasis. ATN can have a wide range of symptoms and the pain can fluctuate in intensity from mild aching to a crushing or burning sensation, and also to the extreme pain experienced with the more common trigeminal neuralgia. ATN pain can be described as heavy, aching, and burning. Sufferers have a constant migraine-like headache and experience pain in all three trigeminal nerve branches. This includes aching teeth, ear aches, feeling of fullness in sinuses, cheek pain, pain in forehead and temples, jaw pain, pain around eyes, and occasional electric shock-like stabs. Unlike typical neuralgia, this form can also cause pain in the back of the scalp and neck. Pain tends to worsen with talking, facial expressions, chewing, and certain sensations such as a cool breeze. Vascular compression of the trigeminal nerve, infections of the teeth or sinuses, physical trauma, or past viral infections are possible causes of ATN.
Glossopharyngeal neuralgia consists of recurring attacks of severe pain in the back of the throat, the area near the tonsils, the back of the tongue, and part of the ear. The pain is due to malfunction of the 9th cranial nerve (glossopharyngeal nerve), which moves the muscles of the throat and carries information from the throat, tonsils, and tongue to the brain.
Glossopharyngeal neuralgia, a rare disorder, usually begins after age 40 and occurs more often in men. Often, its cause is unknown. But sometimes glossopharyngeal neuralgia results from an abnormally positioned artery that compresses the glossopharyngeal nerve near where it exits the brain stem. Rarely, the cause is a tumor in the brain or neck.
Occipital neuralgia, also known as C2 neuralgia, or Arnold's neuralgia, is a medical condition characterized by chronic pain in the upper neck, back of the head and behind the eyes.
Treatment options include medicines, surgery, and complementary approaches.
High doses of anticonvulsant medicines—used to block nerve firing— and tricyclic antidepressants are generally effective in treating neuralgia. If medication fails to relieve pain or produces intolerable side effects, surgical treatment may be recommended.
Neural augmentative surgeries are used to stimulate the affected nerve. By stimulating the nerve the brain can be “fooled” into thinking it is receiving normal input. Electrodes are carefully placed in the dorsal root and subcutaneous nerve stimulation is used to stimulate the targeted nerve pathway. A technician can create different electrical distributions in the nerve to optimize the efficiency, and a patient controls the stimulation by passing a magnet over the unit.
Some degree of facial numbness is expected after most of these surgical procedures, and neuralgia might return despite the procedure’s initial success. Depending on the procedure, other surgical risks include hearing loss, balance problems, infection, and stroke. These surgeries include rhizotomy (where select nerve fibers are destroyed to block pain) and Microvascular decompression (where the surgeon moves the vessels that are compressing the nerve away from it and places a soft cushion between the nerve and the vessels).
Some patients choose to manage neuralgia using complementary techniques, usually in combination with drug treatment. These therapies offer varying degrees of success. Options include chiropractic, acupuncture, biofeedback, vitamin therapy, nutritional therapy, hot-cold compress, and electrical stimulation of the nerves.
Sleep deprivation and malnutrition have also been reported as byproducts of the pain. It is possible that there are other triggers or aggravating factors that patients need to learn to recognize to help manage their health. Bright lights, sounds, stress, and poor diet are examples of additional stimuli that can contribute to the condition. The pain can cause nausea, so beyond the obvious need to treat the pain, it is important to be sure to try to get adequate rest and nutrition.