Neuralgia & Neuropathic Pain – Plano, TX

Neuralgia & Neuropathic Pain

Nerve pain or Neuropathic pain is the pain that originates from the damage or disfunction of the nervous system. The International Association for the Study of Pain (IASP) defines neuropathic pain as pain that happens because of damage or disease in the nerves that sense touch, temperature, and pain (the somatosensory system). A related term, neuropathy, means a problem or damage in a nerve that affects how it works.

Neuropathic pain

Most common neuropathic conditions that affect head, face region are

Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a one of the most common chronic pain condition that affects the facial region affecting trigeminal nerve, which is responsible for sensation in the face.

Trigeminal neuralgia (TN), also known as tic douloureux or the “suicide disease”,  characterized by severe, excruciating pain, which is experienced as sudden, severe shock-like episodes in or around the face.

It’s known for causing sudden, severe, electric shock-like or stabbing facial pain, usually on one side of the face. The pain can be triggered by even mild stimulation of the face, such as brushing teeth, chewing, talking, or a breeze.

Characteristic features of Trigeminal Neuralgia

Sudden, sharp, severe, brief, stabbing, recurrent episodes of shock like electric pain.

Usually affects the mid, and or lower face and jaw, but can also impact the area around the nose and sometimes rarely above the eye.

Typically unilateral (one-sided).

Attacks may last seconds to minutes, and may occur in episodes.

Touching the face, eating, talking, brushing teeth, or even a breeze.

Causes

Often due to vascular compression of the trigeminal nerve root (e.g., a blood vessel pressing on the nerve near the brainstem).

Caused by an underlying disease process such as a tumor compressing the trigeminal nerve (e.g., meningioma, posterior fossa tumor).

Diagnosis

Treatment Options

  • Carbamazepine or Oxcarbazepine (anti-seizure drugs)
  • Other options: gabapentin, baclofen, lamotrigine
  • Botox injections
  • Microvascular decompression (MVD): Relieves pressure from the vessel on the nerve.
  • Rhizotomy: Destroys nerve fibers to reduce pain (e.g., radiofrequency, glycerol injection).
  • Radiosurgery: Focused radiation (e.g., Gamma Knife).
  • Psychological support, physical therapy, or complementary modalities for chronic pain.

Occipital Neuralgia

Occipital neuralgia is a type of chronic headache disorder that results from irritation or injury to the occipital nerves which include the greater, lesser, and third occipital nerves that run from the upper cervical spine to the scalp. It is often characterized by intense, sharp, or electric-shock-like pain in the back of the head, neck, and behind the ears typically on one side of the head.

Common Features

Base of the skull, scalp, behind the eyes, or upper neck.

Excruciating, sharp, stabbing, and sharp, piercing, throbbing, or shock-like.

Touching the scalp, brushing hair, turning the neck.

Scalp tenderness, light sensitivity, and pain with neck movement.

Causes

Diagnosis

Treatment Options:

anesthetic and/or corticosteroid injections

anticonvulsants (e.g., carbazapine, oxcarbazepine, gabapentin), NSAIDs, muscle relaxants, , tricyclic antidepressants

Stretching, posture correction

 

Glossopharyngeal Neuralgia

Glossopharyngeal neuralgia is a rare condition characterized by recurrent episodes of severe, sharp, stabbing pain in areas innervated by the glossopharyngeal nerve (cranial nerve IX).

Common Features

  • Back of the throat
  • Base of the tongue
  • Tonsillar region
  • Oropharynx
  • Pharynx
  • Deep ear (near the Eustachian tube)
  • Angle of the jaw
  • Retromolar area
  • Sudden, stabbing, or electric shock-like pain
  • Usually lasts a few seconds to 2 minutes
  • Often unilateral (one side of the face/throat)
  • Chewing
  • Talking
  • Coughing
  • Yawning
  • Swallowing especially cold liquids
  • Bradycardia (slow heart rate)
  • Syncope (fainting)
  • Hoarseness or changes in voice

Causes

Diagnosis

Treatment Options

  • Anticonvulsants like carbamazepine or gabapentin
  • Tricyclic antidepressants
  • Nerve blocks: Local anesthetic injections may be both diagnostic and therapeutic
  • Microvascular decompression
  • Rhizotomy or nerve sectioning

Atypical odontalgia/ Post Traumatic Trigeminal Neuropathic pain(PTTN)

Atypical odontalgia (AO) also known as persistent dentoalveolar pain disorder is a chronic pain condition characterized by persistent tooth-related pain without any identifiable dental or radiographic cause.

Common Features

  • Constant, dull, aching, or burning pain
  • Can be severe and disabling
  • May or may not be triggered by external stimuli like chewing or temperature in many cases
  • Often localized to a tooth or extraction site
  • May spread to adjacent teeth or jaw
  • Chewing
  • Talking
  • Coughing
  • Yawning
  • Swallowing especially cold liquids
  • Lasts for months or years
  • Daily, persistent, non-paroxysmal

Lack of identifiable cause:

Possible Mechanisms:

Diagnosis:

Must rule out:

Treatment Options:

  • Tricyclic antidepressants (e.g., amitriptyline, nortriptyline)
  • Anticonvulsants (e.g., gabapentin, pregabalin)
  • SSRIs or SNRIs in some cases
  • Topical medications: Capsaicin, Coumpounded topical medications

Cognitive Behavioral Therapy (CBT) or multidisciplinary pain management

Avoid unnecessary dental treatments, as these often worsen symptom

Complex Regional Pain Syndrom

CRPS is a chronic neuropathic pain disorder that develops after trauma associated with nerve injury. CRPS is usually triggered by a sprain, fracture, or a crush or penetrating injury and most often affects one or more limbs.

Types of CRPS:

  • Type I (formerly Reflex Sympathetic Dystrophy): No confirmed nerve injury.
  • Type II (formerly Causalgia): Associated with a known nerve injury.

Common Features:

  • Burning, throbbing, shooting, or stabbing pain
  • Disproportionate to the inciting event
  • Often continuous and worsens with movement or touch (allodynia)

Sensory changes:

Autonomic and vascular symptoms

Motor/trophic changes