This document discusses different types of neuralgia, including: - Postherpetic neuralgia, which occurs after shingles and causes persistent pain along nerve pathways. - Trigeminal neuralgia, which causes severe facial pain and is most common in older adults. Pressure on the trigeminal nerve from blood vessels is a common cause. - Glossopharyngeal neuralgia, which causes pain in the neck and throat from the glossopharyngeal nerve. It also covers causes of neuralgia like infections, multiple sclerosis, pressure on nerves from structures like blood vessels, and less common causes like medications. Treatment options discussed include medications, surgery, and other approaches.

1. NEURALGIA
ARATHY R NATH
NEHRU COLLEGE

4.  Occurs as a complication of shingles and may be anywhere
on the body.
Shingles is a viral infection characterized by a painful rash
and blisters.
Neuralgia can occur wherever the outbreak of shingles was.
The pain can be mild or severe and persistent or
intermittent.
last for months or years.
 In some cases, the pain may occur before the rash.
It will always occur along the path of a nerve, so it’s usually
isolated to one side of the body.
Postherpetic neuralgia

5. Trigeminal neuralgia
It is associated with pain from the trigeminal nerve,
which travels from the brain and branches to
different parts of the face.
The pain can be caused by a blood vessel pressing
down on the nerve where it meets with the
brainstem.
It can also be caused by multiple sclerosis, injury to
the nerve, or other causes.
Trigeminal neuralgia causes severe, recurrent pain
in the face, usually on one side.
 It’s most common in people who are older than 50
years.

6. Glossopharyngeal neuralgia
Pain from the glossopharyngeal nerve, which
is in the throat, is not very common.
This type of neuralgia produces pain in the
neck and throat.

8. Infection
An infection can affect your nerves.
 For example, the cause of postherpetic neuralgia
is shingles, an infection caused by the chickenpox virus.
The likelihood of having this infection increases with age.
An infection in a specific part of the body may also affect a
nearby nerve.
 For example, if you have an infection in a tooth, it may
affect the nerve and cause pain.
Multiple sclerosis
 Multiple sclerosis (MS) is a disease caused by the
deterioration of myelin, the covering of nerves. Trigeminal
neuralgia may occur in someone with MS.

9. Pressure on nerves
Pressure or compression of nerves may cause neuralgia.
The pressure may come from a: bone, ligament , blood
vessel , tumor
The pressure of a swollen blood vessel is a common cause
of trigeminal neuralgia.
Diabetes
 Many people with diabetes have problems with
their nerves, including neuralgia.
 The excess glucose in the bloodstream may
damage nerves.
 This damage is most common in the hands, arms,
feet, and legs.

10. Less common causes
If the cause of neuralgia isn’t infection, MS, diabetes, or
pressure on the nerves, it may be from one of many less-
common factors.
These include: chronic kidney disease ,medications
prescribed for cancer,fluoroquinolone antibiotics, used to
treat some infections , trauma, such as from surgery
,chemical irritation

11. TRIGEMINAL NEURALGIA

14. Trigeminal neuralgia is sudden, severe facial pain.
It's often described as a sharp shooting pain or like having
an electric shock in the jaw, teeth or gums.
It usually occurs in short, unpredictable attacks that can last
from a few seconds to about two minutes.
The attacks stop as suddenly as they start.
In most cases trigeminal neuralgia affects part or all of one
side of the face, with the pain usually felt in the lower part
of the face.
Very occasionally it can affect both sides of the face,
although not usually at the same time.
 People with the condition may experience attacks of pain
regularly for days, weeks or months at a time.
 In severe cases attacks may occur hundreds of times a day.

15. It's possible for the pain to improve or even disappear
altogether for several months or years at a time (remission),
although these periods tend to get shorter with time.
Some people may then go on to develop a more continuous
aching, throbbing and burning sensation, sometimes
accompanied by the sharp attacks.
Living with trigeminal neuralgia can be very difficult.
It can have a significant impact on a person's quality of life,
resulting in problems such as weight loss, isolation
and depression

22. MANAGEMENT
1) Pharmacological
2) Surgical
3) others
Pharmacological
• 1ST line : Carbamazepine 100,200mg
• 2nd line : phenytoin 100 mg
Baclofen 5 – 80 mg/day
Lamotrigine 25mg/day
• 3rd line : Clonazepam 4 – 8mg
valproic acid 250 – 500mg
oxacarbazepine 1200mg/day

23. SURGICAL
Glycerol rhizolysis
Baloon microcompression
Microvasculature decompression (MVD)
Peripheral neurectomy
Linear accelerator radiosurgery
Cryotherapy
Stereiolactic radiosurgery (SRS)
Radiofrequency gangliolysis

26. BRACHIAL NEURALGIA
(Shoulder to elbow )
They may follow injury , operation, inoculation or fever.
Recovery – low
symptoms: : shoulder,arm , forearm , or hand.
Causes :-
1) neck – viloent exercise, tumors,degeneration.
2) Arm- due to infections , injury
3) forearm - fractures
4) shoulder – due to arrthritis, frozen shoulder
 Symptoms :
- tightness,shifteenss of shoulder,arm,forearm
- difficulty in stretching, lifting the arm.
- altered sensation / numbness.

27. TREATMENT
1) Tricyclic antidepressants – nortriptylline
2) Amitriptyline (75 – 150mg) & desipramine
3)Carbamazepine (600mg/dl)
4) Gabapentin (300mg TID)
5) phenytoin & sodium valproate
6) Topical agents - lidocaine

28. THANK YOU