Treatment of neuralgias is aimed at reversing or controlling the cause of the nerve problem (if it is identified) as well as providing pain relief. Therefore, the treatment varies depending on the cause, location of the pain, severity of the pain and other factors. Even if the cause of the neuralgia is never identified, the condition may improve spontaneously or disappear with time.
The cause (if known) should be treated. This may include surgical removal of tumors, or surgical separation of the nerve from blood vessels or other structures that compress it.
Mild over-the-counter analgesics such as aspirin, acetaminophen, or ibuprofen may be helpful for mild pain. Narcotic analgesics such as codeine may be needed for a short time to control severe pain. These traditional pain killers, however, often have disappointing results.
Other types of medications work in different parts of the nervous system and often provide better symptom control. For instance, antiseizure medications such as carbamazepine, gabapentin, lamotrigine or phenytoin may be helpful for pain associated with trigeminal neuralgia. The most common adverse effects of antiseizure drugs are drowsiness, tremor, and incordination.
Antidepressant medications, such as amitryptiline, may be helpful to control pain in some cases. The topical (local) application of creams containing capsaicin also may help to control the pain.
Other treatments may include nerve blocks, using local injections of anesthetic agents, or surgical procedures to decrease sensitivity of the nerve. Some procedures involve the ablation (surgical destruction) of the affected nerve using different methods, such as local radiofrequency, heat (thermocoagulation), balloon compression, and injection of chemicals (such as glycerolysis).
Unfortunately, these procedures do not guarantee improvement and can cause sensory loss and/or abnormal sensory phenomena.
Another strategy sometimes used for resilient cases of neuralgia is called motor cortex stimulation (MCS), which consists of surgically placing an electrode over the sensory cortex of the brain. The electrode is hooked to a pulse generator pocketed under the skin. Such surgical procedures, however, are tried only when more conservative approaches have failed.
For postherpetic neuralgia, injections of anesthetics and steroids (potent anti-inflammatory drugs) in the subarachnoid space through a spinal tap may provide pain relief. For both trigeminal and glosso-pharyngeal neuralgias, a procedure called microvascular decompression, can result in symptom improvement. This surgical procedure consists in removing any possible compression exerted by neighboring blood vessels over the affected nerve.
Physical therapy may be helpful for some types of neuralgia, especially postherpetic neuralgia. Treatment of shingles with antiviral medication may decrease the incidence of postherpetic neuralgia.
