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Dr. Marian Wymore

Q: I have developed intermittent severe stabbing pains on the right side of my face. The pain is excruciating even though it only lasts for a few seconds to a minute.

I’m not really sure what triggers it, but I’ve noticed I’m reluctant to smile, shave, or even to talk much for fear of setting off a spasm of pain again. My doctor says it’s neuralgia but he hasn’t found a cause for it.

What is neuralgia and what can be done?

A: Neuralgia means pain radiating along the course of a nerve, so it is often on only one side of the body.

Neuralgia is caused by inflamed, pinched, or damaged nerves. The pain varies in severity and duration and may feel like electric shocks, stabbing, burning, or aching.

Neuropathy means dysfunctional, diseased, or damaged nerves, and symptoms include pain, tingling, burning, numbness and weakness.

The intermittent severe facial pain you are experiencing sounds like trigeminal neuralgia. The trigeminal nerve (or fifth cranial nerve) supplies sensation to your face. It can become inflamed from impingement of the nerve by an adjacent blood vessel or tumor, nerve injury from surgery, trauma, or even multiple sclerosis. It is often the case that no cause is found for trigeminal neuralgia.

The pain may occur spontaneously, or be triggered by chewing, talking, touching the face, or other movements involving the face. Your doctor may do a few tests to confirm the diagnosis, and treat the underlying condition if any cause is found.

Otherwise, medications may be tried that might help the pain. Some anti-seizure medicines are effective for nerve pain. Analgesics, muscle relaxers, and some types of antidepressants may be prescribed.

In cases of refractory pain, surgery, nerve blocks or ablation may be necessary. In some cases, neuralgia goes away on its own. 

Another common kind of neuralgia is caused by shingles.

An acute shingles infection starts with pain, burning and tingling of the skin, usually on the trunk or face. The pain precedes the rash by a couple days, then redness and blistering appears in the area (dermatome) affected by the inflamed nerve.

The painful rash usually goes away in two to three weeks (sooner if anti-viral drugs against herpes zoster virus are taken). However, sometimes the pain persists after the rash heals because the nerve was damaged. The persistence of pain is called post-herpetic neuralgia.

If the face was involved, there may be persistent muscle weakness or even loss of hearing, vision or taste. So it is important to be vaccinated against shingles. See your doctor for treatment early if you suspect a shingles infection.

In the case of neuropathy, there are many types and causes.

One of the most common is peripheral neuropathy, which usually starts in the feet and hands and is often bilateral. Symptoms include pain, stabbing, burning, throbbing, or numbness and tingling. The most common cause is diabetes.

Neuropathy may involve sensory nerves or motor nerves. When motor nerves are involved, muscles may become weak. If autonomic nerves are involved, involuntary muscles like the bladder or stomach may malfunction.

Peripheral neuropathy may also be caused by alcoholism, autoimmune diseases like lupus, some medications, trauma to nerves, infections, vitamin deficiencies and some chronic diseases.

Management of any underlying health problems, like diabetes, is important to the prognosis of peripheral neuropathy. Numbness of the feet can result in poor balance and foot ulcers, so foot care is extremely important, especially for diabetics.

Treatment of symptoms includes medications similar to the ones used for management of neuralgia, including anti-seizure medicines, oral analgesics, some anti-depressants and topical analgesics. 

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