Neuralgia is basically a condition which leads to pain along the course of the nerve. This stabbing and unbearable pain makes it very difficult to carry out the basic daily activities. Also, since there is a glitch in the nerve conduction, the motor functions are also affected causing the movements to become difficult and tiring. All these consequences of Neuralgia can be dealt well with the help of Physiotherapy. Reliva provides physiotherapy treatment for Neuralgia at its clinics in Navi Mumbai and Thane.

Pain Management forms a very important aspect of treatment in neuralgia as it is one of the most disabling symptoms in patient suffering from neuralgia. One of the passive treatments given is cryotherapy, which is the use of cold packs or ice at the area of pain. This helps by sensitizing the area and hence blocking the sensation of pain. Transcutaneous Electrical Nerve Stimulation (TENS) is also considered one of the electrotherapeutic ways of blocking pain signals to the brain and hence reduce pain, as well as the tingling sensation that is experienced by the patient. In cases of Occipital Neuralgia, where the patient has a stabbing headache, it could be relieved with the help of therapeutic massage therapy Massaging the painful area can hit key spots of the nerve blood and oxygen flow. The increased blood and oxygen flow can help to heal damaged nerves.

Apart from pain control, strengthening, improving flexibility as well as aerobic training forms an important part of the treatment. Flexibility exercises in the form of stretching help in relieving the tension from the muscles and hence reducing the pressure on the nerves, thereby reducing the symptoms. Both passive and active stretching exercises are taught to the patient and also administered as home program.

To begin with, various free exercises for the affected muscles are started to maintain the muscle properties and prevent any further consequence like disuse atrophy which may result from not using the muscle for a long time.

Once the basic exercise protocol has been started and the symptoms of pain reduce, strengthening exercises for the muscles that have been affected can be commenced. Strengthening exercises for the neck and back in case of occipital neuralgia prove very useful as they allow maintaining a better posture. Poor posture, specifically being hunched over and bending your neck down, can put pressure on your nerves and lead to headaches. Also strengthening the muscles reduce the intensity of pain then what is felt usually as the muscles are now able to work more and hence do not give up soon. In case of Pudendal neuralgia rehabilitation of the pelvic floor, abdominal, gluteal, lumbosacral and hip rotator muscles. Along with this, strengthening of certain muscles to improve core and lower extremity balance and stability are done.

As the nerve in this condition is under a lot of stress due to factors like external pressure and entrapment, nerve mobilization proves very helpful in relieving them from the tension. Various nerve mobilization techniques are used to reduce the symptoms of the respective nerve being hampered.

Aerobic training, low impact to begin with helps maintain the body functions and also induces relaxation. Walking helps keep the mind and body healthy and active.

What is Neuralgia ?

Neuralgia is a Greek word where neuron means “nerve” and algos “pain”.

Neuralgia is an intense, stabbing, burning and sharp shooting pain caused along the path of a damaged nerve it. Generally, neuralgia isn’t an illness in its own right, but a symptom of injury or a particular disorder. In many cases, the cause of the pain is not known. Older people are most susceptible, but people of any age. The pain may be continuous/ intermittent or caused just by a triggering factor. Neuralgia can occur in different parts of the body and can have various causes. Neuralgia is classified on the basis of the nerve affected or the cause of affection.

Almost everyone will experience mild neuralgia at some point, but these bouts are usually temporary and tend to ease by themselves within a few days. Some types of neuralgia are longer lasting, debilitating and so agonizing that a person’s quality of life is severely reduced.

The common types of neuralgia are:

1. Trigeminal Neuralgia: This type of neuralgia is associated with pain from the trigeminal nerve, which goes from the brain to the face. 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”. The pain associated with Trigeminal Neuralgia is recognized as one of the most excruciating pains that can be experienced.

Simple stimuli – such as eating, talking, making facial expressions, washing face, or any light touch or sensation – can trigger an attack (even the sensation of a cool breeze). Attacks may be lone occurrences, clusters of attacks, or constant episodes. Some patients experience muscle spasm, which led to the original term for Trigeminal Neuralgia of “tic douloureux” (“tic”, meaning “spasm”, and “douloureux”, meaning “painful”, in French).

2. Postherpetic Neuralgia: This type of neuralgia 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 erupt wherever the outbreak of shingles occurred and can be mild or severe, persistent or intermittent, and can last for months or years. Here the underlying cause that is Shingles is treated to cure the symptoms of neuralgia.

3. Occipital Neuralgia: Irritation of the main nerve that runs from the back of the skull can cause occipital neuralgia. Occipital neuralgia can cause intense pain that feels like a sharp, jabbing, electric shock localized to the back of the head and neck. The pain can sometimes include the forehead. But treatments for those conditions are very different, so it’s important to see your doctor to get the right diagnosis. Other symptoms include aching, burning, and throbbing pain that typically starts at the base of the head and goes to the scalp, Pain on one or both sides of the head, Pain behind the eye, Sensitivity to light, Tender scalp and Pain when you move your neck. People can confuse it with a migraine or other types of headache, because the symptoms can be similar.

4. Pudendal neuralgia: Irritation of the pudendal nerve (severe pain in the distribution of the nerve), i.e. pudendal neuralgia, may result in sensory symptoms in any or all areas it supplies and spasms of the muscles supplied by it. The sensory symptoms could manifest as itching, burning, tingling, cold sensations, and/or burning and shooting pain. The sensory symptoms may extend into the groin, abdomen, legs, and buttocks. The pudendal nerve is the only peripheral nerve that has both somatic and autonomic fibers. Thus, a person can experience increased heart rate and blood pressure, decreased motility of the colon, decreased blood flow, and perspiration with pudendal nerve stimulation.

Signs and symptoms may include the following, but they vary between individuals:

The diagnoses of different types of neuralgia are difficult and could take time to reach the right diagnosis. This is due to the mixed picture that the symptoms give. A person suffering from trigeminal neuralgia could first visit a dentsist as he may suffer from jaw and tooth pain, similarly a patient developing shingles could visit a neurologist before a skin specialist. Your doctor would take a detailed history and ask you the details about how and when the condition developed to make an accurate diagnosis.

What causes Neuralgia ?

The underlying cause of any type of neuralgia is damage to a nerve. Each nerve in your body is protected by a coating called the myelin sheath. When the myelin is damaged or wears away from the nerve, the stabbing, severe, shock-like pain of neuralgia results. There are many different factors, including old age, which can cause damage to the myelin. Unfortunately, in many cases of neuralgia, a cause can never be found. The possible causes of neuralgia are as follows:

1. Pressure on Nerve:The myelin on nerves can be worn away by pressure. The pressure may come from a bone, ligament, blood vessel, or a tumor that is pressing on the nerve. The pressure of a swollen blood vessel is a common cause in trigeminal neuralgia.

2. Entrapment of the nerve:The nerves may get entrapped between the muscles/ muscle tendons or because of the pressure caused by the bones. This leads to an interrupted transmission of signals along with increasing the wear and tear of the myelin sheath causing it to be degenerated faster.

3. Infection: The cause of Postherpetic neuralgia is shingles, an infection caused by the varicella-zoster virus – the same virus that causes chickenpox. This is because the condition causes inflammation of the nerve and leads it to be irritated. The likelihood of having this infection increases with age. Lyme disease, HIV, and syphilis can also cause neuralgia.

4. Diabetes: Many people with diabetes will suffer from some type of neuralgia because excess glucose in the bloodstream can lead to myelin damage

5. Multiple sclerosis: MS is a disease that is caused by the degradation of myelin. Among the many symptoms that result from MS is neuralgia, often in the face.

6. Less Common Causes: If the cause of neuralgia cannot be blamed on an infection, MS, diabetes, or pressure on the nerves, it may be from one of many less common factors.These include:

Benefits of Physiotherapy treatment for Neuraliga

Nociceptive Pain vs Neuropathic Pain

  • Pelvic pain with sitting, but improvement with standing or sitting on a toilet seat.
  • Discomfort with tight clothing.
  • Bladder and/or bowel symptoms (hesitancy, frequency, urgency, retention, constipation, pain
  • Dyspareunia
  • Genital pain
  • Anal pain
  • Abnormal pudendal nerve motor latency test
  • Pudendal nerve block may decrease symptoms
    • chronic kidney disease
    • porphyria (a rare blood disease)
    • medications like cisplatin, paclitaxel, or vincristine (prescribed to cancer patients)
    • trauma, such as that caused by surgery
    • chemical irritation
    • Exercise offers a host of benefits: Besides giving you more energy and strengthening your muscles, it can reduce pain, making day-to-day activities easier to do. Another added exercise bonus is that it can send stress levels plummeting, which can make your pain more manageable.
    • ReLiva Physiotherapy and Rehab helps develop an overall treatment plan for neuralgia which not only helps in relieving pain but also helps cope up with the difficulties encountered in everyday life.
  • Nociceptive painThis is the type of pain that all people have had at some point. It is caused by actual, or potential, damage to tissues. For example, a cut, a burn, an injury, pressure or force from outside the body, or pressure from inside the body (for example, from a tumour) can all cause nociceptive pain. The reason we feel pain in these situations is because tiny nerve endings become activated or damaged by the injury, and this sends pain messages to the brain via nerves. Nociceptive pain tends to be sharp or aching. It also tends to be eased well by traditional painkillers such as paracetamol, anti-inflammatory painkillers, codeine and morphine.Neuropathic painThis type of pain is caused by a problem with one or more nerves themselves. The function of the nerve is affected in a way that it sends pain messages to the brain. Neuropathic pain is often described as burning, stabbing, shooting, aching, or like an electric shock. Neuropathic pain is less likely than nociceptive pain to be helped by traditional painkillers. However, other types of medicines often work well to ease the pain. Neuralgia is a type of neuropathy.
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