NEURALGIA PPT .pdf

NEURALGIA, Definition, types, clinical features, diagnosis and modern science medications

1. Dr. K. MALATHI
PGSCHOLAR
Department OF KAYACHIKITSA

2. Neuralgia(Greekneuron, "nerve" +algos,
"pain") is pain in the distribution of one or
more nerves,
•
Neuropathic painispaincaused by damage or
disease affecting thesomatosensory system.
•
Neuropathicpainmayresultfromdisordersof
theperipheralnervoussystemorthecentral
nervoussystem(brainandspinalcord).

3. •
Trigeminal neuralgia
•
Glossopharyngeal neuralgia
•
Postherpetic neuralgia
•
Occipital neuralgia

4. Glossopharyngeal Neuralgia
•Pain in tonsillar fossa
•Back ofthethroat,larynxandradiating
towards ear
•Pain whileSwallowing
•Not verycommon

5. Postherpetic neuralgia
•Occurs as a complication of Shingles a viral infection,
characterized by painful rash, blisters
•May be anywhere on the body
•Neuralgia canoccurwherever the outbreak of shingles
•Pain canbemild/persistent/ intermittent
•Some casespain may occur before the rash
•Occurs alongwiththe path of nerve so its usuallyisolatedto
onesideof thebody

6. Occipital Neuralgia
•It is a condition in which theoccipital nerves, the nerves
that run through the scalp, are injured or inflamed.
•Headachethat feel like severe piercing, throbbing
•shock-like pain in the upper neck, back of the head or
behind the ears.
•generally starts at the base of the head and goes to the
scalp on one or both sides of the head.

7. Trigeminal neuralgia
•
Trigeminal neuralgia(TNorTGN), also calledFothergill
disease,tic douloureux, ortrifacial neuralgiais along-
term paindisorder that affects thetrigeminal nerve
•
It is a neuropathic pain in the distribution of the one ore
more divisions of the Trigeminal neuron.
•
TN Syndrome: Sudden, severe, paroxysmal of neuropathic
pain

8. •
Unknown
•
Infections
•
Vascular compression on nerve root
•
Exposure tocold,blow, chewing,eating,hotand
cold drinks
•
Diabetes
•
Less common causes -
Chemical irritation
Trauma
Chronikidney disease

9. Symptoms
•
S –Site of the pain
•
O–Onset
•
C–Character
•
R–Radiation
•
A–associate with
•
T–Time(duration)
•
E–Exacerbating and
relieving
•
S–Severity of pain

10. Socrates….
Sympto
m
Site
Onse
t
Radiation
Characte
r
Tim
e
Associate
d with
Exacerbate
and
relieving
Seviarit
y
•SITE–Unilateral facial pain common in
mandibular, maxillary and ophthalmic region
•ONSET–sudden, paraxismalpain
•CHARACTER–cutting, stabbing, electrical shock
like
•RADIATION–angle of the mouth to ear, eye,
nostril
•ASSOCIATED WITH –spasticity, winces, flushing of
face, lacrimation
•TIME-1to2mindurationonly
•EXACERBATING AND RELIEVING FACTORS –
spontaneous, allodynia –
movement/smile/eating/chewing/swallowing,
soft touch-tactile allodynia
•SEVERITY–Very severe, cluster ofattacks, jerks

11. Aetiology
Compressionofbloodvessels,esp.
superiorcerebellarartery
Chronic irritationofTrigeminal
Nerve at the root
Increased firing of the sensory
fibres
TRIGEMINAL NEURALGIA

12. Types of trigeminal neuralgia
•CLINICAL TN: NO serious associated symptoms
NO sensory loss
NOinterictal numbness
Blood vessel compressing to nerve
•SYMPTOMATICTN:Sensoryloss
Interictal facial numbness
Cranial nerve involvement
MyalineandAxon damage

13. •History
•Trigeminal nerveexamionation
•diagnostic nerve blocking
•EEG
•MRI(brain )

14. DifferentialDiagnosis
•MultipleSclerosis
•Vascular pain –migrane, temporal arteritis
•Atypical facialpain-depression, anxiety
•Other neuralgias-Postherpetic neuralgia
Glassopgaryngealneuralgia
Post traumaticneuralgia
•Suddenunilateralneuralgia type of pain with
conjunctiovalinvolvement SUNCT

15. MANAGEMENT
1
ST
line –Carbamezapine
2
nd
line–Phenytoin
Baclofen
Lamotrigine
3
rd
line –Clonazepam
Valproic acid
Oxacarbamezapine
Analgesics

16. Surgery
•Microvascular decompression
•Peripheral neurectomy
•Cryotherapy
•Radiofrequency gangliolysis
•Balloon
Microcompression(MVD)

17. Dr. K. MALATHI
PG SCHOLAR
DEPT OF KAYACHIKITSA