Neuralgia is defined as pain in the distribution of a nerve or nerves, and it is usually named after the nerve that is affected - for instance Trigeminal Neuralgia (the Trigeminal nerve is the nerve that supplies sensation of your face). It is typically cause by pressure on the nerve by i.e. a bulging disc in your spine. There are diseases that can also cause Neuralgia, such as Diabetes.
From an osteopathic perspective once the cause of the neuralgia has been identified there is often a lot we can do to help. If the cause is a physical compression on the nerve then we can work to relieve this pressure, reducing and hopefully stopping the symptoms.
Neuropathic pain
Neuropathic pain is defined as a pain that comes from problems with signals from the nerves. Like with neuralgia there are various causes. It is different to the common type of pain that is due to compression, injury, trauma or i.e a burn, pressure. Usually typical painkillers such as paracetamol and codeine and anti-inflammatories do not help very much. However, neuropathic pain is often eased by antidepressant or anti-epileptic medicines such a gabapentin - by a pathway that is separate to their action on depression and epilepsy.
A big part of the problem with Neuropathic pain is that if the nerve has been compressed badly enough or for long enough the nerve gets irritated to the point that it can't readily switch off, or becomes over-sensitized. Neuropathic pain can cause things like :-
- Hyperalgesia. This means that you get severe pain from a stimulus or touch that would normally cause only slight discomfort. For example, a mild prod on the painful area may cause intense pain.
- Allodynia. This means that the pain comes on, or becomes worse, with a touch or stimulus that would not normally cause pain. For example, a slight touch on the face may trigger pain if you have trigeminal neuralgia, or the pressure of the bedclothes may trigger pain if you have diabetic neuropathy.
I like to think of it like this. Imagine the nerve is a watering hose lying across your garden. Water normally flows through it silently without any problems. However, if you step on the hose you'll hear a hissing noise caused by the altered water flow. If you kept your foot on the hose for long enough you'd kink the hose so that even when you took your foot off, the hose would still hiss. This is sort of what is happening with Neuropathic pain. Injury / insult / compress a nerve for long enough and it will continue to "hiss". But it isn't confined to just the one nerve, it involved the broader nervous system. Stimulus into one nerve can cause an over-reaction in another - a sort of short circuit if you like. Neuropathic pain is central to Complex Regional Pain Syndrome, which is a potential problem after injuries such as fractures.
A personal perspective
I broke my leg a few years back and required a pin to be inserted into my shin to repair it. I suffered Neuropathic pain as a result. It was very unpleasant. For me, any sort of mental or emotional shock, such as being startled by a loud noise whilst I was snoozing, would cause an excruciating shooting pain in my leg, and this was long after the fracture had healed. It didn't progress into Complex Regional Pain because I caught it in time. I used specific rehabilitation exercises, osteopathic treatment (both self-administered and by a colleague) and the lowest dose of Gabapentin I could take to sort it out. Having the locking screws removed (but the pin was left in) also helped a lot as I was convinced the tips of the screws were protruding into the soft tissues and causing a constant irritation and pain (this was the foot standing on the hose pipe). You can see from my xray below how far the ends of the screws poked out beyond the edge of the bone, and from the bottom image that the screws are at all delicate or small.
At the heart of Neuropathic pain is a process known as Habitualization which is a process in the brain. Stimulate a nerve for long enough with a constant signal (such as pain) and the brain forget how to turn the nerve off. Treatment involved retraining the nerve so it remembers how to switch off.
In some cases, osteopathy can help with neuropathic pain, if combined with the correct exercises. It is often the case that drugs such as Gabapentin or Pregabalin are needed to help break the cycle.
If you'd like to chat about this then please do fell free to contact me using the form or info below.
Telephone (Chelsea): 02073523087
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