In the last year, I have been experiencing chronic pain, specifically nerve pain. The orthopedic doctor and my physical therapist have determined that the pain is coming from compression on nerves in my back and pelvic floor, which radiates down both my legs.
The pain has been so severe that I’ve had to rely on a walker, and I am only fifty years old! When I am experiencing a “flare-up,” the sitting position, as well as the pedal action required to drive, causes extreme pain, which restricts the amount of time and distance I can bear driving.
Recently, my general practitioner, along with my pain management team, prescribed Gabapentin. Gabapentin is generally utilized alongside other drugs to prevent and manage seizures. Moreover, it is employed to alleviate neuralgia or nerve pain. Gabapentin is categorized as an antiepileptic or anticonvulsant medication. Gabapentin can be utilized to treat other nerve pain disorders, such as diabetic neuropathy, peripheral neuropathy, and trigeminal neuralgia.
According to research and studies published by John Hopkins Medicine, “Trigeminal neuralgia occurs more often in women than men, is more common in older people (usually 50 and older), and occurs more on the right than the left. It doesn’t usually run in families.
Trigeminal neuralgia symptoms may include:
- Episodes of sharp, intense, stabbing pain in the cheek or jaw that may feel like an electric shock. Pain episodes may be triggered by anything touching the face or teeth, including shaving, applying makeup, brushing teeth, touching a tooth or a lip with the tongue, eating, drinking, or talking — or even a light breeze or water hitting the face.
- Periods of relief between episodes
- Anxiety from the thought of the pain returning”
Okay, so I guess it is safe to say that my symptoms do not indicate trigeminal neuralgia. What about just plain old neuralgia?
What are signs of neuralgia?
In general, neuralgia causes intense and distinct symptoms, including sudden episodes of extreme shooting, stabbing pain, or burning sensation that follows the path of a damaged or irritated nerve, which also includes persistent aching, tingling, or numbness.
Neuralgia is a particular type of pain often caused by damage or injury to the nerves that send messages to your brain to signal pain or to the brain itself. As a competitive athlete for the majority of my life, I have sustained many injuries, broken bones, hard hits, and falls.
As a mother, I have had two big baby boys with intensive labor and delivery. Not to mention, for years, I was the friend you called to help you move. Besides the sports, waiting tables through college also took a toll on my body.
Most recently, though, I was merely playing catch with my youngest son, and while he was not paying attention to where he was throwing, he sailed a fastball directly into the middle of my ankle bone! Fairly certain it is one of the catalysts that created some nerve pain radiating up that leg.
What’s the difference between neuralgia and neuropathy?
During my course of many visits with the orthopedic, physical therapists, physiologists, acupuncturists, specialists who perform nerve blocker procedures, chiropractors, etc. – you name it, I have tried it. Most recently, they finally performed a nerve test. The good news they said was that it demonstrated that I do not have neuropathy; the bad news is they do not know what it is.
So, we continued with MRIs, ultrasounds, x-rays, and blood tests, and what they found was that I did not have a pinched nerve anywhere. What they did find is that I do have widespread nerve pain, but my symptoms are more related to neuralgia than neuropathy.
Neuropathy and neuralgia are both related to nerve damage. However, the difference between neuralgia and neuropathy lies in the symptoms and causes of each condition. Neuropathy refers to general diseases or dysfunctions of the nerves. Neuralgia involves severe, localized pain along a specific damaged nerve, often triggered by mild stimulation of the area, which is exactly how and where my pain has been.
Peripheral neuralgia, or peripheral neuropathy, refers to pain due to nerve damage in the peripheral nervous system, including all nerve fibers outside of the brain and spinal cord. Peripheral neuralgia can affect a single nerve or an entire nerve group. And after many tests and trials, my team of doctors deduced that Gabapentin, rest, and therapeutic massage would be the course of action we take.
So far, these efforts have dramatically reduced the constant pain. The pain is still there if it is triggered or I overexert any muscle group with too much activity. Additionally, I have to be mindful of how long I sit or stand as too much of either will set off that widespread nerve pain. It is vitally important to note that when someone is dealing with this type of pain, it can be extremely exhausting, stressful, and frustrating to manage.
From Medical News Today, “Peripheral neuralgia can cause pain or numbness in the hands, feet, arms, and legs. Other symptoms may include:
- involuntary muscle twitching or cramping
- loss of coordination
- difficulty performing complex motor tasks, such as buttoning a shirt or tying shoelaces
- hypersensitivity to touch or temperature
- excess sweating
- gastrointestinal problems
- difficulty eating or swallowing
- difficulty speaking
Causes
Sustaining damage to the peripheral nervous system can affect nerves that control muscle movements, transmit sensory information, and regulate internal organs.
Medications that can treat the underlying causes of neuralgia include:
- anticonvulsants, such as carbamazepine, topiramate, and lamotrigine
- antidepressants, such as amitriptyline
- muscle relaxants, such as baclofen
- membrane-stabilizing medications, such as Gabapentin
What is the main cause of neuralgia?
Some of the most common causes of neuralgia can be instances such as an injury to your brain, spine, or nerves, poor blood supply to nerves, or heavy alcohol use.
Other neuralgia causes may include viral infections, such as shingles or herpes simplex. These infections can damage the nerves and lead to nerve pain.
Chronic conditions like multiple sclerosis, diabetes, and certain autoimmune disorders can also cause neuralgia. In some cases, neuralgia can result from nerve compression or irritation from structures like tumors or blood vessels.
Additionally, trauma or injury to the nerves can cause neuralgia. Sometimes, the cause of neuralgia may be unknown and is considered idiopathic. It is essential to work with a healthcare professional to determine the underlying cause of neuralgia for proper treatment and management.
Unfortunately, I fall under a couple of these causes:
- Cold sores (herpes simplex since I was born)
- Viral infections (chronic cases of strep throat throughout my life)
- Compression and irritation on nerves
- Trauma by blunt force (fastball to ankle)
- Sports Injuries (shoulders, neck, back, knees, hamstrings, elbows, feet, hands, head, jaw)
- Trauma to the spine (spinal tap when I was eight years old with extreme side effects of incomprehensible pain in my back when I laid down and in my head when I sat up)
What is trigeminal neuralgia?
In conclusion, the chronic nerve pain I have experienced is likely due to neuralgia rather than trigeminal neuralgia or neuropathy. Various causes, including injuries, viral infections, and nerve compression, can contribute to neuralgia. Treatment options such as medication and therapy can help manage pain and improve daily life for those of us suffering from this condition.