Toothache as symptom of trigeminal neuralgia

Toothache as symptom of trigeminal neuralgia

It is known that the trigeminal nerve has three independent nerve-twigs on the both sides of the face, on the right and on the left one. They are called: ophthalmic, maxillary and mandibular nerves.

Two of the three nerves on the each side are responsible for common sensibility of the oral cavity and the teeth.

All types of discomfort senses, such as pain in the affected tooth in case of contact with cold, hot or sweat meals, tearing or dull pain, are transmitted by these trigeminal nerve trunks, for each side of the face independently.

This is precisely why the patients with trigeminal neuralgia often seek stomatological help. They recognize the neurological pain as a toothache.

What’s interesting is that the patients with dentofacial system disorders are less likely to come to neurospecialist, considering the toothache to be a neurological one.

The case is that each nerve-twig is responsible for the eight unilaterally located teeth, and usually at least one of them is affected by caries or parodontal disease. So the patient is more likely to think, that he has a toothache, than a neurological pain. To be exact, eight times more likely.

These symptoms will help to decide, whether it is a toothache or a neurological pain:

  • neurological pain is often described as a stroke of electricity. The pain episodes are shot, and painless periouds are long-lasting. There is no any pain or discomfortable feelings between the episodes. The toothache is not so sudden both in its beginning and in its ending. Figuratively speaking, toothache is similar to the skidding trailer, but the neurological pain is like a high-speed train;
  • neurological pain is so severe that patient freezes his movement, his pupils can be dilatated;
  • it is not common for a neurological episode to occur at night, opposite to the toothache
  • analgesics and pain killers usually help to reduce the toothache, but they are totally useless for patients with neuralgia. The source of the pain is located in the central nervous system, so the pain is not reduced.

A toothache can first appear at any time of the day, from time to time it becomes more or less severe. If asked, the patient can easily show the sore spot.

Toothache increases while chewing, taking meals or temperature variations. After the local dental anesthesia toothache is usually eliminated.

Facial pain is more often connected with dental diseases than with the neuropathological disorders. Toothache appears as a result of dentofacial disorders or former inadequate stomatological treatment.

We hope this article will help you in understanding whether you deal with toothache or a trigeminal neuralgia, choose the right specialist for treatment and save your teeth.

Can the facial nerve affection be called neuralgia?

facial nerve

As it is known, neuralgia is a painful condition, that usually arises from sensitive nerve affect, congestive focus of noxious excitation formation, nerve compression by surrounding anatomical structures or a growing neoplasm; or sometimes as a result of interaction of these factors.

Trigeminal neuralgia, for example, declares itself as a hemifacial pain. It lasts for a split second, but usually is so severe, that the patients describe it as a most painful condition, they have ever suffered from during the whole life.

It is evident to everyone, that the trigeminal nerve itself and it’s nerve-twigs are responsible for facial skin, oral and nasal mucosa sensibility, so one can call it facial. The trigeminal nerve gives three independent nerve-twigs: ophthalmic, maxillary and mandibular nerves. These are bilaterally symmetrical structures, gathering the whole sensitive response (noxious, tactile and thermal) from the associated side of the face.

But beyond that there is another nerve on a human’s head, which is called facial or nervus facialis itself. It has nothing to do with the trigeminal nerve, except one thing: both of them are innervating unilateral face structures. The difference is that the trigeminal nerve collects the sensitive information and translate it to the central nervous system structures for analysis, while the facial nerve receives descending impulses from the brain structure and translate them to the had and facial muscles. While the trigeminal nerve is mostly sensitive, nervus facialis is a motor nerve.

According to the basic physiology rules, described by famous Russian scientist Setchenow, any activity of the man’s organism (voluntary or reflexory), except abstract thinking, is based on muscle contraction.

Facialis is the very same nerve that is responsible for every facial muscle contraction, both on the left and on the right side. It provides numerous types of facial expression and in the long haul helps to express different feelings and emotions. If it were not for the facial nerve and its activity, a man’s face would look like an unemotional stony mask.

Besides that, facial nerve has some additional functions. It contains several nerve fibers, responsible for the taste sensation modality of a great part of the tongue, and secretory fibers, controlling the lacrimation. This expandability the facial nerve gets after the intermediate nerve trunk’s attachment.

Unlike the sensation nerve involvement, resulting in feeling disorders, perversion of sensation and a severe pain syndrome, motor nerve damage causes motor function failure.

Motor function disorder due to facial nerve involvement is called paralysis or paresis. A blank impossibility of muscle contraction is called paralysis. If the muscles are too weak, but yet are capable to perform their function, we speak of a paresis.

That’s why, anyone, if asked, whether the facial nerve disorders can be called neuralgia, should answer in the negative.

Facial nerve damage, resulting in movement disorders, is called neuritis or Bell’s palsy, because the most likely cause of the facial nerve paresis is inflammation.

If both nerves, the trigeminal and the facial, are affected, for example, by the herpes virus, symptoms of sensation and motor disorders are present at the same time. I is an extremely painful due to trigeminal nerve involvement condition accompanied by a unilateral paralysis or paresis as a result of facial nerve compression in its own narrow bony canal.

Coexistent affection of trigeminal and facial nerves is more typical for patients with immunodeficiency: HIV infected persons or those who take immunodepressants after the bone marrow transplantation or for another reason.

Facial nerve paresis is absolutely painless. In most cases the inflammatory nerve swelling appears after a local hypothermia, usually during the night sleep. So in the morning, after leaving his bed and looking at the mirror, the patient is likely to be filled with horror at the sight of his face because of the following changes:

  • the face is not symmetrical, there are no typical mimic skin folds (nasolabial groove or forehead transversal expression lines);
  • due to the orbicular muscle of eye paresis or paralysis the palpebral fissure on the affected side of the face is widened;
  • the lower lip drops down, leaving the mouth half-opened;
  • if the patient tries to smile or bare his teeth, only the healthy part of the face would be in motion, so the mouth goes askew;
  • the eyebrow on the affected side cannot be lifted;
  • if the patient tries to close and screw up his eyes and, he can’t do this: one eye (on the affected side) is opened. It is called lagophtalmos;
  • it is impossible for the patient to whistle or to blow on food, because he cannot pull his lips forward;
  • due to the cheek muscle dysfunction, some food can be stuck between the teeth and the cheek and the water flows out of the mouth while drinking;

The secretory fiber’s involvement in the inflammatory process can cause spontaneous lacrymation, for example, when eating, that definitely makes the things worse. At rest the eye would become dry.

To manage a Bell’s palsy, we need to reduce swelling of the facial and intermediate nerves, eliminating their compression in the bony canals, and to restore the motor function. So treatment includes antiviral and anti-inflammatory drugs, as well as multivitamin complexes prescription, massage and physiotherapy.

It is better for the patient to seek medical advice as soon as it possible. The sooner treatment is begun the better result can be achieved.

 

Trigeminal neuralgia: etiology, symptoms and treatment

Trigeminal neuralgia

Trigeminal neuralgia or tic douloureux is one of the diseases known since ancient times. The general picture of facial pain episode appeared only at the end of the XVIII century, when British medical specialists due to the development of civilization became able to arrange all the data, collected in the written sources since the ancient times. At that time they already knew all about the initiating agent, but almost nothing about the nervous system function or impulse transmission – these were empirical knowledge.

Nevertheless, treatment of trigeminal neuralgia with opium medications was successful, but at the same time a lot of patients became addicted to the drug because of its strong side effects. The case is that the pain in trigeminal neuralgia was extremely severe. Not only the episode itself, but even a memory or  waiting can be stressful enough for some persons to commit a suicide. In non treated or improperly treated patients’ suicidal attempts happened not only during the pain episode, but as well while expecting it.

Trigeminal neuralgia is a functional disorder of the peripheral nervous system, which is instantiated by intermittent pain in one side of the face.

Etiology

The most common reason is a compression of the nerve or its ganglion (peripheral node) by the external object in the cranial cavity.

It can be (the most frequent case) pathologically tortuous artery – arteria cerebellaris superior – upper cerebellar artery. Near the junction of the spinal cord trigeminal nerve  passes at close quarters with the blood vessels. Nerve compression usually develops in patients with congenital defects of the vessel walls in case of arterial aneurysm, especially when the systemic blood pressure is significantly increased. If the trigeminal neuralgia onset happens during the pregnancy, the mechanism is probably the same. Such pain usually goes away simultaneously after the delivery.

Medullary sheath defect

So-termed demyelinating diseases, such as Davic’s disease, disseminated sclerosis, acute disseminated encephalomyelitis can cause neurological pain. In this case it is qualified as a symptom of a more complicated disease and is called secondary trigeminal neuralgia.

Nerve trunk compression by the tumor mass

The causative neoplasm can be benign or malignant, arising either from nervous tissue or meninx. Neurofibromatosis is a classic example, multiple fibromas growing in different parts of the body can show various symptoms, neurological pain, trigeminal or with other localization  is one of them

Post traumatic neuralgia

Severe concussion or brain contusion, long continued unconsciousness can cause the formation of intracerebral cyst. While growing it compresses soft tissues and the nerve trunk which causes pain.

Post herpetic neuralgia is a very unpleasant condition accompanied by the neurological pain, but fortunately it happens quite rarely.  In this case bullous rash similar to that in a chickenpox appears on the face skin in projection of the big nerve trunks, after that comes severe burning pain. These symptoms indicate to the neuropathological pain as a result of nervous tissue damage by the herpes virus.

What can cause a pain episode?

Every pain episode in patients with neuralgia is a result of the trigeminal nerve irritation due to trigger area or a dolorogenic zone induction. They are usually localized on the face skin in nose or eye corners or a nasolabial fold. Being irritate even with minimal effort, the trigger points can generate a long lasting, stable pain impulse. The most common dolorogenic factors are:

  • Shaving of the face in men. Looking at a patient with a big shaggy beard, the fist thing an experienced neuro specialist thinks so is trigeminal neuralgia;
  • Just a light face stroke. Patients with trigeminal neuralgia do their best to keep the face out of any disturbance. They don’t use a handkerchief or a paper nose-wipe;
  • Eating or tooth brushing. Active movements of the face and oral muscles, pharynx constrictors can cause pain due to associated face skin movements;
  • Drinking water or other fluids. That is another reason why trigeminal neuralgia is considered to be a very cruel disease. Even a simple process of thirst satisfying can be extremely painful for these patients;
  • Smiling, crying or laughing as well as talking;
  • Doing the make-up;
  • Aggressive odours such as acetone or ammonia spirit can also cause pain, that’s why sometimes they are called trigeminal.

As you can see, every movement of the facial muscles  or the skin can cause an episode in patients with trigeminal neuralgia. At least the temperature drop when coming from warm room outside as well as a slight wind can promote severe pain. That’s why patients with trigeminal neuralgia consider their own face a train wreck waiting to happen.

Clinical aspects

Neurological pain is described as a lighting or a stroke of electricity, sometimes it is quite intensive to cause loss of consciousness. Typical localization ode side of the face: cheeks, lips, teeth, forehead and orbital. By the way frontal branches of the trigeminal nerve are rarely affected by neuralgia.

Neurological pain has no irradiation, it is localized only in the face skin and does not spread to the arm, tongue or an ear. More than that only one side of the face is affected during the one episode. It never happens that the two sides of the face hurt at the same time.

The pain episode usually is very short, it lasts only several seconds. The frequency of the neurological attacks as well as lucid space interval duration is quite variable. Usually the pain free period lasts from several days to weeks.

Neurological pain can be so strong that it makes the patient to freeze, cause pupil dilatation or tearing.

Diagnostics

The clinical signs of the trigeminal neuralgia are so typical that it is not difficult to put the diagnosis at all. But it is really hard to distinguish the primary source of the problem, that is the main task for a neuro specialist. One can diagnose true primary trigeminal neuralgia only after the oncological or an expansive process or any other reason for the nerve compression is excluded.

That’s why MRI or computer assisted contrast vasography can be very helpful. The CT scan must have high resolution with the magnetic field intensity of more than 1.5 tesla.

Treatment

There are two treatment strategies: conservative management and surgery.

Traditionally, trigeminal neuralgia is first treated with medication and only if conservative management is totally ineffective, an opportunity of the surgical treatment is discussed.

Medical drugs, used to treat trigeminal neuralgia:

Seizure medications (anticonvulsants) are prescribed for patients with trigeminal neuralgia because they are able to eliminate congestive excitation focus in neurons, which is similar to the seizure focus in the cortex in patients with epilepsy. The treatment begins with 200 mg of carbamazepine per day, than the dose is consequently elevated to 1200 mg per day;

Central muscle relaxants such as tolperisone or tinazidine act upon the neurons, responsible for the muscle tonus. They help to reduce muscle tightness and spasm, and as a result, to reduce the trigger point sensitivity and the frequency of the pain episodes;

Simple analgesics are not effective in reducing severe burning pain in postherpetic trigeminal neuralgia. In this case medical drugs for neuropatological pain treatment such as pregabaline or gabapentin are prescribed.

If conservative management is totally ineffective, quality of life is significantly decreased and the duration of the lucid intervals falls – surgical treatment is discussed.

There are two surgical methods of treatment, ordered by level of difficulty:

  • nerve block of the whole trigeminal nerve or its branches: ophthalmic, maxillary or mandibular nerve. This method is used in elderly patients with hard comorbidity and on condition that only one branch of the trigeminal nerve is affected. The nerve block is carried out with novocaine or ethanol. The therapeutic benefit is usually present for a year or so.
  • The trigeminal nerve ganglion block is more complicated surgical intervention. To reach the Gasser’s ganglion, one must get an access to the temporal bone basis in the skull cavity. Now it can be done by an atraumatic puncturing, such as during the glycerol percutaneous rhizotomy. In this case sterile medically clear glycerol is introduced into the ganglion, and after several hours, the nerve is devitalizes.

Pathological neuron groups can be destroyed by chemical, thermal or radio-frequency agent.

  • Unilateral trigeminal nerve root trans-section is a quite traumatic, but radical operation. To perform it the neurosurgeon has to drill several holes in the skull and make a encephalotomy. This operation is not performed now because of high risk of complications and low effectiveness.
  • The cross-section of nerve tracts leading to the sensitive trigeminal ganglion is another high-technology medical manipulation. It is effective if the pain is localized in Solder’s zones or correspond to the ganglion areas.
  • Decompression of the Gasser’s ganglion is carried out if it was proven that the nerve is compressed by a blood vessel. In this case the neurosurgeon disconnects the blood vessel from the trigeminal nerve ganglion. Then the blood vessel is covered by the muscle flap or a special artificial material.

This operation is not radical, but it helps to reduce pain for a definite period of time and has one undeniable advantage: all the nerve structures are preserved, so the face skin sensitivity is not compromised.

Radical operations have one very unpleasant side effect a full loss of sensitivity on the affected side of the face. It feels a bit like stomatological anesthesia, but lasts for a lifetime.

Full numbness of the face is a very uncomfortable condition, one can bite his cheek, for example, and would feel nothing. But what is more  dangerous, dental disorders on the affected side. A tooth can be badly destructed with no toothache at all. That’s why patients with postoperative anesthesia should see their dentist regularly.

And at least there is one innovative atraumatic and noninvasive method of treatment of trigeminal neuralgia. It is gamma-knife or a charge particle accelerator.

This treatment is very expensive for the patient, but still it is cost-effective. During the procedure the affected part of the brain is worked up by several charge particle beams from the sources, located inside the special frame of the apparatus.

As a stream of light, focused by several mirrors like surfaces can burn the fire, the resulting charge particle beam from the cobalt-60 destroys the abnormal brain focus with a high precision of about 0.5 mm. The procedure is so atraumatic, that the patient can leave the hospital just at the day of treatment by his own feet.

Prophylaxis

Trigeminal neuralgia is too hard to prevent. There are a lot of internal factors, not depending on the person’s behavior, so it is very difficult to tell what to do or what not to do to prevent neuralgia. The patients with tic doloreux usually know what can trigger the pain attack and try to avoid it.

The only advice we can give is to visit the neurospecialist as soon as possible if you’ve had a neurological pain attack. It is very important to have an executive check-up, because in case of secondary symptomatic neurological pain it is important to begin  treatment as early as it is possible.

What conditions is intercostal neuralgia frequently confused with?

What conditions is intercostal neuralgia frequently confused with

Intercostal neuralgia is one of the most typical neurological conditions and the talk of the town among the patients and the doctors. It has its own quite special symptoms and clear clinical pattern, but still it is often misdiagnosed. Intercostal neuralgia is considered to be a diagnostic pig in a poke just like the vegetovascular dysfunction.

The problem is that a lot of general specialists are not smart enough to diagnose basic neurological conditions, and neurospecialists are not smart enough to treat them properly.

The main symptoms of the intercostal neuralgia are back, flank or girdle pain, spreading to the left or right part of the chest. What diseases have to be excluded during the differential diagnostics process?

Cardiac (heart) sources of pain:

  • Acute myocardial infarction. The patient feels unreasonable physic tension, death anxiety with restlessness and jactation. He is usually pale with cold, clammy sweating on his skin. The pain is very severe and does not depend on the position of the body;
  • Angina attack is manifested in constant nagging pain, spreading to the hand, shoulder or sometimes mandible on the left side. Usually pain comes after physical or emotional stress, going out in a cold weather. Taking nitroglycerin or peppermint cushions helps to reduce the angina pain.
  • Pericarditis sicca or with effusion. Pericarditis sicca is associated with the fibrous commissure formation, which is painful. If dealing with pericarditis with effusion, pain is a symptom of acute heart insufficiency and is usually associated with extension of the borders of absolute and relative cardiac dullness. This pain is described like dragging or dull, patients sometimes say that it feels like a stone inside the chest. Bending the body forward can make the pain less severe

Exluding heart pathology is an overriding priority for a doctor of any specialty. If there are any doubts it is better to diagnose an infarction in patients having neuralgia than vice versa: identify a heart attack as neuralgia. To make it right one should consider past medical history, for example age of the patient: elder people are most likely to have problems with the heart.

These symptoms can argue or neurological pain:

  • The pain is connected with the movement, straining effort, laughing or any concussion of the nerve, including even the deep breath;
  • The patient is asked to extend his arms sidewards, taking a T-like position and then to lean the body to the right or to the left. Leaning to the right makes left intercostal spaces to widen, that makes the pain stronger

Abdominal cavity and retroperitoneal space organs disorders can cause acute pain which can be mixed with neuralgia. Such conditions are quite rare in comparison to cardiac disorders, but they have to be taken into the consideration:

  • Acute pancreatitis;
  • Gastric and duodenal ulcer complications;
  • Gastroesophageal reflux disease and other esophageal problems.

Pain in acute pancreatitis girdling, the patient tends to lean forward like being folded up. First symptoms usually appear after dietary all down or taking alcohol. Usually pain is accompanied by a collaptoid state: skin pailness and cold sweating;

Gastric ulcer complications such as perforation are usually accompanied by severe acute pain, and consequently symptom-free interval. Abdominal palpation and abdominal X-ray in the upright position (that shows the  intraperitoneal gas formation can help to distinguish these two stages.

Esophageous disorders are usually manifested in dragging pain, that tends to increase while swallowing and relieves after taking antispoasmodic drugs.

Some acute disorders of the thoracic organs as well as trauma can also mimic the intercostal neurological pain:

  • Ribs and vertebral fractures are obviously connected with the chest trauma. Examination of the patient with pain in chest includes rib and vertebrae palpation and at least a chest X-ray. It is difficult to diagnose using only subjective information, thorough examination is of a great importance;
  • Pleuritis sicca;
  • Pyoinflammatory lung diseases as abscess;
  • Aortic aneurysm and its dissection

In general, there are no diseases similar to intercostal neuralgia, if examination of the patient is done correctly. It is not so difficult to make a chest X-ray, electrocardiogram record or an abdominal ultrasound investigation. These simple measures would help to distinguish life threatening conditions as fast as it possible and to make a right diagnostic decision. Some patients should be sent to the cardiological department, some – in the emergence surgery and some can get a treatment plan and stay at home.

 

Role of the trigger areas or pain spots in acute neurological pain episode

trigger areas

What is a trigger area? What is the mechanism of pain uprising in patients with neuralgia, having pain spots?

The words “trigger area” or “pain spots” speak for themselves: if the hammer is cocked all you need is to push the trigger and the gun will shoot. In the context of neurological disorders trigger is a system that can pass from one state to another affected by extrinsic factors.

Neurological trigger is a small tissue area, a point that is extremely sensitive to any intervention. Touching, pressing, puncturing or putting high or low temperature to this area one can trigger a neurological pain attack.

These trigger areas or pain point play a key role in nosogenesis of painful conditions and vegetative disorders. The trigger can be localized in any soft tissue, but the most typical location is skeletal muscles  due to their natural ability to contract.

A trigger point becomes active through one of the ways:

  • Muscle spasm or alteration of muscle tension. Such things frequently happen to paraspinal muscles, that lay down just near to the vertebral column. A lot of modern people have problems with deep back muscle blood supply due to the sedentary lifestyle and lack of physical activity.

A muscle spasm can occur as its natural response for the provoking factor, for example a foozle. First, it is reversible, but later, in most of the cases, the vicious circle is generated. A spastic muscle contraction causes inner capillary network compression and constriction of the small vessels and local swelling as a result. Removal of muscle tissue byproducts, especially lactate, is compromised due to the edema and swelling.

Poisoned by itself, the muscle cannot relax and soon becomes hard and solid to the touch. This is what the neurospecialists call a myofascial syndrome. This condition is diagnosed in most of the patients with intercostal neuralgia. There is also a secondary myofascial syndrome. In this case the spasm is generated as a response to local pain. If neurological attack is a result of muscle spasm, it considered to be a trigger point.

  • Recurrence or exacerbation of internals chronic disease as cholecystitis or pancreatitis. Such conditions are frequently associated with the vegetative pain syndrome, that can mimic acute abdominal cavity or retroperitoneal space surgical disorders. A situation when the patient is taken to the operation room for exploratory laparotomy (abdominal incision), but no surgical pathology is found after the incision.
  • General or local hypothermia. This aggressive physical factor can cause changes in muscle tone itself. In most cases exacerbation of chronic process or frequently recurrent neurological pain is tightly connected with temperature changes.

Trigger zones responsible for facial pain attacks or trigeminal neuralgia episodes worth speaking about. They are usually localized in the corners of lips or nose, or even inside the mouth – more often at the interface of the areas, innervated by sensorial nerve.

Face area has more intensive blood circulation and much more nerve terminals than, for example, back or other parts of the body. That’s why even a slight provocation can cause severe pain attack. It can be shaving, talking or even opening the mouth. Food mastication or swallowing can be a trigger as well. Some patients are so scared about pain provocation, that they begin to avoid meals and become exhausted.

Trigeminal neuroganglion has cellular structures with spontaneous neuronal activity. This is the main peculiarity of pain generation cycle in patients with trigeminal neuralgia. Being activated once this autonomous nervous impulse generator can hold on the pain attack for a long period of time.

Pain attack in patients with neuralgia has much in common with a grand mal seizure episode in the mechanism of its generation. Activation of the nerve structure with spontaneous activity in trigeminal ganglion is similar to the discharging lesion generation in the cortex.

That is  why  neurospecialists use seizure medications (anticonvulsants) for trigeminal neuralgia treatment. It can be for example carbamazepine. These medications can break the vicious circle and stop spontaneous pain impulse generating activity switching the trigger from the activated position to inactivated one.

If neurospecialist has prescribed some seizure medications, it doesn’t mean that he considers the patient to be seizure boy. It is all about its proven therapeutic activity in trigeminal neuralgia treatment. These medications help  reduce pain, that is why they are prescribed.

 

Traditional oriental medicine and treatment of neuralgia

Traditional oriental medicine and treatment of neuralgia

There are a lot of complicated serious health disorders, that require high tech medical care: malignant and benign tumors of the nervous system have to be removed during neurosurgical intervention, for treatment of ischemic stroke one must use thrombolytics, using immunosuppressive agents is the only way to restore nerve function in patients with demyelinating diseases or deissiminated sclerosis. And this is not the full list, but nevertheless…

There are a lot of neurological diseases caused by functional temporary disorders. The only thing we need is to diagnose them in time and they could be treated without any deep intervention into the patient’s organism. These patients do not need a surgeon with a scalpel or a gamma knife to be healed. Physiotherapeutic and naturopathyic methods are extremely  helpful in treating functional disorders, that is why traditional oriental medicine is so popular among the doctors and the patients.

We are not going to delve into the specific feature of Chinese, Taoist, Tibetan and other types of oriental physical, mental and religious practices or to lose ourselves in philosophical project. All that we are going to do is to name several effective and easy performed methods of oriental medicine, used in the treatment of different types of neuralgia.

What methods of traditional oriental medicine are patients with neuralgia referred to?

  • Acupuncture – stimulating of biologically active skin areas;
  • Auriculotherapy is based on the hypothesis, that every part of the human body has its representation on the external ear skin. Affecting these tender zones one can repair any internal organ or system
  • All types of massage therapy from acupressure to individual proprietary methods, work out by the massage therapist himself;
  • Herbal therapy with multicomponent mixtures, including more than 20 components, steam inhalations and herbal wraps;
  • Herbal emplastrum with musk and camphor;
  • Aromatherapy is performed by using sage, peppermint, lavender and rosemary essential oils;
  • Moxibustion – calorpuncture of biologycally active skin areas with the absinthial pipe. It can be made in close contact through the special slab or handling he pipe 1.5-2 cm above he skin surface. Moxibustion can be combined with classical acupuncture technique;
  • Su Jok therapy – a complex method, includes stimulating of the tender points, using seed grains, magnetic stimulation and color therapy

Specialists in traditional oriental medicine sometimes use other complementary methods, such as:

  • Relaxing procedures (stone therapy) relieves pain due to systemic action on the central nervous system, and improves sleep quality due to inhibitory pulse propagation in the downstream cortex areas;
  • Hirudotherapy (treatment with sanguisugas, or leeches) is based on two main effects: antiplatelet action of sanguisugar’s saliva and stimulating of the biologically active skin areas, where the manipulator puts the leeches;
  • Manual therapy

The majority of patients with neuralgia can take some procedures in the clinic of traditional oriental medicine. But first of all they should undergo an executive check-up to find out what kind of disorder, functional or organic one, is present. Complete physical examination is extremely important if pain syndrome is very severe and hard to cure.  For example, If the pain is caused by a malignant tumor, that grows bigger and strangulates surrounding nerve terminals, physiotherapeutic procedures would be of no use or even harmful.

Only after the reason and mechanism of the neurologic pain syndrome are clear, patient can be treated n the clinic of traditional oriental medicine. Otherwise, time for proper treatment may be lost.

Physiotherapeutic and naturopathic methods should not be used in acute period of neuralgia with hard pain syndrome. Only after pain and muscle dysfunction are relieved, one can use acupuncture or moxibustion. During the acute period, patients seek special neurological treatment. If pain syndrome is too severe, he even can get a sleekness certificate.

And at least there are some definite contraindications for traditional oriental treatment procedures:

  • Fever (high bode temperature);
  • Tuberculosis (espessially in communicable period);
  • Generalized tonic-clonic epilepsyи;
  • Mental diseases (schizophrenia, manic-depressive insanity);
  • Severe memory problems and socioenvironmental adaptation failure (Alzheimer disease or senile dementia of another type)

Physiotherapeutic methods in the treatment of neuralgia

Physiotherapeutic methods

Physioterapeutic method has proven to be the most effective one in the treatment of neuralgia during long time practice all over the world. The pathological activity of the nervous system has general symptoms: sensation and movement disorders are the most common ones. An individual perception of pain is based on personal evaluation of the existing problems.

Let us talk about the of physiotherapeutic procedures in the treatment of neuralgia.

The main symptoms of neuralgia do not depend on the nerve trunk gauge or severity of the pathological condition, and usually come as:

  • strong, lighting pain, which is described as a streak of electricity. Frequently it is strongly connected with movements, straining effort, cough or laughing. It happens that a slight movement of air may cause pain or it may come without any reason;
  • sensation disorders in the area supplied by the affected nerve trunk. Usually patients have a creeping sensation, false tactile perception or quite the opposite This is called paresthesia, which exactly means incorrect sensibility;
  • and at last, if sympathetic or parasympathetic nerve trunks, responsible for vascular activity, are affected, skin redness or paleness may appear in the painful area as well as goose skin. The pain is frequently described as burning, severe and strongly unpleasant. In this case the conditions are considered to be complicated and the pain is called neuropathological.

These are the symptoms for the physiotherapeutic methods to fight with.

The main idea is that physiotherapeutic methods can be used only after the acute inflammation (if present) is eliminated with pharmaceutical treatment.

For example, post traumatic neuralgia connected with the extremity contusion so, is caused by soft tissue reactions, such as swelling. After the traditional treatment is carried out, the swelling goes down, causing the nerve decompression and pain is decreased without any additional procedures.

Here are some physiotherapeutic methods frequently used in neuralgia treatment:

  • electrophototherapy is the only procedure that can be used during long lasting assiduous inflammation. Blue or violet light with ultraviolet specter is used to reduce painful symptoms;
  • ultra high frequency treatment of 27-40 Hz) cause deep hyperthermia of the skin, subcutaneous and other soft tissues. This procedure is performed only during the cold period, otherwise, it may cause reverse effect: pain and swelling can increase;
  • decimeter wave treatment boosts soft tissue oxygen consumption, activates microcirculatory bloodstream and immunologic response. This procedure also has an anti-inflammatory action;
  • d’arsonvalization is used to reduce pain in patients with intercostal neuralgia and other superficial pain syndromes. It is not helpful in the treatment of vegetative neuralgia or visceral pain. This method is based on high frequency pulse transmission through the human body tissues. Used in patients with trigeminal neuralgia it can reduce the frequency and severity of the exacerbations;
  • medical iontophoresis with Novocaine (for pain management), vitamins (for example B1 – thiamine) or dibazol is considered to be one of the main physiotherapeutic treatment methods, because it combines physical therapeutic factor and direct drug administration into the painful area. It is extremely helpful if taking medication perorally is undesirable due to  comorbid conditions (gastric ulcer, atrophic or ulcrative gastritis);
  • shortwave diathermy. This method is based on magnetic field action, not an electric one. More than a half of the chemical substances in the human body are electrolytes, so getting into the magnetic field they induce secondary electric current in the painful area, warming it up. Shortwave diathermy is used to reduce primary inflammation in neuralgia or during the sanatorium-resort therapy;
  • laser treatment does not have any contraindications. Using laser based light emitting diodes, one can obtain highly specified wave length, and calculate resulting impulse capacity. This is important, because we have a rule: the narrower range of the wave length we use – the higher clinical effect we achieve. The infrared laser with 10-15 watt capacity is usually used for physiotherapeutic procedures

This is not an exhaustive list of the exhisting methods. Natural therapeutic factors are used for the treatment of neuralgia as well as instrumental procedures. Pelotherapy (therapeutic mud), thalassotherapy (marine climate treatment and diving), insolation are good to perform during the rehabilitation and sanatorium-resort therapy.

Intercostal neuralgia: etiology, symptoms and treatment

Intercostal neuralgia

Intercostal neuralgia is one of the most popular neurological diseases. Since acute pain is the guiding symptom of this condition, patients suffering from intercostal neuralgia get an appointment at general practitioner and surgeon as often as neuro specialist.

Chest and girdle pain caused by intercostal neuralgia is so severe, that it makes patients call for emergency service. Sometimes, especially during the first episode, it seems that it is necessary to send a critical care team for immediate care.

This article contains some useful information about causes, key symptoms of intercostal neuralgia, first aid and paramedical care. It will help you to distinguish intercostal neuralgia from other acute and emergent conditions with similar symptoms. You will also find out what you can do to reduce the pain before visiting a general practitioner or neuro specialist.

Typical symptoms of intercostal neuralgia

  • acute severe chest pain is the guiding symptom of intercostal neuralgia. If asked to locate the painful area, the patient usually draws his hand across the costal margin, from spinal column to the frontal surface of the ribcage;
  • the amount of pain is tightly connected with body movements. It tends to grow stronger, when a patient is moving, for example, during body rotation and arm rising;
  • the pain is also growing during deep breathing;
  • every sudden concussion increase pain. It may be coughing, sneezing, straining of laughing. It may help to distinguish the intercostal neuralgia from other painful conditions. Make a slight coughing or ask somebody to tape your ribs. Growing of the pain is a strong evidence of the intercostal neuralgia;
  • this type of pain is called radiculalgia. It comes immediately as lighting or struck of electricity. Patient freezes his movement, even if it is incomplete and stays steel, afraid of pain elevation. It is clear, why it is called “witches shot”

What is not typical for a pain episode of intercostal neuralgia?

  • Patient usually keeps his balance. Of course he tries to find the most comfortable position, but he is not in distress. Patient doesn’t feel unreasonable psychic tension or death anxiety with restlessness and jactation as during the heart attack;
  • intercostal neurological pain is not accompanied by decrease of arterial blood pressure, paleness, cold sweat and acrocyanosis (bluish color of the lips, point of the nose, ears and fingertips);
  • there is no retrosternal pressing or burning pain, spreading on the left hand or mandible;
  • it doesn’t feel like a wooden stake in the chest as in acute pancreatitis. Patients never take the most typical for pancreatic pain forced position like being folded up.

If there is any small evidence that pain is of the heart or pancreatic origin, or there is a possibility of gastric ulcer, you should better call to the emergency service or take the patient to the hospital as soon as it possible. You may give the patient nitroglycerin, if it was previously prescribed by his consulting physician. Waiting for the rapid response team follow the emergence care dispatcher’s recommendations.

What is intercostal neuralgia caused by?

Intercostal neuralgia is a pluricausal disease. Everything that causes intercostal nerve compression or its inflammation may cause an acute pain episode.

  • severe local hypothermia of dorsum or chest, for example while riding a car with the opened window on a driver’s side in summer or during hard work, accompanied by sweating in the open air in winter;
  • an abrupt movement, acute trauma, landing sidewise or backfall, slipping on the ice or weight handling, especially weight lifting;
  • in patients suffering from osteochondrosis of thoracic spine compromised intervertebral cartilages can cause compression of intercostal nerves in their exit points, which is extremely painful;
  • wearing of tight improper sized underwear, especially underwired bra, can cause pain episodes in women with fragile proportions of the body;
  • herpes simplex virus is one of the most important etiological factors of intercostal neuralgia. It causes bullous rash along the intercostal nerve and acute pain. The vesicles are similar to those in chicken pox, they blow out, dry up and form little crusts. This process is accompanied by burning sensation and discomfort. Herpes infection is most common among weak immunocompromised patients, who frequently suffer from catarrhal diseases and tonsillitis.

Postherpetic intercostal neuralgia appears to happen only in patients who earlier (most often in childhood) had a chickenpox.

Herpetic rash usually goes away spontaneously even without any treatment, but it is not a good time to celebrate the victory. Do you know why this type of neuralgia is called postherpetic? Because pain appears after the acute period of the herpetic infection. This extremely excruciating burning neuropathological pain is caused by deep nerve injury. Long years after the acute infection these episodes may return again and again, leading to sleep disturbances. The point is that herpes virus is not eliminated; it appears to live in nerve tissue in latent form.

That’s why it is extremely important to begin the treatment of the herpetic infection as soon as it is possible. If antiviral drugs would be taken immediately after the vesicle rash appearance, there is a good chance to get rid of the postherpetic neuralgia. Medications can be prescribed for local or per oral use. Every vested minute increases the risk of postherpetic pain syndrome.

Treatment of intercostal neuralgia

First of all, it is extremely important not to take any pain killers before visiting the doctor. It can make the clinical situation unclear and lead to the misdiagnosis of acute pancreonecrosis, perforated gastric ulcer, and other emergent conditions in the peritoneal cavity, that need immediate surgical treatment. As a first aid you may do such things:

  • rub the mixture of peppermint ethereal and any vegetable oil in the ratio 1:5 in the painful area. It helps to reduce pain;
  • it is recommended to use acupressure mat (Kuznetsov’s applicator). This small piece of cloth embedded by hard and sharp plastic disks is a kind of reflex therapy device. You should better use it before rubbing in the oil mixture;
  • you can use also topical non-steroid anti-inflammatories containing ibuprofen, ketoprofen or diclofenac.

After clinical examination and full diagnostic procedure the doctor can prescribe some drugs for per oral or even intramuscular administration:

  • centrally acting muscle relaxants such as tolperisone, tizanidine help to reduce muscle spasm and associated myoedema, that consequently decreasing nerve compression and allows to control pain;
  • non-steroid anti-inflammatories: meloxicam, Celecoxib, naproxen usually prescribed for 3-5 days in injections, then in per oral form. Patients having gastritis, gastric ulcer or epigastric burning should take omeprazole while using non-steroidal anti-inflammatories to prevent recrudescence;
  • multivitamin supplements containing vitamin B group are used to improve neural metabolism, prescribed in injections for 10-14 days;
  • emplastrum with a local anesthetic such as lidocaine helps to reduce pain without systemic side effects. Usually it is used in the evening and gives a good night’s sleep. Low frequency of side effects is a great advantage of local therapy. Medication gets right into the inflamed area, passing over the liver, so its concentration is not decreased.

It is extremely important to reduce swelling in the inflamed area, especially during the first days of the disease. That is why it is recommended to reduce water intake and, in some cases use potassium-sparing diuretic such as spironolactone.

Right protective regimen is of great importance as well. The patient is asked to avoid currents of air and not to wrap up. It is not necessary to stimulate local blood circulation during the first days of the disease, when swelling is extremely high. Using an orthopedic mattress will help to reduce pain.

When acute inflammation is gone and pain is controlled on the 5-7 days of illness, physiotherapy, massage and manual therapy can be used. When the acute period is gone patient should remember about preventive measures. It means no extreme physical activity, no abrupt movements, traumas or hypothermia. Patients with intercostal neuralgia need rational physical training and activity regimen.