Introduction
Nerve pain, also called neuralgia or neuropathic pain, occurs when a health condition affects the nerves that carry sensation to the brain. It is a particular type of pain that feels different from other kinds of pain.
There are different types of nerve pain, including:
- post-herpetic — this can happen after an episode of shingles (herpes zoster) and affects the same area as the shingles rash
- trigeminal — causing pain in the jaw or cheek
- occipital — causing pain at the base of your skull that can spread to the back of your head
- pudendal — causing pain in the ‘saddle area’ between the legs
Signes et symptômes
Sudden, shooting, stabbing or burning sensation, sharp like an electric shock.
Affected area is very sensitive to touch or cold and can experience pain with a soft stimulus such as brushing the skin.
Pain is often worse at night.
People with nerve pain often find that it interfering with daily life activities including sleep, sex, work and exercise.
Some people with nerve pain become angry and frustrated, and may lead to anxiety and depression.
Causes
Nerve pain can be due to problems in the central nervous system (brain and spinal cord), or in the nerves that run from there to the muscles and organs. It is usually caused by a disease or injury.
Common causes include:
- an injury to the brain, spine or nerves
- poor blood supply to the nerves
- alcohol abuse
- phantom pain after an amputation
- vitamin B12 or thiamine (vitamin B1) deficiency
- certain medicines
Conditions that can cause nerve pain include:
- infections such as shingles and AIDS
- multiple sclerosis
- le diabète
- stroke
- cancer and its treatment with radiation, surgery or chemotherapy
- trapped nerves, such as in carpal tunnel syndrome
There are other conditions associated with nerve pain.
Sciatica is pressure on the nerves of the lower back that causes pain down the leg. The pain can be accompanied by pins and needles, numbness or weakness in the leg.
Fibromyalgia is a chronic pain syndrome associated with burning or aching pain in different parts of the body. The cause is not well understood, but it can be triggered by emotional distress and poor sleep. There may be genetic factors, also.
Peripheral neuropathy occurs when the peripheral nerves that connect the brain and spinal cord to the rest of the body are damaged in diseases such as diabetes.
Physiopathologie
Ongoing pain likely represents spontaneous discharge in afferents. The injured afferents are an obvious source of abnormal input. Sodium-channel dysfunction likely plays an important role in leading to ectopic generation of action potentials. Abrupt pain may correspond to bursts of spontaneous activity in the injured afferents related to sodium-channel dysfunction. The intact afferents that share the innervation territory of the injured afferents also discharge spontaneously. Studies of their cell bodies reveal striking phenotype changes. Trophic factors released from the partly denervated skin working through their receptors on the peripheral terminals may account for these abnormalities. The abnormalities seen in these “intact” nociceptors likely account for the fact that patients such as this may respond to therapies applied at the level of the skin. Central changes also play a role in neuropathic pain. Many of the mechanisms probably are the same as those observed with inflammatory pain. Substantial pain will be present when the skin was lightly stroked (allodynia). Multiple lines of evidence indicate that this allodynia is due to central sensitization, such that tactile afferents acquire synaptic efficacy, which enables them to trigger activity in central pain signalling neurons. Prevailing work has focused on the dorsal horn as the site for this sensitization, but more rostral pathways may be involved as well. Though not easily understood as yet, peripheral nerve injury induces some striking trans-synaptic effects. One is apoptosis that appears to preferentially affect GABA inhibitory cells. Several lines of evidence indicate that immune mechanisms are involved both peripherally and centrally. Activation of microglial cells occurs in the dorsal horn, and this activation may play a vital role in initiating central sensitization. The role of this activation in ongoing neuropathic pain is less clear. The sensation of pain begins with a simple thesis: nociceptors encode information about noxious stimuli and propagate these messages to the CNS and pain is felt. In the case of neuropathic pain, however, it is seen that a lot of chemical and electrical reactions occur.
Diagnostic
Prise d'antécédents
Physical examination including the strength of the muscles, reflexes, and sensitivity to touch. Tests to be done include:
- blood tests to check underlying conditions
- nerve conduction studies
- CT scan or MRI
Traitements
There are many ways to treat nerve pain. Treating the underlying cause, if there is one, is the first step.
Painkillers and a range of different medicines can help.
Nerve pain can be difficult to treat. Any underlying conditions such as diabetes or Vitamin B12 deficiency should be managed. Otherwise, treatments aim to directly ease the pain. Options include medicines and non-medicine strategies.
Médicaments
Some nerve pain will be controlled with simple painkillers like aspirin, paracetamol or a non-steroidal anti-inflammatory drug (NSAID). Stronger painkillers such as opioids are sometimes used, but these have significant side effects that can be harmful especially in the long term, and can be addictive.
Many other medicines can be effective against nerve pain. They include medicines originally used to treat depression such as amitriptyline and duloxetine or seizures such as gabapentin, pregabalin, and carbamazepine.
Non-medicine treatments
Non-medicine treatments can help people to understand and cope with the pain. They include:
- education and counselling
- exercise
- acupuncture
- relaxation techniques
- psychological treatments to help you feel in control of your pain and reduce distress
- Transcutaneous electrical nerve stimulation (TENS) to block the transmission of pain sensations to the brain
Pronostic
Neuropathic pain is difficult to treat completely but is usually not life-threatening. With a log-term prognosis, this condition needs rehabilitation and medications administered together.
Complications
Permanent nerve damage
Permanent or chronic pain
Permanent physical disability
Side effects from medications
Metastasis in carcinoma patients
Paralysie
Spread of infection
Visual disturbances in trigeminal neuralgia
Maladies et Ayurveda
Naadeeruja
Nidana
Dhatukshaya-degeneration or emaciation
Aavarana-obstruction of channels
Kshata-injury
Bahyanimittaja-external factors like infection
Purvaaroopa
Non mentionné
Samprapti
Due to either obstruction to channels, or depletion of body tissues, the movement of Vaata gets deranged. The normal functions of Vaayu when disturbed like this and gets lodged in nerves, it produces severe pain.
Lakshana
Teevraruja – Severe pain
Divisions
Non mentionné
Pronostic
Saadhya in new and without complications
Yaapya in chronic and complicated cases
Chikithsa
Ayurvedic treatment for neuralgia aims mainly at pacifying the aggravated Vaatadosha. It is variable depending upon the cause for Vaatakopa and any associated dosha present. If Vaata is vitiated due to obstruction in channels/Kapha is the associated vitiated dosha, first approach should be to remove the accumulated toxic metabolic waste (Aama) from the body. It can be done by drying up and body-lightening therapies like:
Lepanam with Rookshana dravyas
Swedanam
Mild fasting
Internal medicines with dry and tikta potency
If the Vaatakopa is due to degeneration and Vaata-Pitta doshas are aggravated, for the initial Aamapaachana, some medicines or diet modifications will be enough. The treatment with snehana swedana sodhana panchakarma and then brumhana (Rasayana) will be more suitable in this case.
Samana
Lepana, upanaha and pindasweda
Pradesikadhara with soolaharadravyas
Rasayana
Brumhana
Sodhana
Snehana-swedana
Virechana
Kashayavasti
Snehvaasti
Médicaments couramment utilisés
Guggulutiktakaghrutam
Maharasnadi kashayam
Yogarajaguggulu
Amruthaguggulu
Marques disponibles
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Remèdes maison
No effective home remedies are proven to cure neuralgia. As the pain is very severe and unbearable, medical help is sought in most cases
Régime alimentaire
- À éviter
Les repas lourds et les aliments difficiles à digérer provoquent des indigestions.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Boissons gazeuses - rendent l'estomac plus acide et perturbent la digestion
Aliments réfrigérés et congelés - provoquent une digestion faible et paresseuse en affaiblissant Agni (le feu digestif).
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Caillé - provoque le vidaaha et, par conséquent, de nombreuses autres maladies
- A ajouter
Des repas légers et des aliments faciles à digérer
Green gram, soups, fresh fruits and vegetables
Aliments fraîchement cuits et chauds traités avec des graines de cumin, du gingembre, du poivre noir, de l'ajwain, etc.
Comportement :
Protect yourself from cold climate.
Il est préférable d'éviter une exposition excessive à la lumière du soleil, au vent, à la pluie ou à la poussière.
Maintenir une alimentation et un sommeil réguliers.
Évitez de retenir ou de forcer les envies comme l'urine, les selles, la toux, les éternuements, etc.
Avoid sedentary lifestyle. Be active.
Avoid stress and emotional hurricanes.
postures de Yoga
Regular stretching and mild cardio exercises are advised if the patient is comfortable doing with. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended to control Vaatadosha in the early stages.
L'exercice régulier contribue à améliorer la biodisponibilité des médicaments et des aliments ingérés et favorise la santé.
Le yoga permet de maintenir l'harmonie à l'intérieur du corps et avec le système environnant.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Exercices simples pour la santé des poumons et du cœur
Tous les exercices et les efforts physiques doivent être décidés et effectués uniquement sous la supervision d'un expert médical.
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