NEURALGIA, a term generally used to indicate pain affect ing a particular nerve or its branches from any cause. The exist ence of neuralgia usually betokens a depressed or enfeebled state of health. It is often found to affect the hereditarily rheumatic or gouty. In weakened conditions from improper or insufficient food, in anaemia from any cause, and in syphilis or malaria, neu ralgia is a frequent concomitant. The pain is often localized, but may come to extend beyond the area of its first occurrence. It is usually paroxysmal, not unfrequently periodic ; occurring at a certain time of the day or night, varies in intensity, and may be agonizing or less severe and tingling. Perverted nerve function may co-exist with or following neuralgia. Thus there may be hyperaesthesia, anaesthesia, paralysis or alterations of nutrition, such as wasting of muscles, whitening of the hair, etc.
The commonest forms of neuralgia are facial neuralgia or tic douloureux, intercostal neuralgia and sciatica.
(or tic douloureux) affects the great nerve of sensation of the face (fifth nerve), and may occur in one or more of its three divisions. It is usually confined to one side. When the ophthalmic division of the nerve is involved the pain is mostly felt in the forehead and side of the head. It is often intensely sharp, cutting or burning, either constant or with exacer bations, and often periodic. The skin over the affected part is often red and swollen, and, even after the attack has abated, feels stiff and tender to the touch. In this, as in all forms of neuralgia, at certain localities the pain is more intense, these "painful points" usually being where the branches of the nerves emerge from bony canals or pierce the fascia to ramify in the skin. Hence, in this form, the greater severity of the pain above the eyebrow and along the side of the nose. There is also pain in the eyelid, redness of the eye, and flow of tears. When the maxillary division of the nerve is affected the pain is chiefly in the cheek and upper jaw, the painful points being immediately below the lower eyelid, over the cheek bone and about the upper lip. When the mandib ular division of the nerve suffers the pain affects the lower jaw, and the chief painful points are in front of the ear and about the chin.
is pain affecting the nerves which emerge from the spinal cord and run along the spaces between the ribs to the front of the body. It affects the left side more than the right, is much more common in women than in men, and oc curs generally in enfeebled states of health. It might be mistaken for pleurisy or some inflammatory affection of the lungs ; but the absence of chest symptoms, its occurrence independently of res piration and other considerations establish the distinction. The
specially painful points are chiefly at the commencement of the nerve as it issues from the spinal canal, and at the extremities towards the front of the body, where it breaks up into filaments which ramify in the skin. This form of neuralgia occasionally precedes or follows an attack of shingles (Herpes zoster).
is another common form of neuralgia. It affects the great sciatic nerve which emerges from the pelvis and runs down the leg to the foot. It is often traceable to cold or damp, to over use of the limbs in walking, etc. Any source of pressure upon the nerve within the pelvis, e.g., pregnancy, a tumour or even constipation, may excite an attack of sciatica. It is often con nected with a rheumatic or gouty constitution. In general the nerve of one side only is affected. The pain which is felt at first a little behind the hip-joint steadily increases in severity and ex tends along the course of the nerve and its branches, perhaps, down to the toes. The specially painful points are about the knee and ankle joints; besides which a feeling of numbness is experi enced throughout the whole limb. In severe cases all movement of the limb aggravates the pain, and the patient is obliged to re main in bed. In prolonged attacks the limb may waste and be drawn up and fixed in one position. Attacks of sciatica are often attended with great suffering, and are apt to be very intractable to treatment.
In the treatment of all forms of neuralgia it is of first importance to determine if possible any underlying cause. When the attack is periodic the administration of a large dose of quinine two or three hours previous to the usual time of the seizure will often mitigate, and may even prevent the paroxysm. Many topical applications are of great efficacy. Liniments con taining opium, belladonna or aconite rubbed into the affected part will often soothe the most severe local pain. And antipyrin, phen acetin, aspirin and similar analgesics are commonly taken. The plan at one time resorted to of dividing or excising a portion of the affected nerve is now seldom employed, but the operation of nerve-stretching in some forms of neuralgia, notably sciatica, is sometimes successful. Such an operation is justifiable only in cases where other less severe measures have failed to give relief. Electricity proves serviceable in many instances. In the severest forms of tic douloureux complete relief has followed extirpation of the Gasserian ganglion. (F. W. Mo.)