Neuropathic Pain and Neuralgias
At Future Dental, we can refer you to specialists who can treat neuropathic pain and neuralgias.
While we are likely to see neuralgias and, hopefully, recognise that this form of orofacial pain is neurogenic, dentists are not generally the primary physicians involved in the treatment of these pain conditions.
Generally, we need to refer you to neurologists or other specialists because of this as a result, while the specialist you are referred to depends on your symptoms. Other specialists Future Dental may refer you to may include ophthalmologists, ENT surgeons, neurologists, psychologists, or other pain specialists.
Non-odontogenic orofacial pain is about twice as frequent in females as males and affects around 2% of the population.
What are neuralgias?
There are various types of neuralgias which will be explained below. As we serve to connect you to specialists who treat neuralgias and neuropathic pain, we have left you a selection of information pertinent to the condition below.
Classic Trigeminal Neuralgia
CTN causes brief paroxysms of unilateral, electric shock type pain which lasts from a fraction of a second to 2 minutes, with or without continuous additional pain. This can affect the Maxillary and the Mandibular Branches of the 5th or Trigeminal Cranial Nerve, (V2 and V3) far more frequently than the Ophthalmic Branch (V1).
This most frequently occurs through triggers like shaving, a breeze on the face, brushing one’s hair, chewing, swallowing, some tastes and smells and even light contact to the trigger area. Of note, firm skin contact on the same spot may produce no paroxysm of pain, a feature that is useful in diagnosis.
Secondary TN can also occur from space-occupying lesions (tumours) that affect the trigeminal nerve, this has many causes, such as Multiple Sclerosis (MS) amongst others.
Painful Trigeminal Neuropathy
PTN or Painful Trigeminal Neuropathy, sharp paroxysms of pain with additional pain which may be continuous, described as “pins and needles”, burning, or squeezing pain. It may be masticatory muscle weakness or sensory nerve changes caused by one of the below problems:
- Herpes Zoster, Shingles.
- Post-Herpetic (Herpes Zoster or Shingles).
- Other disorders as origin.
This is characterized by transient electric-shock pain in the base of the tongue, below the angle of the mandible, the tonsillar fossa and usually triggered by swallowing.
Occipital Neuralgia is a condition in which the occipital nerves, the nerves that run through the scalp, are injured, or inflamed.
This causes headaches that feel like severe piercing, throbbing or electric-shock-like pain, at times chronic, in the upper neck, back of the head, behind the ears, behind the eyes, scalp and forehead areas, and usually on one side only.
It often starts in the neck and radiates upwards. It may be a primary headache or can be a secondary condition to other more serious causes, such as tumours, infection, trauma, and haemorrhage.
Primary Headaches including:
- Cluster Headaches.
- Trigeminal Autonomic Cephalgias.
- Paroxysmal Hemicrania.
- Facial Migraine, a variant of Migraine, may present as facial pain alone or with cranial pain.
Most commonly unilateral, cervicogenic headaches usually start posteriorly but may radiate to orofacial and/or frontal areas. Provoked by the movement of the neck or prolonged positions of the neck.
These headaches can be stimulated by cervical manipulation. A physiotherapist or craniosacral practitioner can create the pain as a part of diagnosis, and by their skilled manipulation, can just as quickly treat the stimulated pain, often bringing about sustained relief.
The space immediately below the base of the skull where the first vertebra, the Atlas vertebra, the second or Axis vertebra and a third cervical vertebra is the area in which cervicogenic pain is experienced. We will refer you to our local physiotherapist with a high level of experience in this area.
Cervical radiculopathy, also known more commonly as a pinched nerve, is a condition that can affect people’s spinal cords, especially in the C1, C2 and C3 areas. In these cases, one feels pressure on the nerves of their neck.
Atypical Facial Pain (Persistent Idiopathic Facial Pain)
Typically, a history of 3 months at least with a dull aching pain that lasts several hours with a frequent history of ENT surgical, Facial surgical, or Dental treatment where pain results after healing. No dermatome distribution. This is also more frequent in females.
Central Neuropathic Pain
- Multiple Sclerosis.
- Cervical carotid artery or Vertebral artery dissection.
- Cerebral ischaemic events, vascular malformations, and cerebral haemorrhages.
- Pituitary Apoplexy.
- Stylohyoid or Eagle Syndrome, with elongation of the styloid process, or calcification, of the stylohyoid ligament which is easily demonstrated on an OPG Radiograph. While this is a common observation on OPGs, pain from this is very uncommon.
- Neck-Tongue Syndrome. A rare syndrome characterised by unilateral neck and occipital pain provoked by turning the head.
Less frequent sources of pain
Those less frequent but potentially far more sinister sources of pain requiring urgent referral may include:
- Sudden onset headaches.
- Chronic history of headaches where there is an increase in frequency and severity.
- Headaches that commence after age 50 years of age.
- New headaches with other systemic illnesses or medical conditions.
- Headaches along with unintentional weight loss, a history of malignancy, cranial nerve dysfunction, papilledema and those precipitated by postural change aggravation or brought on by a Valsalva manoeuvre.
- Headaches with lymphadenopathy.
- ENT signs and symptoms along with headaches like loss of smell, taste or hearing, or bloody noses.
- Temporal arteritis, usually in the over 50 year age group. Often presents with blurred vision, scalp tenderness, enlarged highly visible temporal arteries and a raised ESR (Erythrocyte Sedimentation Rate).
These fewer common sources of pain serve as a big warning sign that you are in urgent need of care, and that you should seek it as soon as possible for the best long-term treatment of neuropathic pain.
Neuropathic Pain Management in Cairns
If you are being affected by neuropathic pain or neuralgias, we may be able to refer you to the specialist your condition needs here at Future Dental.
It is not our intention to elaborate further on these conditions, but simply to highlight the need to be referred to other allied health professionals, and introduce sufferers to the multi-disciplinary team management they need.