Pharmacology treatment of neuralgia and neuritis. Drug treatment of inflammation of the trigeminal nerve

In the treatment of pain syndrome caused by pinched nerve roots as a result of muscle spasms, various diseases of the spine, stressful situations, hypothermia, hernial protrusions, and tumors, medications for neuralgia are prescribed. Their list includes various groups of pharmaceutical preparations characterized by a wide spectrum of action.

Neuralgia is a serious disease that requires timely treatment when the first signs of a pain attack appear. Timely seeking help from a qualified specialized specialist provides an opportunity to avoid aggravation of the situation, breathing difficulties, clouding of consciousness, and the development of complications.

Drug therapy is in first place in the treatment of acute pain attacks caused by pinching of nerve endings in various areas of the human body. The appointment of drugs for neuralgia provides for the achievement of certain goals. These include:

• decrease in the intensity of pain syndrome caused by pinching of the nerve roots;
• adjustment of treatment after the removal of the combat syndrome, aimed at improving metabolic processes in nerve fibers;
• achievement of anti-inflammatory, stabilizing, analgesic, sedative, analgesic effect;
• strengthening the immune system, which determines the protective functions of the human body;
• restoration of the activity of nerve endings after the relief of pain, their stimulation
• prevention of recurrence of neuralgia;
• increase in the content of vitamins, minerals, trace elements in the patient's body.

The strictest observance of the recommendations, prescriptions of the attending physician is an important condition for achieving positive results in the diagnosis of neuralgia. Self-selection of pills and other forms of medication to relieve pain can cause a deterioration in the patient's health, the development of complications provoked by side effects from the medications taken.

Different forms of medications are used to treat neuralgia. Their list includes: tablets, capsules, emulsions, ointments, gels, injections. The correct conduct of drug therapy involves strict adherence to the doses and frequency of medication prescribed by a neurologist.

Analgesics to eliminate neuralgia

To effectively solve the problem of pinched nerve roots in different areas of the human body, different groups of pharmacological agents are intended, which differ in their multidirectional action, properties, speed of action on the focus of inflammation, and side effects. What medications to take for neuralgia is determined only by the attending physician. The results of diagnostic measures form the basis of their choice. Among the common components of pharmacotherapy that successfully eliminate the manifestations of a pathological condition, as well as effectively eliminate the main causes of its development, it is necessary to note analgesics, which are painkillers. Their action is aimed at relieving a painful neuralgic syndrome caused by pinched nerve roots.

Medicinal painkillers are available in the form of tablets, capsules, creamy substances, ointments, gels, injection ampoules. A diverse type of analgesics provides the opportunity to use them externally, orally or in the form of intramuscular injections. The most popular analgesics include: Sedalgin, Baralgin, Spazmalgon, Analgin, Tempalgin, Bral. The use of novocaine and lidocaine blockades allows you to eliminate acute pain that cannot be treated with tablets and topical agents. Painkillers are recommended to be used for 3-4 days. Longer intake of analgesics can lead to inflammation of the gastrointestinal tract.

NSAID medications

Pharmaceutical drugs NSAIDs are non-steroidal drugs characterized by a pronounced anti-inflammatory effect. With their help, it is possible to localize the neuralgic syndrome, reduce the intensity of pain and seizures, and significantly improve the general condition of patients who are faced with a disease of the nervous system. Such properties of NSAID preparations, which have the ability to influence not only the inflammatory process, but also the magnitude of the thermal state of the body of a sick person, pain, play an important role in the treatment of pathology.

Drug therapy of neuralgia involves the use of a wide range of drugs of this type. The most common of these include: Diclofenac, Ortofen, Ibuprofen, Ketoprofen, Piroxekam, Voltaren, Indomethacin. Such drugs and their analogues are available in the form of tablets, capsules. They are recommended to be taken no more than 1-2 times a day. It is strictly forbidden to exceed the dosage prescribed by the attending physician. Ignoring the recommendations of a neurologist can lead to the development of diseases of the gastrointestinal tract, including ulcerative conditions of the mucous membranes of the stomach and duodenum, gastritis and other pathologies. The course of drug therapy based on non-steroidal anti-inflammatory drugs is 5-7 days.

In addition to the form of tablets and capsules, NSAID drugs are available in the form of rectal suppositories, injections. For external use, ointments, creams, gels, special plasters are produced. These include Diprilif, Voltaren, Ketonal, Nise, Diclofenac and other analogues with a similar composition. When using NSAIDs for external use, careful handling is recommended, careful rubbing into the foci of pain, excluding pressure and massaging the inflamed areas. Special patches, which include Ketonal thermo, are considered a modern alternative to applications with ointments, creams, gels.

Muscle relaxants, vitamin complexes, neuroprotectors

When diagnosing neuralgia, drugs designed to relieve muscle spasms play an important role in drug therapy. They are called muscle relaxants. Their use allows achieving positive results, significantly reducing the intensity of the pain syndrome due to the relaxation of muscle fibers and reducing the amount of pressure on the affected nerve process, as well as alleviate the patient's condition. The list of popular muscle relaxants includes: Clonazepam, Baclofen, Sirdalud, Mydocalm, Tizanidin. The treatment course is prescribed by the attending physician.

Complexes based on vitamins of group "B" are designed to compensate for their deficiency in the patient's body, to effectively combat the inflammatory process. The purpose of neuroprotectors is due to their ability to improve and normalize metabolic processes in the brain tissues and peripheral nervous system. Their list includes: Mexidol, Actovegin, Milgama, Neurobion. In addition to the above drugs

the attention and praise of patients deserve ointments based on bee or snake venom, as well as pepper patches, the use of which allows you to get an excellent effect.

Drug treatment of pathology, with strict adherence to the recommendations, doctor's prescriptions, is the key to a successful solution to the problem of pinched nerve roots, acute pain syndrome, and also to exclude relapse.

Panina Valentina Viktorovna

Actress, Honored Artist of the RSFSR

Open review scan

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I found out about you on the Internet - I urgently need an MRI.

And here I am after the performance. I really liked your employees. Thank you for your attention, kindness and accuracy.

May everything be as good in your soul as I am now, despite all the problems ...

Be!!! We are happy! Your Panina V.V.

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I found out about you on the Internet - I urgently need an MRI.

And here I am after the performance. I really liked your employees. Thank you for your attention, kindness and accuracy.

May everything be as good in your soul as I am now, despite all the problems ...

Be!!! We are happy! Your Panina V.V.

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I found out about you on the Internet - I urgently need an MRI.

And here I am after the performance. I really liked your employees. Thank you for your attention, kindness and accuracy.

May everything be as good in your soul as I am now, despite all the problems ...

Be!!! We are happy! Your Panina V.V.

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Sergei Shnurov

Russian rock musician, film actor, TV presenter and artist.

Ts. M. R. T. "Petrogradsky" thank you!

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Thank you so much for such a good, professional service in your clinic. Nice, comfortable! Great people, great environment.

Open review scan

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Rusanova

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Everything is very competent, very friendly service. I will recommend this clinic to my friends. Good luck!!!

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Kuznetsov V.A.

Open review scan

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Khrabrova V.E.

Open review scan

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Thank you very much for the consultation and examination ... Very polite, accessible and explained in detail the course and result.

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It is characterized by the development of a pathological process in the peripheral nerves. The defeat of soft tissues leads to the occurrence of pain syndrome of varying intensity. Patients feel burning, prickling or sharp pain in some parts of the body.

To relieve pain, conservative methods are used: physiotherapy or drug treatment of neuralgia.

In this article, we will consider what are the symptoms of neuralgia and what are the advantages of drug treatment of the disease with injections and tablets: muscle relaxants, B vitamins, painkillers, non-steroidal anti-inflammatory and other drugs.

So, what pills to drink with neuralgia, what is prescribed in such a situation? Does this kind of treatment really help?

Drug therapy is prescribed in the following cases:

• with low efficiency of physiotherapy;
• if severe pain does not help to eliminate the usual methods: massage, baths, warming up, applying a compress;
• if the patient's condition deteriorates sharply;
• with frequent relapses of neuralgia;
• as symptomatic therapy if neuralgia is a symptom of another disease.

Drugs can be used to relieve pain before the arrival of an ambulance. In a critical situation, you need to use only drugs that were previously used by prescription from your doctor. This is necessary to eliminate the risk of developing an allergic reaction.

Taking painkillers (painkillers)

So, what drugs are taken for neuralgia, how can you relieve pain. Painkillers are classified into 2 categories: painkillers from the group of metamizole sodium derivatives and non-steroidal anti-inflammatory drugs (NSAIDs), the latter with neuralgia can be prescribed in the form of droppers.

The first group of medicines include:

1. Tempalgin. Rapid drug. Contraindicated in severe disorders of the liver and kidneys, heart failure and low blood pressure.

   The active substance suppresses the nerve impulses responsible for the transmission of information about pain.

2. Analgin. It is the original drug of Tempalgin.
3. Baralgin. Blocks neurons that transmit information about pain. Prohibited in case of damage to the kidneys and liver, diseases of hematopoiesis, in childhood.

Let's figure out what else can be taken for pain relief in case of neuralgia, what medicines. From the group of NSAIDs, Diclofenac, Amelotex, Ibuprofen or Meloxicam are prescribed. They have similar contraindications.

These pain pills for neuralgia are not recommended for people with gastrointestinal diseases due to the high risk of internal bleeding.

Weak painkillers are produced mainly in tablet form: Ibuprofen, Analgin, Tempalgin. Drugs with a stronger effect are also produced in the form of solutions for intramuscular injection. They are used to get a quick effect on severe pain.

Blockade method

Consider what injections are given for neuralgia in especially difficult cases.

Nerve blockade is used for severe pain of damaged nerves. The drugs are prescribed in the form of solutions for topical administration.

Injections with painkillers are injected into diseased nerves. In 90% of cases, Novocain is used in combination with Prednisolone.

The drugs provide quick relief and help speed up the process of nerve tissue repair. Blockade has a minimum of side effects. The procedure can be repeated several times.

The technique can be used for various:

• damage to the facial and.

A contraindication to the procedure is the increased sensitivity of tissues to the structural components that make up the drug.

B vitamins

Neuralgia is characterized by damage to the nervous tissue. Due to damage to its structure, the conduction of nerve impulses is disrupted. For a full-fledged treatment, it is important not only to eliminate the pain syndrome, but also to preserve the functions of the nerves, to accelerate the regeneration process. To achieve a medicinal effect allows taking multivitamin medicines containing B vitamins.

With neuralgia, drugs are used in the form of solutions for intramuscular injection:

1. Kombilipen- a complex remedy containing vitamin B group, Lidocaine and ascorbic acid.

   Prohibited for use with increased susceptibility of structural substances, severe heart failure, pregnant and lactating women.

2. Milgamma. Based on thiamine, benfotiamine and pyridoxine. It is used in degenerative and inflammatory diseases of the peripheral nervous system.

B vitamins support the functional activity of nerve fibers thanks to the combined action of vitamin B1 (thiamine), B6 ​​(pyridoxine) and B12. As an additional therapy, tablet forms can be used, for example, Neuromultivit.

Anticonvulsants

So, what else can you drink from neuralgia, that is, what drugs can be prescribed by a doctor in this case. It should be noted also anticonvulsant drugs. They are effective against central neuralgia when pain occurs not in the peripheral nerves, but in the brain or spinal cord. Apply when.

There are the following types of anticonvulsants:

Anticonvulsants help to cope with convulsions in the development of neuralgia against the background of diseases of the central nervous system. They are available both in the form of solutions for injections and in tablet form.

Contraindications to the use of anticonvulsants are:

• renal and liver failure;
• period of pregnancy and lactation;
• bone marrow damage, hematopoietic disorders;
• individual intolerance to structural components;
• mental disorders.

If patients with intercostal neuralgia are taking anticonvulsants, they should take a blood test 2 times a year. It is required to exclude the toxic effect of drugs.

Muscle relaxants

Muscle relaxants are used for lesions of the central and peripheral nervous system in which neuralgia is accompanied by sharp spasms of skeletal muscles. With a strong contraction of muscle tissue, the nerve endings are compressed, which leads to severe pain.

The following types of drugs are used:

• Tizanidine;
• Sirdalud;
• Mydocalm;
• Thisalud.

Drugs of the central type relieve muscle spasm in a short time by acting on the motor neurons of the spinal cord. Available in the form of injections for quick relief of an attack and in the form of tablets for a slower action.

There are several contraindications to taking muscle relaxants:

• increased susceptibility of active and auxiliary compounds of medicines;
• severe damage to the liver and kidneys;
• parallel reception of Ciprofloxacin;
• hereditary diseases associated with a lack of galactose, glucose-galactose malabsorption;
• children under 18;
• muscle weakness.

Muscle relaxants are often prescribed for severe pain against the background of intercostal neuralgia, when it is difficult for the patient to breathe due to muscle spasm.

This group of drugs is taken under the supervision of the attending physician, because abuse of the drug can lead to respiratory arrest and heart failure. It is important to remember that the diaphragm and myocardium are made up of muscle tissue.

sedatives

Acute attacks of the disease provoke changes in the patient's psycho-emotional state: a person becomes more irritable, interest in world events disappears, apathy and depression develop.

To eliminate stress and general overstrain, the doctor prescribes antidepressants together with painkillers and sedatives. It is recommended to take tablets developed on the basis of natural plant compounds. In this case, as an answer to the question of what to drink from neuralgia from sedatives, the following examples should be given:

• hawthorn extract;
• mint leaf components;
• Melissa;
• valerian extract.

Sedatives are not released in the form of solutions for injection. To relieve stress, use combined means in tablet form: Novo-Passit, Nevronorm. They contain extracts of several medicinal plants. The duration of the course is about 4 weeks. Sedatives improve sleep quality and elevate mood.

The main contraindication to the appointment of sedatives is the presence of mental disorders or individual intolerance to one of the structural components.

What are the pros and cons of drug therapy?

Compared to physiotherapy for neuralgia taking medications has a therapeutic effect in a short time.

Drugs with good compatibility can be combined to obtain a complex effect on the nervous system.

Painkillers help to quickly get rid of the pain syndrome, sedatives stop the development of depression. By taking anticonvulsants and muscle relaxants, severe muscle spasms can be stopped. The drugs relieve the patient of severe pain.

At the same time, medicines have a number of disadvantages:

• there is a risk of side effects, which increases with improper use of the drug;
• for each patient it is required to select a certain dosage;
• there are contraindications;
• drugs have a negative effect on liver and kidney cells;
• affect the central nervous system: they can cause withdrawal syndrome, addiction.

Now you know what medicines and pills to treat neuralgia, whether injections are given and in what cases, how to safely anesthetize an attack. Despite the positive dynamics of the treatment of neuralgia, medication should be prescribed by the attending physician.

Abuse of certain types of medications can cause overdose and side effects, so the dosage and frequency of medication should be determined by a neurologist.

When prescribing drugs, the specialist relies on the degree of intensity of the pain syndrome, the presence of concomitant diseases and the individual characteristics of the patient.

trigeminal neuralgia may be primary or secondary. The etiological factors of primary neuralgia (idiopathic) have not been fully elucidated, attaching, in particular, the importance of atherosclerosis and narrowing of the bone holes, where the branches of the trigeminal nerve pass. Secondary trigeminal neuralgia occurs as a result of influenza, malaria, syphilis, tuberculosis, diabetes mellitus, brain tumors and trauma, cerebral arachnoiditis, meningitis, pachymeningitis, rheumatism, inflammatory diseases of the paranasal sinuses and dental diseases.

An attack of neuralgia develops according to the mechanism of a multineuronal reflex with the involvement as a result of prolonged pathological impulses from the periphery of both specific and nonspecific structures of the brain stem, subcortical formations and the cerebral cortex.

The clinic is characterized by pain paroxysms, localized in the zone of innervation of one of the branches of the trigeminal nerve. The second branch is most often affected, less often the third, even less often the first; often two branches are affected. The attack lasts from a few seconds to several minutes. In the periods between attacks, pain is not felt. Attacks can be repeated several times during the day. Sometimes they follow one after another for several minutes and even one hour. Such elongated attacks consist of short-term, repetitive pain attacks. During an attack, patients experience shooting, resembling an electric shock, excruciating pain.

Attacks often occur for no apparent reason, but are more often provoked by chewing, washing, laughing, fluctuations in air temperature, touching certain areas of the face and oral mucosa.

During an attack, the pain spreads to the entire half of the face. On the same half, hyperemia, hyperhidrosis, lacrimation, nasal discharge, often tic-like contractions occur.

individual muscles of the face. A characteristic sign of trigeminal neuralgia is the presence of small provocative (“trigger”) zones (on the skin of the face and oral mucosa), touching which causes another attack. Between attacks, pain is determined at the exit points of the corresponding branches of the nerve and hyperesthesia (especially pain sensitivity). Involvement in the process of the trigeminal node is accompanied by a herpetic rash in the zone of innervation corresponding to the branch of the trigeminal nerve (59).

Patients may develop an obsessive fear (constant fear of an attack). They avoid unnecessary movements, walk carefully, try to be silent more, are afraid to wash, shave, brush their teeth, chew, laugh, and make unnecessary head movements.

In cases of secondary, symptomatic, neuralgia, first of all, treatment of the underlying disease should be carried out - sinusitis, frontal sinusitis, ethmoiditis, dental caries, brain tumors, basal meningitis, arachnoiditis, arachnoencephalitis, dorsal tabes, etc.

Anti-inflammatory and analgesic drugs are prescribed: amidopyrine, acetylsalicylic acid, analgin, indomethacin, butadione, phenacetin, reopyrin (pirabutol), etc. Biostimulants (vitreous body, plasmol, etc.) and B vitamins have also been shown. use antiepileptic drugs (Finlepsin, Falylepsin, Suxilep, etc.). Of the physiotherapeutic methods, local darsonvalization is used - ultraviolet irradiation of the corresponding half of the face, novocaine electrophoresis, pelotherapy (paraffin-ozocerite or mud applications) on the corresponding half of the face, acupuncture. In severe cases, they resort to X-ray therapy, novocaine and alcohol blockades.

Occipital neuralgia is a symptom complex consisting of signs of damage to the nerves of the cervical plexus (n. occipitalis major, n. occipitalis minor, n. auricularis magnus, n. transver-sus colli, nn. supraclaviculares).

The main symptom is constant pain in the zone of innervation more often than one, less often several of these nerves. The most commonly affected n. occipitalis major, innervating the occipital region of the head, less often - n. occipitalis minor, innervating the skin of the lateral part of the occiput. When involved in the process n. auricularis magnus pain is perceived in the area of ​​the auricle and external auditory canal. The attack of pain intensifies with sneezing and coughing, head movements, sometimes radiating to the supraclavicular and subclavian region, less often the face and shoulder blade. The head is in a forced position - somewhat tilted towards the affected nerve. In the zone of innervation of the affected nerves, hyperesthesia of all types of sensitivity is noted, as well as pain points along the course of the nerves.

In the etiology of this type of neuralgia, infection, intoxication, changes in the cervical spine (deforming spondylosis, spondyloarthrosis), tuberculous spondylitis, tumor or pseudotumor of the cervical spinal cord and posterior cranial fossa, craniospinal tumor, pachymeningitis of the cervical spine, aneurysm of the vertebral artery play a role, hypertension, especially with dysgemic disorders in the vertebrobasilar vascular pool.

Due to the fact that pain in occipital neuralgia is permanent, not paroxysmal, and is often associated with pathology of the spinal column, some authors refer this symptom, like pain in intercostal neuralgia, to slerotomy pain.

Treatment of the underlying disease, the use of symptomatic agents,

Intercostal neuralgia manifested by constant pain of girdle nature along one or more intercostal nerves. At times, this pain intensifies, especially when bending the torso, coughing, sneezing, inhaling.

Objectively, hyperesthesia (mainly pain sensitivity) is detected in the area of ​​the intercostal nerve involved in the process and pain points along the lower edge of the corresponding rib: vertebral (the exit point of the affected nerve), lateral (the place where the axillary lines intersect with the rib) and anterior (the junction of the sternum with costal cartilage). Sometimes intercostal neuralgia is accompanied by shingles.

Intercostal neuralgia, as a rule, is secondary and is caused by the following processes: changes in the thoracic part of the spinal column (deforming spondylosis and spondylitis, tuberculous spondylitis), rib injuries (cracks, fractures, periostitis, calluses), inflammatory processes in the chest cavity (pleurisy , chronic pneumonia, lung abscess), syphilis (syphilitic periostitis with rib caries, dorsal tabes), diseases of the spinal cord (tumor, meningomyelitis, syringomyelia).

Treatment of the underlying disease, the use of symptomatic agents.

Neuritis of the facial nerve clinically manifested by facial asymmetry as a result of paresis or paralysis of the muscles of the corresponding half of the face. On the affected side of the nerve, forehead skin folds are smoothed or absent, the palpebral fissure is widened, the nasolabial fold is smoothed and lowered, and the lower lip hangs down. When showing teeth or laughing, the mouth is drawn to the healthy side. When opening the mouth, its angle on the side of the process is sharper than on the healthy one. When the eyebrows are raised upward, horizontal folds of the skin of the forehead are not formed, since the eyebrow of the paralyzed side does not rise. When closing the eyes, the eyelids do not close completely and the palpebral fissure on the side of the nerve lesion gapes. This symptom is called lagophthalmos (1a-gophtalmus). The patient cannot stretch his lips with a tube, whistle, kiss. When eating, food gets stuck between the paralyzed cheek and teeth. Superciliary, corneal and conjunctival reflexes are reduced or absent.

Depending on the level of nerve damage, the described picture is accompanied by signs of taste disturbance in the region of the anterior two-thirds of the tongue (lesion of the chorda tympani). Hypercasis (paresis of m. stapedius), herpetic rash in the external auditory canal (damage to gangl. geniculi), increased tear secretion (involvement of n. petrosus major in the process), dry eyes (damage to the nucleus of n. facialis) are observed.

In the etiology of neuritis of the facial nerve, the main factor is local cooling, often in combination with infection (flu). In the development of neuritis, an important role is played by inflammatory processes in the middle ear (otitis media, mesotympanitis) and the posterior cranial fossa (arachnoencephalitis, meningoencephalitis). Damage to the facial nerve is sometimes observed with a traumatic fracture and a crack in the base of the skull, a tumor of the cerebellopontine angle, surgery for a purulent process due to mastoiditis, otitis, parotitis, etc.

In the pathogenesis of neuritis of the facial nerve, dyscirculatory phenomena are important both in the nerve itself and in the tissues surrounding it, especially in the periosteum of the facial canal, leading to the development of edema of the nerve trunk with its subsequent infringement.

With secondary, or symptomatic, neuritis, treatment is aimed at eliminating the etiological factor. Treatment of primary neuritis of the facial nerve of catarrhal infectious etiology consists in the appointment of acetylsalicylic acid, amidopyrine, reopirin, antibiotics, dehydrating therapy, B vitamins, anticholinesterase drugs (prozerin, galantamine, nivalin), dibazol from the very first days of the disease. Patients are prescribed a massage of the face, neck and collar zone, first superficial, and then of medium strength, physiotherapy exercises for the muscles of the face (in front of the mirror) using a special complex, UHF on the mastoid process. After 10 days, diathermoelectrophoresis is prescribed on the face in the form of a mask with a solution of potassium iodide and other physiotherapeutic procedures. With neuritis of the facial nerve, acupuncture is indicated.

Radial neuritis deprives the patient of the opportunity to straighten the arm in the elbow joint, the hand in the wrist joint, fingers in the proximal phalanges, abduct the thumb and perform supination of the hand, and also causes sensitivity disorders in the zone of its innervation (34). Dangling of the hand (35) is characteristic. Damage to the radial nerve is observed in injuries (household, gunshot), especially with fractures of the shoulder, nerve compression during surgery, sleep, use of a crutch, intoxication (lead, alcohol, toxicosis of pregnant women) and infections (flu, pneumonia, typhus, brucellosis, etc. .).

Neuritis of the ulnar nerve more often caused by trauma and is often combined with simultaneous damage to the median nerve. When the fingers are bent into a fist, the distal phalanges of the IV-V fingers do not bend, it is also difficult to bend the paroxysmal phalanges, bring the little finger to the IV finger and the thumb to the index finger, spread and reduce the fingers. The hand assumes a characteristic “clawed” position due to the fact that the proximal phalanges are sharply extended, the middle ones are bent, the thumb and little finger are abducted (36). Sensitivity disorders are noted in the zone of innervation. Neuritis of the ulnar nerve occurs mainly as a result of trauma.

median nerve neuritis makes it impossible for the patient to bend the distal phalanges of the I-II and partially III fingers when clenching the hand into a fist (37), to oppose the thumb to all the others. Violated flexion of the wrist in the wrist joint, and the brush deviates outwards. There are trophic disorders in the area of ​​the hand, accompanied by severe pain, which is explained by the content of a large number of sympathetic fibers in the nerve. Sensitivity disorders are found in the zone of innervation of the nerve.

The main etiological factor of nerve damage is a traumatic factor.

Neuritis of the sciatic nerve causes paresis or paralysis of the foot and fingers, impaired flexion of the leg at the knee joint, weakening or loss of the Achilles reflex, impaired superficial types of sensitivity of the peripheral type along the posterior surface of the lower leg and on the back of the foot (roots L^-Ls, Si-83), sharp pain, trophic and vegetative disorders, soreness along the sciatic nerve (points of Balle - at the exit of the sciatic nerve under the gluteal fold, along the back of the thigh in the popliteal fossa and on the back of the foot).

Of great diagnostic value is the definition tension symptoms nerve trunks: 1) Neri-pain in the lower back when the patient's head is bent; 2) Lasega - pain in the lower back when lifting the patient's outstretched leg by the heel (first phase), when the leg is bent at the knee, the pain disappears (second phase); 3) Bonnet -

pain in the lower back or along the sciatic nerve when adducting the leg; 4) Sikara - pain in the popliteal fossa during flexion or extension of the foot; 5) Vilenkina - pain along the sciatic nerve with strong percussion of the buttocks. Possible neuritis of the branches of the sciatic nerve: the common peroneal and tibial nerves.

Neuritis of the common peroneal nerve causes drooping of the foot (pes equinus), makes it difficult to extend the foot and fingers. The patient can stand on his toes, but cannot stand on his heel. Sensitivity disorders are found on the outer surface of the lower leg, the back of the foot and in the region of I-II fingers.

The most common cause of damage to the common peroneal nerve is trauma, dislocation in the knee joint, intoxication (alcohol, lead, arsenic).

Neuritis of the tibial nerve makes plantar flexion of the foot and toes difficult. The foot is raised up (pes calcaneus). The patient can stand on his heel, but cannot stand on his toes. Hypotension and atrophy of the calf muscles are noted. The Achilles reflex is not elicited. Sensitivity disorders are found on the back of the leg and sole. There are burning pain, trophic and vegetative disorders.

Plexus neuritis(plexites). Shoulder plexitis(plexitis brachialis) causes motor, sensory, vegetative, including trophic, disorders on the corresponding upper limb. The defeat of the entire plexus is rare, more often there is a lesion of its upper or lower trunk (truncus superior et inferior), in connection with which the upper or lower type of peripheral paresis or paralysis of the muscles of the hand is distinguished.

The upper type of peripheral paralysis (Duchene-Erba) is caused by damage to the spinal nerves Cs - Cs, or the upper trunk, which provides innervation to the muscles of the proximal upper limb, and therefore the patient cannot remove it from the body and bend at the elbow joint. The flexion-elbow reflex drops out and the metacarpal-beam (carporadial) reflexes decrease. Disorders of skin sensitivity are determined by the outer surface of the shoulder and forearm, where pain is localized, which increases when trying to take the arm away from the body. When pressed, pain in the supraclavicular fossa is determined.

The lower type of peripheral paralysis (Dejerine-Klumpke) develops when the spinal nerves Cs-Thi or the lower trunk are damaged, which provides innervation of the small muscles of the hand, flexors of the hand and fingers, and therefore there is atrophy of the muscles of the hand and a disorder of sensitivity on the inner surface of the forearm, and also in the area of ​​the hand and fingers. Bernard-Horner syndrome is noted as a result of damage to sympathetic fibers coming from the ciliospinal center (in the cells of the lateral horns of the Cg-Thi segments of the spinal cord).

The defeat of the entire brachial plexus is accompanied by peripheral paralysis of the arm and shoulder girdle, sensitivity disorder, pain in the neck, scapula and arm, pain on pressure in the supraclavicular and subclavian regions.

In the etiology of shoulder plexitis, infections (influenza, brucellosis, typhus, syphilis, etc.), and other diseases (alcohol, diabetes, gout, etc.), injuries (wound, dislocation of the shoulder) take the leading place.

lumbosacral plexitis(plexitis lumbosacralis) is observed with damage to the nerve fibers Lg, Si - 83, spinal nerves and is accompanied by flaccid paralysis of the flexors and extensors of the foot, flexors of the lower leg, adductors of the thigh, sensitivity disorder in the zone of innervation of the nerves emerging from the plexus, pain radiating to the leg, prolapse Achilles reflex and autonomic disorders in the area of ​​the foot and lower leg. The defeat of the entire plexus is rare.

The etiological factors of lumbosacral plexitis are such as trauma to the plexus of the fetal head during childbirth, inflammatory processes, tumors emanating from the tissues of the pelvis and abdominal organs, infections and intoxications.

Neuralgia is a lesion of the peripheral nerves, accompanied by intense pain in the region of innervation of a particular nerve. If symptoms appear, seek medical attention immediately. The prognosis for early treatment is favorable.

Reasons for the development of the disease

Neuralgia develops in both adults and children, as a result of various causative factors. They vary with different localizations of the lesion. The main reasons are as follows: benign and malignant neoplasms that occur in the region of the cervical spine; osteochondrosis and degenerative changes in the intervertebral discs; gout and injuries of the cervical vertebrae.

Nerve lesions are often infectious. The causative agents can be both viruses and bacteria. For example, in most cases, intercostal lesions are represented by herpetic neuralgia.

Predisposing factors for the development of the disease:

• physical inactivity, leading to impaired muscle tone;
• obesity and overweight;
• chronic infectious foci in the body: sinusitis, caries, pulpitis, etc.;
• diabetes mellitus and other metabolic disorders;
• chronic;
• in women - pregnancy;
• chronic or acute stressful situations (the psychosomatics of neuralgia is still being studied by specialists).

A particular patient may have several risk factors for the disease at the same time. In this case, treatment should be aimed at eliminating each of them.

Classification of pathology

Depending on the type of occurrence, the disease is divided into idiopathic and secondary. Idiopathic is exposed to patients if it is not possible to establish a specific cause for the development of symptoms. Secondary disorders occur against the background of any disease: herpes infection, malignant tumor, etc.

In neurology, the division of pathology according to the type of course is used:

• acute - proceeds with a pronounced pain syndrome of a constant or paroxysmal nature;
• chronic - manifested by periodic recurrences of symptoms.

In most patients, acute neuralgia turns into a chronic form due to untimely access to a doctor.

Symptoms

The disease is polysymptomatic. The main complaint is pain. Their localization depends on which nerve is affected. In addition to pain, sensory, motor and autonomic disorders are noted. In the symptomatology of the disease, positive and negative signs are distinguished.

Positive symptoms include:

• hyperalgesia - intense pain in a certain anatomical region, they can occur with irritation of neighboring or distant zones of nerve innervation;
• allodynia - the occurrence of pain when exposed to non-painful stimuli, for example, when exposed to bright light, sound, or clothing touching the skin;
• hyperpathy - the persistence of a feeling of pain after the cessation of exposure to the stimulus;
• paresthesia or spontaneous pain, having the character of "crawling", etc.

The main negative symptom is hypalgesia - a decrease in pain, tactile and temperature sensitivity. In addition to pain, movement disorders occur in the region of innervation of the affected nerve. They often have the character of paresis, accompanied by a decrease in muscle strength, less often - paralysis.

trigeminal neuralgia

Trigeminal neuralgia is the most common. The trigeminal nerve innervates the skin of the face, providing tactile, temperature and other types of sensitivity. The main clinical manifestations of an attack of neuralgia are as follows:

• sharp, intense, acute pain - localized from the side of the affected trigeminal nerve;
• autonomic disorders in the form of lacrimation, salivation and sweating.

Pain in trigeminal lesions can occur when talking, shaving, or moving the jaws. With changes in the mandibular branch of the nerve, disorders develop in the masticatory muscles - spastic contractions or twitches.

Trigeminal nerve and areas of its innervation

Runs for a long time. The patient has periods of remission and relapse. Exacerbations occur against the background of provoking factors: hypothermia, increased physical activity, stress, etc. With complex therapy, it is possible to achieve stable remission without clinical manifestations.

Glossopharyngeal nerve injury

The nerve innervates the tympanic cavity, tongue, pharyngeal muscles, parotid salivary gland, and tonsils. It often develops against the background of infectious diseases - acute or chronic tonsillitis, influenza, etc.

The main complaint is pain in the ear, tongue or soft palate. It is acute and occurs without connection with any factors, lasts several minutes. With severe pain, vegetative reactions are additionally noted: loss of taste sensitivity or its perversion, swallowing disorders, etc.

Glossopharyngeal nerve symptoms develop not only spontaneously, but may be associated with talking, yawning, or swallowing. Provoking factors include the intake of hot or cold food that irritates the nerve endings.

Pterygopalatine neuralgia

The main reason for the development is inflammatory diseases of the upper respiratory tract. It is manifested by acute pain in the region of the orbit, the root of the tongue and the teeth of the upper jaw, which can pass to the temple and neck, making it difficult to diagnose.

Symptoms often occur at night, lasting several minutes. In some patients, the pain persists for several hours. Pathology often proceeds in a chronic form and is characterized by frequent exacerbations that develop against the background of infectious diseases, overwork, etc.

Intercostal neuralgia

The main manifestation is pain along the affected intercostal nerve. It intensifies with movements of the body, inhalation, coughing, etc. The nature of the pain is intense, up to the inability to talk or move.

Signs appear on the background:

• intense physical activity;
• lingering cough;
• long-term preservation of an uncomfortable posture;
• inflammatory diseases of the respiratory system;
• osteochondrosis and other pathologies of the thoracic spine.

Intercostal neuralgia

If pain occurs in the chest area, differential diagnosis should be carried out. Doctors exclude pneumonia, pleurisy and pneumothorax, which are characterized by similar clinical manifestations, aggravated by movement and coughing.

How to understand if the heart hurts or is it neuralgia?

As a rule, in angina pectoris and myocardial infarction, the intensity of pain does not depend on movements and is accompanied by characteristic changes on the electrocardiogram.

Herpetic lesion

Herpetic infection in newborns, children and adults is a common cause of neuralgia. The disease develops against the background of infection of the body with the herpes virus type 3 (Varicella zoster). The resulting damage to the nervous system is associated with an exacerbation of the infectious process against the background of an immunodeficiency state.

The peculiarity of the course is the localization of pain in the area of ​​​​appearance of skin rashes and their persistence for several weeks or months. The nature of the pain is different: dull, stabbing, cutting, shooting, etc.

With a herpetic lesion, the patient has pronounced allodynia. A characteristic sign of the disease is the presence of a herpetic rash on the skin, which looks like small bubbles filled with a clear liquid.

Diagnostic measures

Only a doctor determines neuralgia. For the selection of therapy, it is necessary to establish the cause of the development of the disease. Diagnostic measures are carried out according to the following algorithm:

1. Collection of complaints and anamnesis of the disease.
2. Clinical examination using questionnaires to determine the nature of the pain.
3. Laboratory and instrumental research methods.

During the collection of anamnesis, the neurologist learns the features of the occurrence of pain, their nature, as well as the factors that provoke the appearance of pain. It is important to identify its localization, prevalence and duration. During the survey, existing disorders are revealed: muscle weakness, the appearance of paresthesia, etc., as well as concomitant diseases.

During a clinical examination, the doctor determines the nature of the pain. In the case of damage to the nervous structures, it is neuropathic, i.e., it is localized in the anatomical region of the innervation of a particular nerve. This makes it possible to distinguish it from psychogenic or muscular neuralgia. Neurological examination reveals sensory disturbances, decreased muscle strength and reflexes. To determine the intensity of pain, special scales and a diagnostic questionnaire for neuropathic pain are used.

Changes in laboratory tests are typical of neuralgia that occurs against the background of infection. In a clinical blood test, an increase in the number of lymphocytes and an acceleration of the erythrocyte sedimentation rate are determined. In the biochemical analysis, the level of C-reactive protein and fibrinogen increases. The revealed deviations indicate an inflammatory process in the body.

Instrumental examination methods are used to identify the cause of nerve damage. If you suspect osteochondrosis, benign or malignant tumors, as well as traumatic changes, computed or magnetic resonance imaging is performed. To assess the structural integrity of the nerves, electrodiagnostic studies with evoked potentials are used.

Differential diagnosis is carried out with pain syndromes of a muscular or psychogenic nature. In the case of neuropathic pain, the localization of unpleasant sensations corresponds to the region of innervation of the affected nerve. Psychogenic disorders are manifested by the transient nature of the clinic, as well as the occurrence in the presence of "observers". Muscle pain is accompanied by violations of the tone of the muscles of the back. To distinguish neuralgia from heart pain allows an ECG.

Approaches to therapy

Patients with intense pain syndrome are interested in what to take with neuralgia to alleviate the condition. Doctors do not recommend self-medication, as it is fraught with the progression of the underlying disease and the development of its complications. Therapy is complex, aimed at:

• elimination of the underlying disease;
• elimination of pain syndrome with the help of drugs and non-drug methods;
• carrying out surgical and minimally invasive interventions with the ineffectiveness of conservative approaches.

The basis of therapy is drugs from various pharmacological groups, which are prescribed by a doctor, taking into account the patient's indications and contraindications.

Medical treatment

Standard painkillers from the group of non-steroidal anti-inflammatory drugs for neuralgia are not effective. For therapy, several groups of drugs are used:

• Anticonvulsants - Gabapentin, Finlepsin, Tebantin, etc. Used as first line therapy for any nerve damage. The dosage is selected individually. When using Gabapentin, the dose increase is stopped at the level of 3600 mg per day, since its further increase does not affect the effectiveness.
• With low effectiveness of anticonvulsants, tricyclic antidepressants, for example, Amitriptyline, are used. They reduce the severity of chronic pain syndrome and prevent mental disorders.
• Muscle relaxants (Mydocalm, Baclofen) are used for the muscle component of the pain syndrome, when there are violations of the tone of individual muscle groups.
• Local anesthetic ointments and gels (Fastum-gel, Deep Relief, etc.) have limited effectiveness.
• To improve the condition of the nervous structures, drugs with B vitamins are prescribed - Neurorubin, Milgamma, etc.
• Opioids or Tramadol may be used as needed. Narcotic analgesics are used for intense pain leading to full labor and a person. The use of tramadol and opioids begins with the minimum therapeutic dosages.

What can be done at home and what drugs are better to take?

Doctors do not advise self-medication, since the underlying disease leading to neuralgia can progress rapidly and become more complicated.

Non-drug measures

Physiotherapy is selected depending on the location of the lesion. With changes in the trigeminal nerve during remission, massage of the collar zone, paraffin baths, reflexology and acupuncture are used. In the acute stage of the disease, physiotherapeutic methods are limited - drug electrophoresis with anesthetics and vitamins is possible, as well as ultrasound exposure to the affected area with glucocorticosteroids.

With damage to the intercostal nerve, one-sided UV exposure is used, as well as electrophoresis with Lidocaine. The analgesic effect is observed during applications with mud, hydrogen sulfide or radon baths, as well as massage.

Physiotherapeutic effects are complemented by physiotherapy exercises and swimming. This avoids atrophy of the innervated muscles. Exercises are selected in accordance with the level of physical fitness of the patient and the severity of the disease.

The use of traditional medicine and homeopathy is prohibited. These methods of therapy do not have proven efficacy and safety, and therefore should not be used for any type of neuralgia.

Surgical and invasive methods

To alleviate pain, electrical stimulation methods are used: chronic electrical stimulation of the peripheral nerves and spinal cord. For their implementation, a neurostimulator is implanted, which provides a constant effect on the structures of the nervous system.

What is dangerous neuralgia

A long-lasting pain syndrome leads to the fact that a person becomes irritable, and is noted in him. Negative emotions can provoke somatic pathology - angina pectoris, arterial hypertension, etc. This causes a decrease in working capacity and social disadaptation.

Pathology without treatment leads to persistent depression. The patient may not seek medical help for a long time, trying to cope with pain on his own with the help of non-steroidal analgesics. Depressive disorder tends to progress, affecting personal and professional life.

Forecast and prevention

The prognosis for neuralgia of a secondary nature is favorable. Identification of the causes of its development and selection of therapy to eliminate the underlying disease allows the patient to recover and avoid the development of complications.

How long does the disease last?

Doctors note a period of 2-4 weeks, depending on the nature of the pathology. Attempts at self-therapy or non-compliance with doctor's prescriptions worsens the prognosis, as the disease can progress rapidly.

With a primary lesion of the nervous system, it is difficult to find an effective treatment. It is possible to achieve a stable remission, in which the symptoms of the disease will be absent.

1. Eliminate bad habits - smoking, drinking alcohol and drug addiction.
2. Regularly engage in physical activity that is adequate in terms of the level of sports training of a person.
3. Provide a balanced diet rich in protein, vitamins and trace elements.
4. If there are diseases of the internal organs and the nervous system, treat them in a timely manner, following the doctor's prescription.
5. Normalize sleep and wakefulness (the duration of night sleep should not be less than 8 hours).
6. During pregnancy, register at the antenatal clinic and visit the gynecologist regularly.
7. Do not self-medicate with the use of medicines or traditional medicine methods.

The main reason for the development of pathology is infectious diseases and traumatic injuries. Their prevention, as well as early detection and prescribing of complex therapy, allows achieving full recovery and avoiding negative consequences.