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Is neuralgia related to spasm at back and sore throat?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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What would the neuralgia be caused by and the spasms are they by the back which are sore at the bottom of the spine and and the top under the neck?
Posted Wed, 18 Dec 2013 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 7 hours later
Brief Answer: My replies are below Detailed Answer: Hi, Thank you for posting your query. The neuralgia in your case is referred to as trigeminal neuralgia (TN). This is not related to the back problems or the sinus problems. The most common reason for TN is pinching or pressure over the trigeminal nerve by a blood vessel near the brainstem, as the nerve is emerging from there. It can be picked up on a high resolution MRI with angiogram. Initial treatment consists of medications such as carbamazepine. Please consult a neurologist. I hope it helps. I would be pleased to answer any follow up queries. Best wishes, Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
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Follow-up: Is neuralgia related to spasm at back and sore throat? 15 hours later
Hi I have had a MRI done very recently and it states that the trigeminal nerve, 7th & 8th cranial nerve complexes and the abducens nerve and otherwise normal in the cisternal portions. Conclusion: there is no suggestion of a brain parenchymal abnorality. In particular no focus of gliosis or oedema. On the limited imaging through the posterior ofssa, the trigeminal nerve is normal in the cisternal portion and within Meckel's cave.. 7th & 8th cranial nerve complexes are also normal within their cisternal portions with no inflammation seen within the mastoid air cells. The abducens nerve is also grossly normal in its cisternal portion. Noted however is sinusitis involving the maximallary sinuses, worse in the left and mild in the right maxillary sinus? the source of the facial pain. No suggestion of a mass seen within the curtaneous tissue of the cheek or orbits to implicate infraorbital nerve pathology on the limited imaging of the facial cutaneous region. No intracranial pathology. On cervical spine there are minor disc bulges seen of the cervical spine at the c5/6 and the C7T1 level abutting the tecal sac mildly anteriorly. There however remains capacious central canal. No cord signal abnormality seen to suggest evidence of myelomalacia cord oedema. craniocervical junction is normal. Minor disc desiccation seen throughout all the cervical discs. No annular fissures/tears seen of the cervical discs. Their conclusion: Minor disc desiccation see through the cervical levels. Minor disc bulges seen at the lower cervical levels as described abutting the tecal sac anteriorly at the above described levels. There is however no resultant central canal, lateral recess or foraminal compromise. No cord signal abnormality to suggest myelomalacia or focus of demyelination. No impingement seen of the cervical nerve roots to suggest cervical radiculopathy. The vertebral arteries show normal flow voids. Sorry to give you such a long description but I thought this my help. What does this mean? I have abbreviated the report so maybe it can give a bit more insight. Also what can the be causing the spasms, they are very slight, can they come from the back? Thank you
 
 
Answered by Dr. Sudhir Kumar 13 hours later
Brief Answer: My replies are below Detailed Answer: Thank you for posting the reports of the MRI, it was helpful. The sinusitis as seen on the MRI may cause facial pain and headaches, if other symptoms also match, such as fever, blocked nose, other ENT symptoms, etc. In any case, I leave that to the ENT specialist to decide. However, in the cases that I see, maxillary sinusitis is almost never the cause of facial pain. Sometimes, the MRI may be normal in cases of Trigeminal neuralgia (in about one third of cases). Neck pain and spasms could be explained by mild disc bulges. Physiotherapy of the neck would be helpful. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Is neuralgia related to spasm at back and sore throat? 26 hours later
You mentioned carbamazepine as a treatment if you were to have neuralgia. What are the effects on a person, do they amplify the symptoms? Can you take say panadol or panadeine l as a pain reliever? How long would they take to take effect? Do you have to take carbamazepine permanently or just temporarily?
 
 
Answered by Dr. Sudhir Kumar 6 hours later
Brief Answer: My replies a re below Detailed Answer: Carbamazepine is a specific drug to relieve neuralgia. It works quite fast and is required 2-3 times per day. Panadol or other analgesics are not specific for neuralgia, but they have mild effect in reducing pain due to neuralgia. You can try whether they would work for you. Carbamezepine is required for a few months. However, in some cases, the neuralgia becomes chronic, when it may be required for a few years. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Is neuralgia related to spasm at back and sore throat? 6 days later
Hello Doctor, just wanted to know I had hystercopty and 8 days later stated getting the neuralgia. I just remember I used a product which is a rust dissolver which is made up of phosphoric acid bought from hardware store , it was out in the open and I used gloves, a mask you also can get from a hardware store, and sunglasses. I had a bit of a sore throat at the time a tightness in the chest, but I went to the doctor at the time and they didn't seem concern. I started developing the neuralgia two days after use. I am in no way blaming the product as all the usual safety concerns are on the bottle, it is just a enquiry. Is there slight chance that they can be connected and if so what can you do to try to reverse or medicate the problem. Also can the neuralgia be more intense in an air conditioned environment? Thanks for your help so far.
 
 
Answered by Dr. Sudhir Kumar 35 minutes later
Brief Answer: My replies are below Detailed Answer: Thank you for getting back with more information. 1. Rust dissolver and the chemicals contained in that are not related to neuralgic pain. 2. Yes, neuralgia does get more severe in presence of air conditioner or in cold climates/seasons. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Is neuralgia related to spasm at back and sore throat? 11 days later
Hi I have been trying carbamazepine over the last couple of weeks with some success. I will still be going to the ENT doctor soon. Can you make neuralgia worse by being helped up by someone from the floor and your head seems to be a bit XXXXXXX as you get up? Before that I have been getting neck pain and a feeling behind my ears and around the ears and face as if it is full of pressure, can this be caused by that neuralgia you were talking about or sinusus?
 
 
Answered by Dr. Sudhir Kumar 13 minutes later
Brief Answer: My reply is below Detailed Answer: Thank you for getting back. It is good to note that you are better with carbamazepine. These symptoms are more likely to occur because of sinuses or cervical spondylosis, and not due to neuralgia. Also, neuralgia would not get worse with the maneuver you described. Please keep me updated about your review with ENT. Best wishes, Dr Sudhir Kumar MD DM
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Follow-up: Is neuralgia related to spasm at back and sore throat? 20 hours later
Many thanks for your answer. Would also after a hysterectomy, my tummy is a bit sore after the pick up from the floor, the stitches should be alright wouldn't they?
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer: My reply is below. Detailed Answer: Stitches of hysterectomy on lower abdomen would normally completely heal within 7-10 days. However, some degree of soreness may occur for longer periods. So, there is no need to worry about the stiches now. Best wishes, Dr Sudhir Kumar MD DM
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Follow-up: Is neuralgia related to spasm at back and sore throat? 15 days later
Hi I went to the ENT doctor and she stated that I will need to have the left sinus drained. Neuralgia is not directly from the sinus she thought but could not say that it could not be also. I have been having pains from the back of the neck, middle of the head & top with the scalp sore, the carbamazepine gives some relief but not totally. I a still have pressure behind the back of the ears and some occasional feather feeling at the sides of the head and around the mouth. Can TN cause such pain at the back of the head and your scalp to be sore? thank you
 
 
Answered by Dr. Sudhir Kumar 11 hours later
Brief Answer: Thank you for getting back. Detailed Answer: Trigeminal neuralgia (TN) causes pain in the face, or front or top of head. The back of head is not affected in TN. The back of head may be affected in cervical spondylosis or muscle tension headache. Getting the sinus drained may help you get rid of facial pain, which could be one of the factors for pain (in addition to TN), which explains the incomplete response to carbamazepine. Best wishes, Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
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Follow-up: Is neuralgia related to spasm at back and sore throat? 3 hours later
Hi thank you for your answer. I have constant pain in the back of my head and top and the behind the ears which is very debilating. Again could my other half having to pick me caused the neck to be a bit more strained at the top if felt a bit compressed behind the ears as I went up?. Any suggestions for pain? The top of my shoulder blades is also very sore and top of arms. I have been going to a physio, would a chiropractor be more helpful?
 
 
Answered by Dr. Sudhir Kumar 5 hours later
Brief Answer: Thank you for getting back. Detailed Answer: It is difficult to pinpoint the reasons for the pain. However, physical movements, lifestyle, daily activities, etc do play a role. The good medications for this pain could be dosulepin (dothiepin) or amitriptyline. Pregabalin is also useful. I am not sure whether you get them freely in Australia or not, but they are available in many countries. Physiotherapy is good. They can do IFT/ultrasound/TENS/traction, etc to relieve the pain. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Is neuralgia related to spasm at back and sore throat? 3 days later
You have mentioned cervical arthritis. What can be done about this, is there a easy procedure to fix? Again you previously mentioned the items above can this could be pain relief for this condition?
 
 
Answered by Dr. Sudhir Kumar 3 hours later
Brief Answer: Thank you for getting back. Detailed Answer: For cervical spondylosis, physiotherapy is the best treatment option. This would include neck extension exercises and IFT/ultrasound therapy, etc. Medications would help in pain relief. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Is neuralgia related to spasm at back and sore throat? 17 hours later
Can you please tell me the symptoms of cervical spondylosis,, can it effect the neck and back and give you a sore back? Can it send waves of pain up the back of the neck? Can it effect the front of the face? thank you for your help.
 
 
Answered by Dr. Sudhir Kumar 9 minutes later
Brief Answer: Thank you for getting back. Detailed Answer: Cervical spondylosis can cause pain in the neck, shoulders and arms. Neck movements may be painful. Muscles in the neck and back may be sore. Front of the face is not affected in cervical spondylosis. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Is neuralgia related to spasm at back and sore throat? 6 days later
Hi thank you for your help so far. I have just been to the Neurologist and he has said that he thinks that is muscular around the neck and head which has been giving me the headaches at the back of the head. He said just to have massages. I went and had acupuncture in the morning and a massage which is apparently the Chinese way which involved as part of the massage his fingers massaging fairly deeply into the back of the neck to the brain stem. Several hours later I have had a huge headache, and am sore at that point. Do you think it has caused any damage, or has it just flared it up and will eventually subside? thank you
 
 
Answered by Dr. Sudhir Kumar 4 hours later
Brief Answer: Thank you for getting back. Detailed Answer: It is possible that you have muscular pain due to tension in head and neck muscles, so, I agree with your doctor. Massage may be fine, but not the deep or vigorous one. You should go for mild to moderate pressure massage. The current flare up of pain is temporary would go away in a few days. There is no risk of any damage due to that massage. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Is neuralgia related to spasm at back and sore throat? 43 hours later
Thank you for your answer. The pressure is still there, and waives of pain go up to the back of the neck and into the head. Would this effect my eyesight? How long do you think that the muscular pain will take, could it be months? The pain seemed to be going away a bit, but with the massage it is ten time worse. PT exercises particularly leaning forward starts the headache. He also stated if I take to many harder pain killers like endone, that it would lead to chronic headache. Do you also have suggestions for this type of pain? Also there is some neuralgia type activity in my face, though he has said that this not trigeminal neuralgia, what could be the cause, could it be the sinuses? Many thanks
 
 
Answered by Dr. Sudhir Kumar 5 hours later
Brief Answer: Thank you for getting back. Detailed Answer: It is good to note that your pain is getting better. In my opinion, your pain may take 4-6 weeks to get better, and not months! Physiotherapy should be continued. This would ensure that the pain does not recur in the future. I agree that strong pain-killers should not be used. However, medications such as dothiepin (dosulepin) and amitryptiline would be useful in muscle spasms of the neck. Facial pain could be related to the sinuses. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Is neuralgia related to spasm at back and sore throat? 19 hours later
Thank you for your reply. I am still getting neuralgia type symptoms in the face, and shooting pain up the back of the neck to the head. Can I have a pinched nerve? Would that cause such a pain. I have had incredible pressure behind the ears but also my nerves seem to be running all over the face, I know the neurologist said it could be muscular, but the pain in so intense and at times my vision is a bit blurred, do you think the hard massage has aggravated it? I have had many blood tests for everthing including diabetes are good except a little bit high in cholesterol. Does such symptoms seem to be still muscular, and would the pain be so intense? Do you think the pain will still subside?
 
 
Answered by Dr. Sudhir Kumar 4 hours later
Brief Answer: Thank you for getting back. Detailed Answer: It is unfortunate to note that your pain is still persisting. However, I am sure you would get better over time. The description of your pain seems to suggest that you have muscular as well as nerve-related pain. Pain in the back of neck could be due to pinched nerves there. Even in the facial pain, there is suggestion of nerve-related pain. I agree that hard massage has aggravated your symptoms (I saw a similar patient in my OPD yesterday, he is getting better after one month of massage). Normal blood tests is a good news! Please continue the treatment as advised, you would get better. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Is neuralgia related to spasm at back and sore throat? 5 hours later
Hi thank you for your help so far. Do you think if I have a pinched nerve that PT massaging gently would be still ok and that it would alleviate the nerve, and that the nerve front related pain will go? The ENT doctor put me on FESS, a steriod spray for the nose and Prednisone (panafcort) for a week for the sinuses to help the blocked XXXXXXX sinus, would also help the nerve? As well as the stabbing pain at the neck, brain stem & top of my head my head burns, as well as the back, but also I get pressure and pain along the forehead and sides of the head & back, do you still think that is muscular? I have used a heat back which does not seem to help at the back of the neck and head, but I have also used a ice pack rapped in one layer there as well is this okay? Much appreciated for your comments.
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer: Thank you for getting back. Detailed Answer: Gentle massage and physiotherapy would help with the pinched nerve in the neck region. Specific things that help are IFT/ultrasound and traction. You can discuss these with your physiotherapist. The treatments suggested by the ENT seem to be fine and your overall pain and health condition would improve with that. Though with these, nerve pain may not change much. Facial pain and blocked sinus would definitely improve with them. Muscular pain is part of your symptoms. Ice pack is helpful in relieving muscular pain. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Is neuralgia related to spasm at back and sore throat? 3 days later
Hello doctor, I am still persisting in the ice packs at the back of the head. As stated previously before I had the chinese massage, I seemed to be getting better. When I lean forward my head at the back starts to hurt still particulary nearly the brain stem. Will it be persistent and why? Also when I lean forward I get a bit dizzy and sensations seem to go over my cheeks, forehead & mouth? Is this the sinuses? I feel like I have a continued pressing at the back of my head and forehead, and I seem to break out in a sweat on the forehead? Is this still also muscular and how long do you think it will take to get better? Thank you
 
 
Answered by Dr. Sudhir Kumar 26 minutes later
Brief Answer: Thank you for getting back. Detailed Answer: Your symptoms seem to be related to pinched nerves in the neck (cervical disc disease) as well as sinuses. Recovery would happen gradually over the next 4-6 weeks. However, every week, you would notice some improvement. You can continue with simple neck extension exercises, ice pack, ointments of diclofenac on the painful area of neck, etc. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Is neuralgia related to spasm at back and sore throat? 26 minutes later
Do think think I should get another MRI would that show the pinched nerves? Will they recover fully? Again would the PT help with this? I also have a burning along the middle back, would this be related? Do you think the Chinese massage aggravated the problem? Am I dizzy with the sinuses, and is the sensations do you think are from them along the face? Thank you
 
 
Answered by Dr. Sudhir Kumar 7 minutes later
Brief Answer: Thank you for getting back. Detailed Answer: Yes, getting another MRI of spine (cervical with screening of whole spine) would help. You would recover fully with treatment. PT would definitely help with recovery. Burning along middle back is related to spine problem. Chinese massage has most likely aggravated the problem. Dizziness and face sensations are related to the sinus. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Is neuralgia related to spasm at back and sore throat? 41 minutes later
So you think it is not muscular now? Can I do anything about the sinuses except what they have told me as it is quite distressing and I can't look down at work as I get dizzy, would PT help there as well? My GP has said I should not do any Phsyio, as to let is heal with time. Is this also while my head feels compressed at the back, and that I can hear my head turning? Do you think that the surgery probably started the aggratation, and do you feel it will still eventually heal completely?
 
 
Answered by Dr. Sudhir Kumar 3 hours later
Brief Answer: Thank you for getting back. Detailed Answer: No, muscular symptoms are related to cervical problem in most cases, and I still feel that you have a component of muscular pain as well. For sinuses, you can try steam inhalation, take medications such as anti-histaminics and antibiotics (in consultation with ENT). PT would not help with sinuses. Surgery may have aggravated the problem, and it would heal over time. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Is neuralgia related to spasm at back and sore throat? 2 hours later
Thank you for your help, it is very helpful. Do you think that it is still a 4-6 weeks time frame, and that the cervical problem will head with PT? Between my back and front of head it is quite overwhelming with the pain, mostly though the back. I will try the steam inhalation, I have taken antibiotics twice and it has not shifted, what at anti_histamines that you mention? With the traction for the neck, idea can this be done from home? Why do you think all of a sudden it hurts so much at the back of the head?
 
 
Answered by Dr. Sudhir Kumar 12 minutes later
Brief Answer: Thank you for getting back. Detailed Answer: Yes, we are looking at 4-6 weeks time frame from now for recovery. Cervical problem may get better with PT. Levocetrizine is common drug used in sinus problem. Traction of neck can be done from home. Back of head pain could be muscular or related to cervical. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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