It is seldom that neuralgia occurs as a separate entity; it is usually a symptom of some co-existent malady. General debility is the most common, and, owing perhaps to their devitalising powers, cold and fatigue should be given second place. A third common cause is chronic irritation - e.g., the facial neuralgia due to sepsis connected with the teeth. It may also be a symptom of neuritis, provided the nerve involved contains sensory fibres.

It is obvious, therefore, that massage treatment for neuralgia is only calculated to relieve the symptom - pain, and not to cure; but relief is important; and massage, used as a means to this end, is a very potent remedy.

Like most ailments, neuralgia may be acute, sub-acute, or chronic. In the acute stage the slow, gentle rhythmical surface stroking offers the best chance of success, and seldom will it fail to alleviate. If it does fail, all massage is contra-indicated. The relief of pain renders it certain that no serious organic lesion (e.g., an intra-cranial tumour) is present; failure is a strong indication that prolonged and thorough search should be made for the cause of the trouble.

When the pain is subsiding, or during the sub-acute stage, the stroking may be given more firmly towards the middle of the treatment, becoming purely superficial again at the end. No other forms of massage should be used until the chronic stage is approaching or has actually been reached. It will never come except as the result of one of two causes. Either the neuralgia is due to chronic illness, or to changes in the sheath as a sequel of neuritis. In the first instance relief will be secured by the means already suggested; in the second, success will depend on removal of the irritant.

Neuralgic pain, even in the chronic stage, may be sharp with acute acerbitations, or a dull chronic aching. In either case, general kneading of the parts around will aid the vascularity of the part, thus hastening the removal of waste products, and will tend to stretch any minute adhesions that may have formed between the sheath of the nerve and surrounding structures.

Percussion may be a valuable asset, but, when using it, the movements should be slow if the pain is acute, or rapid if the pain is dull. Thus the mechanical vibrator will succeed best when treating neuralgia of the latter type. When any definite "knotty" points can be felt near the course of the nerve, local nerve frictions are of great service. They should be applied for short periods only, and as an addition to treatment rather than as a complete remedy.

Prognosis depends on the conditions present. If the cause is still operative - e.g., if anaemia is marked - alleviation is all we can hope for. If the general debility is transient - e.g., if the neuralgia occurs during convalescence from some prolonged illness - alleviation may amount to cure. If there are obvious changes in the nerve-sheath, or if the pain is due to the presence of adhesions, it is right to encourage great expectations. In fact, these cases frequently afford opportunity for sensational cure. If treatment fails to produce amelioration of the symptoms from the outset, it is useless to continue; success, however small, should encourage perseverance. Thus it may be possible to save a patient from nerve section or stretching, or from alcoholic injection. No amount of perseverance will ever give more than temporary relief to a sufferer from the after-pains of herpes.

Neuritis is the name given to all inflammatory conditions of nerve-fibres. It may affect motor or sensory nerves, and may be multiple or local.

Multiple neuritis is a symptom of chronic poisoning. It may appear as a sequel to certain diseases, the most common being diphtheria; or it may be due to continued dosage of poison - alcohol, lead, and arsenic being the chief offenders. The poisons that accumulate in the body during the later stages of all chronic illnesses may produce a multiple neuritis, and even over-exertion may suffice.

Whatever may be the origin of the trouble, the outlook in cases of multiple neuritis is usually good, though where it follows diphtheria the condition may be very grave and even fatal. Treatment should be conducted on lines similar to those mapped out for the treatment of flaccid paralysis. Alcoholic neuritis may be accompanied by the most intense pain. When this is present treatment must be postponed, as no form of massage can be tolerated. The whirlpool bathmight give relief; it certainly merits a trial. If successful it would often save many months of wearisome inaction, during which wasting steadily progresses. When the pain is subsiding, downward surface stroking can be used long before any other form of massage. This prepares the way for other methods. Passive movements should be administered to all joints regularly. Strict obedience to the law, that no paralysed muscle is ever to be allowed to stretch, will effectively prevent the onset of contractures. In all cases of multiple neuritis it is, for some reason unknown, wise to give a much more guarded prognosis for recovery in the case of the long extensor of the great toe than in the case of any other muscle.

It is probable that the neuritis which follows the prolonged absorption of arsenic or lead can be benefited in two ways by massage. Local treatment maintains the nutrition of the muscles, and so keeps them in readiness for the day when the innervation is re-established. General treatment, by assisting elimination of waste products, also hastens the excretion of the poison. Thus in all cases of arsenical poisoning, or of plumbism, general massage should always be given as well as local treatment, and special attention should be paid to assisting the portal circulation (see Chapter XXVII (Massage Treatment For Disorders Of The Digestive System).).

Local neuritis of motor nerves is due to cold, trauma, or involvement in the general inflammation which is spreading from surrounding structures.