Causation

Neuralgia is a term applied to a variety of nerve pains which may be associated with organic lesions of various structures which irritate the peripheral nerves, or which may be purely functional and temporary excitations of the nerve trunks or their end organs. Lesions involving the nerves themselves are not described as neuralgias. The irritability and conductivity of nerve fibres is so dependent upon nutrition that debility resulting from imprudent living and improper or insufficient food would naturally be expected to rank among the chief predisposing causes of this affection.

Persons undergoing severe mental worry or strain, physical fatigue, prolonged exposure to cold, prolonged lactation, etc., are apt to suffer from indigestion or malassimilation of their food, and the one condition reacts upon the other in altering the tone of the nervous system.

Moreover, many diseases which may be called dietetic in that they are so closely associated with or influenced by dietetic errors (acting eventually through the composition of the blood) are very commonly accompanied by neuralgic pains. Such are gout, rheumatism, lithaemia, arthritis deformans, diabetes, and chronic alcoholism. To benefit the diseased condition by appropriate diet, among other means, is to cure the neuralgia.

Neuralgic pains are often connected immediately with the digestive tract, especially in cases of neurasthenia and hysteria among women, and are excited by irritating foods or by fermentative processes.

Dietetic Treatment

The dietetic treatment of neuralgia is based upon certain general principles which may be observed where-ever they do not conflict with the special disease of which the pain may be merely an incidental symptom. This treatment is liable to be overlooked while attention is wholly given to devising new remedies for the immediate, though often merely temporary, relief of the pain.

It is of the utmost importance to early ascertain the cause of the pain and learn whether it be not due to one of the conditions above mentioned, which may be found to exist in a latent form. Careful examination of the urine should in all cases be made to ascertain the possible presence of the uric-acid diathesis, of sugar, of phosphaturia, etc.

Since a majority of cases are accompanied by general debility and occur in anaemic, constipated women who take little outdoor exercise, the blood also should be examined for anaemia. A nutritious and ample diet should then be prescribed, accompanied by moderate exercise and abundant fresh air, to insure more perfect oxidation. Anstie says correctly that "neuralgic patients require, and greatly benefit by, a nutrition considerably richer than that which is needed by healthy persons." This is particularly true of the extremes of age.

Fats and oils are most serviceable, and under this heading cream, Devonshire cream, butter, bacon, fat meat, salad oil, olives, and cod-liver oil may be used.

Neuralgic patients usually dislike fats, perhaps on the general principle that people are likely to prefer different food from that which they most need for disordered conditions of the system. Some are even made bilious by fat, but with a little tact and perseverance in selecting the proper kind of fatty food and directing the mode of taking it these objections may be overcome. Patients may take more butter than usual, though they refuse cream, or they will take cream though they refuse cod-liver oil. Salad oil and fat bacon are not apt to provoke objection.

In neuralgia due to general debility or anaemia without lithiasis, nitrogenous foods are indicated in addition to the fats above mentioned, and good roast beef, beefsteak or chops, eggs, milk with bread and butter, light starchy foods, and fresh vegetables should be ordered. Meat should be eaten two or even three times a day, and additional lunches may be given between meals, consisting of milk, a glass of claret and a sandwich, a cup of cocoa and a biscuit, or broth thickened with beef meal or an egg.

Gowers says that he has sometimes known " severe neuralgia to occur first on the patient commencing a purely vegetable diet, to disappear when meat was taken, and recur with severity on each of four successive attempts to return to vegetarianism".

If the nervous system has been greatly overtaxed or the digestive organs are exceptionally feeble, it may be advisable to put the patient for a few days on a diet consisting largely of milk, eggnog, beef broth, and purees, accompanied by rest and passive exercise (massage). After a few days the more substantial nitrogenous foods may be added. In cases associated with lithaemia or rheumatic diathesis, however, the quantity of such foods should be reduced, and the special regulations described under the heading of rheumatism and lithaemia must be followed.

Coffee and tea should be used only in moderation, and in bad cases had better be prohibited altogether.

Alcohol in restricted dosage benefits many anaemic cases. Claret or Burgundy may be drunk with meals, but alcohol should never be taken merely to relieve pain or otherwise than a food, for there is danger of becoming too much addicted to its use.

Substances to be especially forbidden are pastry, sweets, and confectionery of all kinds, griddle cakes, condiments, fried food, and rich, highly seasoned sauces and foods.

All meats should be eaten at regular intervals, and, except as directed above, eating between meals must be prohibited.