Pain is something that cannot be measured or seen on a scan. A doctor has no "pain meter" — they can only rely on what the patient describes. And descriptions of pain often sound similar across very different conditions.
Similarity of Symptoms
A patient with neuropathic pain (e.g., nerve damage) often describes:
- burning,
- stabbing,
- stinging,
- electric shock-like sensations.
But a person with psychosomatic pain — pain driven primarily by psychological factors — may use the exact same words. How else would you describe suffering?
No Identifiable Cause on Imaging
In neuropathies, nerve damage can usually be detected (e.g., on MRI or EMG).
But not always. In trigeminal neuralgia, for example, imaging studies very often come back "clean" — yet the pain is absolutely real and extremely severe.
This means that when a doctor sees no evidence on scans, they may begin to suspect a psychogenic cause.
The Overlap Between Pain and Psychology
Chronic pain affects the brain. After months or years of suffering, it is entirely natural for the following to develop:
- anxiety,
- depression,
- insomnia.
And here it becomes easy to oversimplify: "it's probably psychosomatic." Meanwhile, the patient feels dismissed — because their pain is real.
What the Ideal Approach Should Look Like
- Thorough clinical history — questions about the character of pain, aggravating and relieving factors.
- Neurological examination — MRI, EMG, nerve conduction studies.
- Neuropathic pain screening tools — such as DN4 or PainDETECT, which help differentiate neuropathy from psychogenic pain.
- Interdisciplinary collaboration — neurologist + psychiatrist/psychologist, because in chronic pain, physical and psychological factors almost always coexist.
A patient in pain does not need a label.
They need to be heard, understood, and approached appropriately.
Natalia — since 2014 I've been living with trigeminal nerve pain. I write in plain language, based on reliable sources and personal experience. Read my story →
Frequently Asked Questions
What is trigeminal neuralgia?
Trigeminal neuralgia is a chronic facial pain condition. It manifests as sudden, severe, usually one-sided pain attacks — often described as an electric shock. A single attack typically lasts from a few seconds to about two minutes.
What is the difference between neuralgia and neuropathy?
In simple terms: neuralgia primarily involves paroxysmal pain along a nerve, usually without loss of sensation. Neuropathy involves nerve damage that more often causes constant pain along with numbness and sensory loss.
Do regular painkillers help with neuropathic pain?
Usually not. Neuropathic pain responds poorly to paracetamol or anti-inflammatory drugs. Instead, medications that act on nerves are used, such as anticonvulsants like carbamazepine.
Why is an MRI performed?
MRI helps detect neurovascular conflict and rule out other causes of pain, such as tumors or multiple sclerosis. The diagnosis of neuralgia itself is primarily clinical.
Which doctor should I see for facial pain?
First, see a neurologist. If surgery is being considered, a neurosurgeon. If a dental cause is suspected, it is also worth ruling it out with a dentist.
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