Modern Approaches to the Diagnosis, Treatment, and Prevention of Neuralgias in Military Personnel: Clinical Experience and Prospects for Enhancing Medical Support in the Armed Forces

Introduction. Neuralgias in military personnel represent a pressing medical and social issue, as chronic neuropathic pain significantly reduces combat readiness, physical performance, and the quality of life of service members. The aim of this study was to examine the clinical characteristics, diagnostic methods, treatment, and prevention of various types of neuralgias (trigeminal, postherpetic, occipital, intercostal, sciatica, and others) in military personnel. The study included one hundred twenty cases recorded at the Military Educational and Scientific Center of the Air Force from 2018 to 2023.

Materials and methods. A retrospective analysis was conducted to assess clinical manifestations, etiology, diagnostic procedures (neurological examination, MRI, CT, electroneuromyography, diagnostic nerve blocks), as well as treatment outcomes and preventive measures.

Results. The most frequently diagnosed types were sciatica (33.3%) and occipital neuralgia (20.8%). Chronic pain lasting more than 3 months was observed in 30% of patients. Standard first-line therapies (carbamazepine, gabapentin, pregabalin, amitriptyline, duloxetine) led to complete remission in 67% of cases and partial improvement in 29%. In treatment-resistant cases, physiotherapy, botulinum toxin injections, and neurosurgical interventions were employed. Preventive measures included Varicella Zoster virus vaccination, regular medical check-ups, health education, and improvements in the ergonomic design of military equipment.

Conclusion. The implementation of modern approaches to the diagnosis and treatment of neuralgias at the Military Educational and Scientific Center of the Air Force ensures high effectiveness of medical care: over 90% of servicemen returned to duty after treatment. Prospects for improvement include the establishment of specialized centers in military hospitals, the development of departmental clinical guidelines for neuropathic pain treatment, training of medical personnel in early detection and multidisciplinary management of patients with neuralgia, as well as further exploration of new methods (gene therapy, neuromodulation) for patients with refractory pain.

Compliance with ethical standards. All participants in the study provided voluntary informed consent.

Contribution:
Skripnikova A.A. — concept, writing, and editing of the manuscript.

Conflict of interest. The author declares no conflict of interest.

Funding. The study had no sponsorship.

Received: April 30, 2025
Accepted: May 28, 2025
Published: August 20, 2025

1. Vallerand A.H., Cosler P., Henningfield J.E., Galassini P. Pain management strategies and lessons from the military: A narrative review. Pain Res. Manag. 2015; 20(5): 261–8. https://doi.org/10.1155/2015/196025

2. Stepanchenko O.A., Sharov M.N., Maksimova M.Yu., Fishchenko O.N., Shestel’ E.A. Modern approaches to therapy of postherpetic trigeminal neuralgia. Consilium Medicum. 2013; 15(2): 16–8. https://elibrary.ru/qomcvj (in Russian)

3. Bendtsen L., Zakrzewska J.M., Abbott J., Braschinsky M., Di Stefano G., Donnet A., et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur. J. Neurol. 2019; 26(6): 831–49. https://doi.org/10.1111/ene.13950

4. Maarbjerg S., Di Stefano G., Bendtsen L., Cruccu G. Trigeminal neuralgia – diagnosis and treatment. Cephalalgia. 2017; 37(7): 648–57. https://doi.org/10.1177/0333102416687280

5. Karpov S.M., Karpov A.S., Vyshlova I.A., Voskanova A.A., Raevskaya A.I., Shtemberg L.V., et al. Modern approaches in the treatment of paroxysmal trigeminal neuralgia. Rossiiskii zhurnal boli. 2022; 20(2): 9–13. https://doi.org/10.17116/pain20222002156 https://elibrary.ru/rhegle (in Russian)

6. Danilov A.B. Postherpetic neuralgia. In: Gusev E.I., ed. Neurology. National Guide [Nevrologiya. Natsional’noe rukovodstvo]. Moscow: GEOTAR-Media; 2009: 445–56. (in Russian)

7. Johnson R.W., Rice A.S. Clinical practice. Postherpetic neuralgia. N. Engl. J. Med. 2014; 371(16): 1526–33. https://doi.org/10.1056/NEJMcp1403062

8. Finnerup N.B., Attal N., Haroutounian S., McNicol E., Baron R., Dworkin R.H., et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015; 14(2): 162–73. https://doi.org/10.1016/S1474-4422(14)70251-0

9. Dworkin R.H., Johnson R.W., Breuer J., Gnann J.W., Levin M.J., Backonja M., et al. Recommendations for the management of herpes zoster. Clin. Infect. Dis. 2007; 44(Suppl. 1): S1–26. https://doi.org/10.1086/510206

10. Swanson D., Guedry R., Boudreaux M., Muhlenhaupt E., Kaye A.D., Viswanath O., et al. An update on the diagnosis, treatment, and management of occipital neuralgia. J. Craniofac. Surg. 2022; 33(3): 779–83. https://doi.org/10.1097/SCS.0000000000008360

11. van Hecke O., Austin S.K., Khan R.A., Smith B.H., Torrance N. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014; 155(4): 654–62. https://doi.org/10.1016/j.pain.2013.11.013

12. Gilron I., Baron R., Jensen T. Neuropathic pain: principles of diagnosis and treatment. Mayo. Clin. Proc. 2015; 90(4): 532–45. https://doi.org/10.1016/j.mayocp.2015.01.018

13. Zakrzewska J.M., Linskey M.E. Trigeminal neuralgia. BMJ Clin. Evid. 2014; 2014: 1207.

14. Baron R., Binder A., Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet. Neurol. 2010; 9(8): 807–19. https://doi.org/10.1016/S1474-4422(10)70143-5

15. Bouhassira D. Neuropathic pain: Definition, assessment and epidemiology. Rev. Neurol. (Paris). 2019; 175(1-2): 16–25. https://doi.org/10.1016/j.neurol.2018.09.016

16. Joffroy A., Levivier M., Massager N. Trigeminal neuralgia. Pathophysiology and treatment. Acta Neurol. Belg. 2001; 101(1): 20–5.

17. Bachiev K.B. Facial pain syndromes in servicemen under various climatic and geographic conditions: pathophysiological and organizational aspects: Diss. Moscow; 2018. (in Russian)

18. Minkin K.I., Ponomarev V.V. Neuralgias and neuropathies: modern prevention methods in the army. Voenno-meditsinskii zhurnal. 2020; 341(7): 45–50. (in Russian)

19. Gilden D.H. Postherpetic neuralgia and viral latency. J. Clin. Investig. 2007; 117(7): 1678–80.

20. Zakrzewska J.M., Palmer J.N., Nally F.F. Bearing down on occipital neuralgia – an evidence-based review. Pract. Neurol. 2018; 18(1): 53–7.