NICO (Neuralgia-Inducing Cavitational Osteonecrosis) is one of the jawbone versions of ischemic osteonecrosis, a common disease affecting any bone but with special affinity for those of the hips, knees and face. By definition, NICO is associated with pain. Osteonecrosis itself may or may not be painful. It may or may not affect multiple sites. It is a problem of poor blood flow through the marrow Patients can trace the onset of their pain subsequent to one or more extractions, perhaps decades ago. Notably, if patients had infections following their extractions or even dry sockets, there was a greater likelihood of NICO development. NICO's can refer pain across the midline; that is, a lesion in the right jaw can cause pain on the left side of the face, head, neck or body. Yes, NICO's can refer pain to various areas of the body, including the neck, arms and hands, legs and feet, groin.