Trigeminal Neuralgia: Excruciating Facial Pain

Trigeminal Neuralgia is a chronic pain disorder that affects the trigeminal nerve, causing severe facial pain for its sufferers. It is considered to be one of the most painful conditions in medicine.

The trigeminal nerve is the fifth cranial nerve; it is responsible for motor functions such as chewing and transmitting sensations from the face to the brain. The trigeminal nerve reports all facial sensations, including temperature and direct physical contact. If anything should interfere with the normal functions of the trigeminal nerve, it can result in a range of abnormal symptoms known as trigeminal neuralgia.

Trigeminal neuralgia can affect both men and women, especially middle-aged and elderly persons. The most common cause of trigeminal neuralgia is when a blood vessel moves too close to the trigeminal nerve and begins to press against it. This causes the patient to experience a sharp pain on the face similar to an electric shock, or pain in and around the gums where patients sometimes wrongly assume that tooth decay is the cause of these symptoms, and may even resort to having teeth removed in an attempt to relieve the pain.

The symptoms of trigeminal neuralgia show up periodically, but are more likely to occur during physical contact with the face such as when washing one's face, brushing one's teeth, shaving, or even when in windy weather.

When diagnosing trigeminal neuralgia, the doctor will examine the patient's medical history in detail, and may also perform a brain scan using magnetic resonance imaging (MRI). This allows the doctor to distinguish trigeminal neuralgia from other conditions which produce similar symptoms, as well as make an accurate diagnosis.

When a patient is diagnosed with trigeminal neuralgia, the doctor will begin treatment by prescribing anticonvulsant medication to alleviate any painful symptoms. The doctor will then examine how the symptoms respond to the medication – and may alter the dosage as required. If the patient's symptoms do not respond to the medication, the doctor may then consider surgical treatment.

Surgery is performed on a small area behind the ears, where any blood vessel which is pressing on the trigeminal nerve can be repositioned. This procedure is known as microvascular decompression (MVD), and it involves opening the skull and inserting a sponge between the nerve and offending artery or vein causing the pain. It is successful in relieving symptoms for 80-85% of trigeminal neuralgia patients. However, as with any type of surgery, there is the risk of further complications developing, such as infection and bleeding at the site of the operation. The major benefit of MVD is that it causes little or no facial numbness compared to other methods.

Another method of treatment involves using radiation to destroy the nerve, which then numbs the affected area. However, in some cases the pain may reoccur spontaneously, a condition otherwise known as anesthesia dolorosa.

Trigeminal neuralgia is a painful disorder that can disrupt a patient’s quality of life, but there are ways to treat its symptoms and get patients back to living a normal life.

By Assoc. Prof Dr. Yot Navalitoha, Neurosurgeon, Neuroscience Center, Bumrungrad Hospital

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