A Shocking Development: The Pains Of Trigeminal Neuralgia

Trigeminal Neuralgia, also known as Tic Douloureux, is one of the most excruciating pains one can ever experience. A patient who was diagnosed with this problem described this fact to me. Approximately 15,000 cases of trigeminal neuralgia are reported each year in the U.S., and yet the mechanism for this problem is not entirely crystal clear.

What Is Trigeminal Neuralgia?

Trigeminal Neuralgia is a sharp, lightning-quick pain which one experiences on the side of the face. These pain episodes are brief, some lasting less than a second, but one can have a succession of rapid-fire pain episodes, bringing the pain to a crescendo. Pain is usually one-sided, although bilateral episodes have been known to occur. It is most often found in women, and in people over 60 years of age. They are often described as electrical shocks, and may last up to days and weeks if therapy is not properly sought. About five people in 100,000 may suffer from this problem.

What Causes Trigeminal Neuralgia?

No one knows for sure, but it is thought to be due to compression of the trigeminal nerve as it enters the brain stem. As one gets older, blood vessels may enlarge due to formation of plaques or aging, and is thought this expansion of certain cerebral vessels may cause this compression. For people with trigeminal neuralgia, they complain of pain that coarses through the branches of the trigeminal nerve along the side of his face. Although it can occur spontaneously, touching of the face can trigger trigeminal neuralgia. Brushing one's teeth, chewing food, and talking can all set off painful episodes.

How Is Trigeminal Neuralgia Diagnosed?

Your physician will often uncover trigeminal neuralgia through a complete history and physical examination. There are no laboratory tests that will help diagnose trigeminal neuralgia, although a CAT scan of the head is usually recommended to rule out other causes of facial pain, such as a brain tumor. Often, people with trigeminal neuralgia go to their dentist, thinking their pain is from either a toothache or a cavity.

What Is The Treatment For Trigeminal Neuralgia?

Medications have been the mainstay of treatment for trigeminal neuralgia. Carbamezepine (Tegretol) is the classic initial medication for treating this problem. It is not without side effects however, and follow-up on blood tests to check for liver function and sufficient drug levels are mandatory. Carbamezepine is usually stopped once the pain goes away. The recently approved Gabapentin (Neurontin) has also been found to be a successful medication against trigeminal neuralgia. Adjunctive drugs such as Baclofen (Lioresal) and Amitryptiline (Elavil) may also be tried in more difficult cases.

Surgical therapy has been found to be an effective treatment in those that fail or can no longer tolerate medications. Surgical procedures such as microvascular decompression of the trigeminal nerve have led to 90 percent cure rates of trigeminal neuralgia. Due to the general risks of brain surgery, these procedures are considered as a last option for most trigeminal neuralgia patients.

The pain of trigeminal neuralgia can be so great and unrelenting, that it has been known to drive people to suicide. It is important for both physician and family members to be closely involved in the care of the trigeminal neuralgia patient, and to make sure their needs are appropriately addressed.

Reference:

Trigeminal Neuralgia. Rakel: Conn's Current Therapy 2000, 52nd ed., W. B. Saunders Company.

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