Pain is a feeling or discomfort caused by an illness or injury or a sensation caused by a noxious stimulus to the naked nerve endings. It is normally due to tissue damage and characterised by discomfort like pricking, throbbing, aching, etc.
TYPES OF PAIN
Acute pain last for a while but rarely it becomes chronic pain.
Chronic pain persists for longer periods and is resistant to most medical treatments.
Identifying the ethology instead of simply treating the pain can give more targeted and successful pain treatment.
FACIAL NERVE PAIN
The nerve most commonly associated with facial nerve pain is trigeminal nerve. The branches of trigeminal nerve are:
The facial pain cause by this nerve is called trigeminal neuralgia (Tic Douloureux). It is a chronic neuropathic condition affecting any part of the face, head, neck, shoulders and is considered one of the most painful conditions.
Trigeminal neuralgia is unpredictable, cause due to compression or damage of the nerve resulting in pricking, sharp pain like electric shocks. It can affect any of the three branches.
SIGNS AND SYMPTOMS
Women above 50 years are more commonly affected.
The cheek, jaw, teeth, gums, and lips are most commonly affected.
Onset is sudden and lasts for seconds to minutes.
The pain worsens with time and mostly affects one side of the face.
Sometimes, both sides of the face are involved, bilateral trigeminal neuralgia.
People with trigeminal neuralgia may have anxiety because they are uncertain when the pain will return so they are also called suicidal disease.
TRIGGER FACTORS
- Hair brushing and cleaning of teeth
- Tilting head and shaving
- Stress and tiredness
- Cold and hot weather
- Chewing and swallowing
- Touching and washing face
- Light breeze or wind on face etc.
TREATMENT
Depending on the severity and types, the treatment can be with medications or surgery.
Medications (non invasive)
Carbazepine is the drug of choice due to fewer side effects.
If carbazepine causes more troublesome side effects, lower the dose and add baclofen. Oxycarbazepine with lamotrigine or phenytoin may also be use.
During refractory period, gabapentin is most commonly used.
In recalcitrant cases, pregabalin, topiramate or older anticonvulsants – valproate and phenytoin may be used.
Note: Please take the above medicines only after consulting a practicing doctor. Do not self medicate. This article is written for informational purposes only.
Surgery (invasive)
Those patients who do not respond to medications and are physically fit can go for invasive procedures.
1. Peripheral injections
Longer acting anesthetic agents
Agents like bupivacaine with out adrenaline but with or without corticosteroids are injected to the peripheral nerve end.
Alcohol injections: 0.5-2 ml of 95% absolute alcohol is used for injection.
2. Glycerol injection in the gasserian ganglion
Injected behind the ganglion and destroy both small and large nerve fibers.
3. Peripheral Neurectomy
Oldest and most effective method.
Mostly performed on the infraorbital nerve, inferior alveolar nerve, mental nerve and rarely lingual nerve.
4. Cryotherapy
Direct application of cryoprobe (temperature -60◦) intramurally to the affected nerve producing wallerian degeneration of the affected nerve.
In this, the nerve is not sectioned but destroyed.
5. Open or intracranial procedures
Incision given over the mastoid process and release the nerve compression from the pulsating artery. Separate the nerve and the artery by placing Teflon between them.
6. Gamma knife radio surgery
Non invasive, scalpless radio-surgery by delivering radiation to the targeted site.
CONCLUSION
Trigeminal neuralgia has been an enigma since ages. Although the pain is intense, progresses and worsens with time the condition is not life-threatening. Proper diagnosis and treatment plan still plays an important role in success of the treatment. However, the various advances help in understanding the condition and increase the success rate of the treatment. If not cure there is a way to reduce pain and improve the quality life of the patient.