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Breaking Free From Facial Nerve Pain: Understanding And Treating Trigeminal Neuralgia

Trigeminal Neuralgia (TN), also known as the “suicide disease” due to the extreme pain it causes, is a neurological disorder that results in intense, sudden, and stabbing pain in one side of the face. The condition affects the trigeminal nerve, which is responsible for sensation in the face, including the gums, eyes, cheeks, and forehead. While the disorder may sound rare or complicated, it is crucial for patients and their families to understand the causes, symptoms, and the most effective treatments available to manage this condition. 

What is Trigeminal Neuralgia? 

The name “Trigeminal Neuralgia” comes from the combination of two terms: “Trigeminal” and “Neuralgia.” The trigeminal nerve is a large nerve that provides sensation to the face and is responsible for transmitting information from the facial skin, eyes, mouth, and gums to the brain. There are two trigeminal nerves, one on each side of the face, and the pain is typically unilateral, affecting only one side of the face. 

“Neuralgia” refers to nerve pain, so Trigeminal Neuralgia is essentially pain associated with the trigeminal nerve, manifesting on one side of the face. The pain caused by TN is excruciating and often described as sharp, electric-shock-like, or akin to a sudden blast of heat, making it one of the most severe forms of facial pain. 

Symptoms and Diagnosis 

Trigeminal Neuralgia is primarily diagnosed based on a clinical history and patient symptoms. Patients typically experience sudden, severe pain that may last anywhere from a few seconds to a few minutes. The pain is usually localized in areas served by the trigeminal nerve, such as the gums, lips, teeth, and even the forehead and eyes. 

Characteristics of Trigeminal Neuralgia Pain 

The most distinguishing feature of TN pain is its intensity and unpredictability. The pain attacks can occur without warning, often triggered by seemingly harmless activities like talking, brushing teeth, or even a gentle breeze against the face. People with TN describe the pain in various ways, including: 

• A sudden electric shock sensation
• A sharp, stabbing pain as though a knife has been driven into the face
• A sudden blast of heat or an explosive sensation
• The sensation of being pricked by multiple sharp needles

The duration of these attacks can vary, but they often terminate quickly, leaving the individual pain-free until the next attack. Over time, as the disease progresses, the pain may become more frequent and intense, sometimes lasting longer and even causing continuous low-grade pain between the attacks. 

Which Trigeminal Nerve Branches Are Affected? 

The trigeminal nerve is divided into three main branches: V1 (ophthalmic), V2 (maxillary), and V3 (mandibular). Of these, the V2 and V3 branches are most commonly affected in about 40% of patients, resulting in pain in the jaw, cheek, and surrounding areas. Only around 10% of patients experience pain across all three branches. 

Common Triggers for Trigeminal Neuralgia 

A defining characteristic of Trigeminal Neuralgia is the presence of trigger points that provoke pain attacks. These can include: 

• The upper lip or the area around the nose
• The forehead, specifically above the eye or just below the lower eyelid
• The area in front of the ear or the upper and lower gums

These trigger points can be easily activated by touch, cold blasts, or even routine activities like brushing teeth, washing the face, or talking. The trigger points can make daily life incredibly difficult for patients, who often have to modify their habits and environment to avoid discomfort. 

The Severity of Trigeminal Neuralgia Pain 

The pain experienced by TN patients is often described as the worst pain imaginable. Many individuals have likened it to: 

• “The worst pain experienced by mankind”
• “A deadly curse” that no one should endure
• “A pain so severe, you would not wish it on your worst enemy”

Because of its intensity, Trigeminal Neuralgia is often associated with feelings of helplessness, and some patients even experience suicidal thoughts, as the severity of the pain becomes unbearable. It is critical to understand that the pain can overwhelm an individual’s emotional and psychological well-being. 

Psychological and Emotional Effects 

In the early stages of Trigeminal Neuralgia, the pain attacks are sporadic, and patients may appear to be in relatively good health between episodes. However, as the disease progresses, the frequency and intensity of the attacks increase. The ongoing pain leads to noticeable changes in behavior and emotional state. These can include: 

• Avoidance of cold or windy environments (e.g., air-conditioned rooms, open windows, etc.)
• Reluctance to engage in social activities that require talking, eating, or facial movements
• Avoidance of facial hygiene routines like brushing teeth or shaving
• Reduced appetite or loss of interest in food
• Persistent tiredness, exhaustion, and mental weariness
• Severe depression and feelings of isolation
• Cognitive issues such as memory loss, balance problems, and even sexual dysfunction due to the high doses of pain medications required

The Progression of Trigeminal Neuralgia 

Trigeminal Neuralgia often progresses slowly, with pain attacks becoming more frequent, longer in duration, and more severe as time goes on. Initially, patients may experience brief periods without pain, referred to as “pain holidays.” However, as the disease advances, these relief periods become less frequent and eventually disappear. In untreated cases, the pain may become nearly constant, leaving the patient in a debilitated state, desperate for relief. 

Trigeminal Neuralgia Causes 

The underlying cause of Trigeminal Neuralgia is the compression of the trigeminal nerve by blood vessels at the point where the nerve enters the brain, called the Root Entry Zone (REZ). Blood vessels, particularly arteries, can press against the nerve over time, causing damage to the myelin sheath that insulates the nerve fibers. This leads to abnormal nerve signaling and the excruciating pain associated with TN. 

In some cases, the nerve compression results from aging blood vessels that elongate and harden, a condition known as ectasia. Over time, these blood vessels can progressively press against the nerve, causing damage and leading to TN symptoms. Some patients may experience a temporary reduction in symptoms as the body attempts to repair the damaged myelin, but the pain typically returns as the compression continues. 

In rarer cases, conditions such as multiple sclerosis (MS), brain tumors, or cysts can cause similar symptoms by affecting the REZ of the trigeminal nerve. 

Diagnosis and Investigations 

The diagnosis of Trigeminal Neuralgia is largely based on the patient’s clinical history, symptoms, and physical examination. Patients usually describe sudden, severe pain in response to specific triggers, and careful observation of these attacks can help confirm the diagnosis. 

While an MRI is often used to rule out other causes of facial pain, such as tumors or multiple sclerosis, the MRI may not always show the blood vessel compression that is responsible for TN. However, during surgery, vascular compression can often be observed, confirming the underlying cause. 

 Treatment for Trigeminal Neuralgia 

The treatment for Trigeminal Neuralgia generally involves a combination of medication and, in more severe cases, surgical interventions. 

Trigeminal Neuralgia Medication​ 

In the early stages of TN, anticonvulsant medications such as Carbamazepine (Tegretol) and Gabapentin are commonly prescribed to alleviate pain by numbing the nerves. However, these medications only provide temporary relief and come with side effects, such as drowsiness, loss of balance, memory issues, and sexual dysfunction. As the disease progresses, higher doses are required, which can further impair the patient’s quality of life. 

Trigeminal Neuralgia Surgery 

Microvascular Decompression For Trigeminal Neuralgia​ 

For patients with more severe or chronic TN, a surgical option called Microvascular Decompression (MVD) offers a potential cure. MVD surgery involves using a neurosurgical microscope to relieve the pressure from the blood vessels compressing the trigeminal nerve. This surgery is highly effective, with success rates exceeding 98% when performed by experienced surgeons. MVD offers the potential for long-term relief and can eliminate the need for medications that numb the nervous system. 

At specialized centers, MVD surgery has provided lasting relief for hundreds of patients, helping them regain their quality of life. The success rate of MVD improves when performed early in the disease progression before irreversible nerve damage occurs. 

Radiofrequency Ablation For Trigeminal Neuralgia 

Radiofrequency ablation (RFA) is a minimally invasive procedure offering significant relief for patients suffering from Trigeminal Neuralgia. This targeted technique involves using heat generated by radiofrequency energy to selectively disrupt the pain-carrying nerve fibers of the trigeminal nerve. Generally performed under local anesthesia and guided by advanced imaging,  

Patients experience numbness of the face after the nerve fibres are burned by the RFA, and this results in pain relief over the next few days, potentially lasting for a few months to a year. The technique is effective in about 40-50% of the patients, depending on the skill of the person doing it, and the type of machine used. It is an excellent option for those who have not responded well to medications, are hesitant about immediate surgery, or are unfit for surgery. This is a temporary intervention, and the pain often returns in a few months, albeit increased. The procedure can be repeated, but is likely to be less successful subsequently.  

Because of its reasonable efficacy and reduced recovery time, it is a valuable option in the comprehensive treatment of TN. It is a procedure that is potentially risky, but is less invasive than surgery.  

With its balance of efficacy and reduced recovery time, radiofrequency ablation is gaining recognition as a valuable option in the comprehensive treatment of Trigeminal Neuralgia. 

Why Choose Dr. Jaydev Panchawagh at Sahyadri Hospitals for Trigeminal Neuralgia? 

Sahyadri Hospitals stands out as a trusted destination for treating Trigeminal Neuralgia, offering world-class care with a patient-centric approach. Our experienced and  accomplished neurosurgeon, Dr Jaydev Panchawagh  specialises in surgery of Microvascular Decompression (MVD), ensuring high success rates and minimal risks.He has successfully performed over 2,700 Microvascular Decompression (MVD) surgeries for Trigeminal Neuralgia and Hemifacial Spasm. With extensive experience treating patients from around the world, he is recognized as a leading expert in this specialized field. Equipped with advanced diagnostic tools and state-of-the-art operation theatres, Sahyadri provides precise and effective treatment. Patients benefit from personalized care plans tailored to their specific needs, coupled with compassionate support throughout their journey. Sahyadri ensures you receive the best possible care from the region’s leading trigeminal neuralgia specialists 

Conclusion 

Trigeminal Neuralgia is a debilitating condition that causes extreme pain and can significantly impact an individual’s quality of life. While medications can provide temporary relief, they come with side effects and do not address the root cause of the condition. Microvascular Decompression surgery offers a potential cure for many patients, providing long-term relief and eliminating the need for heavy medication. 

For those suffering from Trigeminal Neuralgia, early intervention is crucial in managing the condition and improving long-term outcomes. With advancements in medical techniques and the expertise of specialized surgical teams, patients can regain control over their lives and finally experience relief from the pain that has tormented them for so long. 

FAQs 

• What causes Trigeminal Neuralgia? 

TN is typically caused by compression of the trigeminal nerve by blood vessels, leading to damage in the myelin sheath. Other causes include multiple sclerosis, tumors, or cysts. 

• How is Trigeminal Neuralgia diagnosed? 

TN is primarily diagnosed through clinical history and symptoms. Imaging tests like MRI may be used to rule out other conditions causing facial pain. In addition sometimes other tests like angiography or venography may be required for surgical planning. 

• What are the treatment options for Trigeminal Neuralgia? 

Treatment includes medications like anticonvulsants for pain relief and surgical procedures like Microvascular Decompression (MVD) for long-term solutions. 

• What is Microvascular Decompression surgery, and is it effective? 

MVD involves relieving pressure on the trigeminal nerve caused by blood vessels. It has a success rate of over 98% when performed by experienced surgeons. 

• Can Trigeminal Neuralgia be cured? 

While medications and injections provide temporary relief, MVD surgery offers a potential cure for many patients by addressing the root cause of the condition. 

• Why should I act early if I have Trigeminal Neuralgia? 

Early intervention prevents the condition from worsening and increases the success rate of treatments like MVD, leading to better long-term outcomes. However, early does not mean within weeks of diagnosis. A fair trial of medications is necessary, before further surgical decision is taken. 

• How do I get in touch? 

You can easily get in touch with us through multiple channels. Call our helpline number, visit our official website for contact details, or drop by the hospital for direct assistance. We’re here to ensure your queries are addressed promptly. 

• Do I need to find other specialists outside the hospital if supportive treatment is necessary? 

No, you don’t need to look elsewhere. Our hospital offers a comprehensive range of specialists and supportive care services under one roof. This ensures seamless treatment and minimizes the stress of coordinating with external providers. 

• I am from outside Pune and Maharashtra. Can someone help me? 

Absolutely! Our dedicated patient support team can assist you with travel arrangements, accommodations, and local guidance to make your visit as convenient as possible. We’re committed to ensuring a smooth experience for all our patients, regardless of their location. 

• What are the indications for surgery? 
• High doses of medications 

• Intolerance to medications and their side effects 

• Allergy to medications 

• Demanding professions 

• Desiring permanent relief  

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