Nerve disorders are usually rare in occurrence but rather severe in their symptoms and complications. One such type of disorder is trigeminal neuralgia, where the trigeminal nerve located in the face sends painful impulses to the brain. The result is chronic and severe face pain.
Unexplained face pain, which can last for a few seconds to a few hours may seem like a medical anomaly. Unless there is a wound or a lesion, how can the face ache? It can, if the individual is affected by Trigeminal Neuralgia (TN). This is a rare but serious nerve disorder, where the pain originates in and is due to the trigeminal nerve, located in the face and ending at the base of the skull.
The pain is so severe and sensitive, that even blowing air on the individual’s face can trigger an attack. Sometimes the pain attacks are sudden and without any stimulation. The cause and risk factors involved in this disease are unknown. Its occurrence is observed in individuals over the age of 50 but even children and young adults can be affected. In this article, take an in-depth look at the various steps of the trigeminal neuralgia treatment process.
Diagnosing Trigeminal Neuralgia
With such obviously painful symptoms, the presence of this disorder should be confirmed quickly. But due to the rarity of trigeminal neuralgia’s occurrence, it is not thought of as a probable cause and can be misdiagnosed at times. It also depends on the expertise of the practitioner. An individual suffering from TN can visit a dentist, thinking it is tooth pain or ache and the dentist must not perform any serious surgical or extraction procedures before ruling out the possibility of TN.
A through physical exam should be conducted and the face should be put through a neurological exam. This involves touching different areas of the face and neck, to note location and occurrence of pain. Disorders like migraine, cracked tooth pain and jaw pain have similar symptoms and their presence should be ruled out.
Images of the brain through an MRI is used in special cases of TN occurrence, such as if the patient is below 40 years of age (TN is very rare in individuals below 40) or if there is some doubt regarding the diagnosis. It can also be used to confirm the underlying cause or reason for TN being present, such as a brain tumor or blocked nerve or maybe an infection or malformed brain structure. An MRI is also used in most cases to confirm the need for surgery.
How to Treat Trigeminal Neuralgia – Medications
Anticonvulsants or medicines which are used to treat seizures, can be used under medical advise by TN sufferers, as the nerve impulses are calmed, so some of the pain can be reduced. Carbamazepine (Tegretol) is the most widely prescribed and is thought of as the most effective medicine for pain relief. Other medicines include baclofen, phenytoin and gabapentin. The effectiveness of such drugs can decrease with regular use and in some cases, side effects like sleepiness and nausea, can be observed. Anticonvulsants can interfere with the working of other medicines being taken, so care must be taken while prescribing such medications. Regular painkillers and pain-relief medicines will not reduce the symptoms of TN.
How to Treat Trigeminal Neuralgia
The following are some methods to treat TN, which are not surgical in nature. Each method is effective in its own way but there are certain risks involved and a complete solution to TN cannot be promised.
☛ Carrying out a nerve blockage by injecting an anesthetic into the face over a period of time. This procedure numbs the nerves in the face, so feelings of pain can be reduced greatly.
☛ Injecting alcohol in the face, under the skin layer and around the trigeminal nerve region can also relieve pain by numbing that facial area. But such injections have a temporary effect, so the patient must be injected with weekly or monthly doses.
☛ PGR or Percutaneous Glycerol Rhizotomy is another injecting method. This is slightly more complex in operation, as compared to injecting alcohol. The needle must pierce facial skin around the base of the skull and is meant to inject glycerol into the trigeminal nerve. Due to the extent of penetration under the skin and the delicate nature of nerves in the face, X-rays are taken even during the procedure, to make sure the needle is inserted in the right nerve. Once injected, glycerol attacks the fibers of the nerve and will damage them, in order to stop the pain.
☛ Balloon compression involves inserting a needle into the face such that it is at the exit point of the trigeminal nerve. After insertion, a catheter fitted with a balloon at one end, is threaded through the needle. The balloon is inflated slowly and with the right amount of pressure, it will expand and compress the nerve, thus blocking it. The nerve cannot function properly with such blockage and pain will reduce.
☛ Percutaneous stereotactic radiofrequency thermal rhizotomy involves insertion of an electrode in the trigeminal nerve. A needle is used to make the primary insertion and once it has touched the entry point of the trigeminal nerve in the skull, the electrode is threaded through and made to rest against the nerve’s root. Then it is heated to a particular temperature for 70 seconds. The heat harms the nerve fibers and creates a cut or lesion in that area. Such damage to the nerve numbs the face of sensation and reduces the pain caused by TN.
TN surgical methods include:
- Microvascular Decompression (Janetta procedure or MVD)
- Stereotactic radiosurgery (using Gamma knife)
- Radiofrequency electrocoagulation (RFE)
- Cryotherapy or cryosurgery
Trigeminal neuraglia is a long-term, debilitating condition but relief from the pain or complete eradication of the pain does occur, through various treatment methods. There are no natural or non- medication methods to curing this illness, as the nerve and its location in the body are both sensitive. The key step in treating this disorder is a correct and prompt diagnosis, so that the patient can receive relief as early as possible.