While the thought of being stabbed with a red hot knife or experiencing a lightning bolt in the face can bring to mind horrifying mental images, this experience is sadly all to real for sufferers of facial pain. For victims of Trigeminal Neuralgia, a very common form of facial pain, the condition is quite often completely debilitating because so many forms of mild facial stimulation can induce what many in the medical field consider to be one of the the most extreme forms of pain known. The agony and extreme restriction of daily activities that can be caused by this nonfatal condition has contributed to its title as the Suicide Disease.
The pain associated with Trigeminal Neuraligia or TN occurs for periods of time ranging from seconds to hours and is recurring with occurrence in some people being up to hundreds of times each day. The pain can be caused by mild facial contact, activities such as eating, talking or any slight facial movement. Given the intensity of the pain, the ease with which it can be triggered and high frequency, the significant impact on the lives of those with the condition is quite easy to comprehend.
Though severe in its effects, trigeminal neuralgia is often misdiagnosed, sometimes as tooth pain, leaving some sufferers without treatment for an extended period of time before they are properly diagnosed. Unfortunately, many possibilities to treat the condition become less effective as the patient has the condition for a greater period of time. While it is thought to affect 1 in 15,000 people, the frequency of misdiagnosis suggests that the number of people could be higher. In the US, the number of new cases diagnosed is approximately 15000 per year.
Despite not being completely understood, the cause of the pain in trigeminal neuralgia is thought to be a result of compression of a major facial nerve by an artery on the surface of the brain . This nerve, with three main branches extends from the side of the head to the scalp, forehead, eyes, nose, lips, and jaw. It is at any of these locations where the pain is typically experienced. The same nerve formation exists on both sides of the head. Not coincidently, based on its having three branches, this nerve is called the trigeminal nerve.
For those newly diagnosed with the condition, one or more anticonvulsant medications are often a highly effective means of treating the pain and are taken on an ongoing basis to prevent future episodes. Unfortunately, in some cases, the effects of the drugs wear off over time or are insufficient to prevent pain. In such cases, various forms of surgery are the next option with both destructive and nondestructive procedures that each has their own benefits and risks.
In the destructive forms of the surgery, various techniques are used to mildly damage the nerve covering near the site of the nerve compression to prevent transmission of pain signals. The variations of this technique have initial success above 80-90% in terms of eliminating or severely reducing pain, and are the safest of surgical options with various severities of permanent numbness being the principal side effect although other more serious effects have However, recurrence of the condition is common with this technique and 66% rates of recurrence have been seen in some studies.
Of the surgical procedures, microvascular decompression (MVD) has been repeatedly shown as the most effective long-term solution with 80% of patients still without pain symptoms after 5 years following surgery according to some studies. However, this surgery is the most invasive as it involves accessing the point at which the trigeminal nerve root enters the brain behind ear and adding spacers between the artery and the trigeminal nerve in order to reduce pressure on the nerve. Because the procedure makes no attempt to cause damage to the nerve, it does not typically cause facial numbness. While the chance of dying from the surgery is below 0.3%, the rarity of the condition means that ones odds are much better with a surgeon who has experience in the procedure.
Because of the relative success of vascular decompression, but higher risks, a newer variation of MVD using a keyhole incision technique and an endoscope is also being used and improved upon. The Endoscopic Vascular Decompression (EVD) approach has, in at least two studies, shown similar success rates with standard MVD with a lesser risk of complications that is common with keyhole-based surgical approaches.
While Trigeminal Neuralgia still has the potential to cause significant long-term pain if not correctly diagnosed, the good news for most sufferers of the condition is that medical science has yielded a number of options that offer to take the squeeze out of facial pain. If you or someone close has experience with the condition and any treatment techniques, please share your story and where you are now in your journey to be pain free.
Related Links:
http://www.umanitoba.ca/cranial_nerves/trigeminal_neuralgia/manuscript/mvd.html
http://clinicalevidence.bmj.com/ceweb/conditions/nud/1207/trigeminal-neuralgia-standard-ce_patient_leaflet.pdf
http://www.medicalnewstoday.com/articles/148958.php
http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm
http://healthlink.mcw.edu/article/1031002809.html
http://www.neurosurgerytoday.org/what/patient_e/trigeminal.asp
http://jnnp.bmj.com/cgi/content/abstract/76/11/1574
http://www.fpa-support.org/learning/Articles/2009/documents/LinskeyCohortMVDGKTNstudy32609.pdf
http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/trigeminal_neuralgia.htm
http://www.nlm.nih.gov/medlineplus/trigeminalneuralgia.html
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2435473
http://www.skullbaseinstitute.com/papers/endoscopic-vascular-decompression.htm
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