Dr Rohit Lahori
Trigeminal neuralgia (TN) is probably the most well known and notorious of the facial pain (Pain in face) syndromes caused by nerve dysfunction *(5th Nerve) , It is usually unilateral. The pain is in the distribution of one or two nerve divisions(Branchs) of Trigeminal Nerve
Most commonest is Mandibular Nerve, supplying the lower face from ear
Second most commonest is Maxillary nerve supplying the middle face and least commonest is ophthalmic division (nerve) supplying the forhead.
World Trigeminal Neuralgia Awareness Day
Often called the *Suicide Disease*, trigeminal neuralgia pain may range from sudden, severe, and stabbing to a more constant, aching, burning sensation. Any light or normal touch can act as a trigger for an episode of intense facial pain such as shaving, washing the face, putting on makeup, brushing teeth, eating, drinking, talking, or even the feeling of cold air on the face. The pain may be seasonal with a peak in the fall and spring.
Trigeminal neuralgia pain is typified by attacks that stop for a period of time and then return, but the condition can be progressive. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. Eventually, the pain-free intervals disappear and medication to control the pain becomes less effective. The disorder is not fatal, but can be debilitating & mostly affects quality of life.
Often, diagnosis is delayed due to conflicting diagnoses. TN and its variants can be caused by multiple sclerosis, benign tumors, prior inflammation, herpes zoster (shingles) and post-herpetic neuralgia and trauma. The most common cause of classic Trigeminal Neuralgia (TN1) is due to a blood vessel pulsating against the trigeminal nerve at the brainstem.
There are many types of treatment options, ranging from medical therapy to surgical or radiosurgical options.
*Medical therapies* include various anti-epileptic medications such as carbamazepine or gabapentin; or tricyclic antidepressants for the treatment of pain. Normal pain medications like non-steroidal anti-inflammatory drugs (NSAIDs) or opioid narcotics are typically not effective. These medications are effective in many patients, but some patients either do not respond or cannot tolerate the side-effects. Hence, they may be candidates for procedural intervention.
Minimally invasive surgical procedures are divided into percutaneous treatments or nerve damaging *(Rhizotomy- Radio-frequency Ablation)* procedures and nerve decompression *(microvascular decompression – MVD)*. Each has some rate of success and durability and side effects can vary. In very select patients, deep brain stimulation *(DBS)* may be considered as a treatment option for refractory facial pain.
(The author is Interventional Pain and Palliative Care Specialist Govt Hospital Gandhinagar)
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