Trigeminal Neuralgia is probably the most well-known and notorious of the facial pain syndromes caused by nerve dysfunction and is particularly traumatic and debilitating, warranting its own awareness day on October 7th.

International National Trigeminal Neuralgia Awareness Day

 

Often called the Suicidal 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 at the onset of winters and spring.

Trigeminal Neuralgia 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.

Often, diagnosis is delayed due to conflicting diagnosis. The most common cause of classic Trigeminal Neuralgia is idiopathic, meaning no apparent cause can be attributed to. It can also be caused by a blood vessel pulsating/ touching against the trigeminal nerve at the brainstem. Trigeminal Neuralgia and its variants can be caused by multiple sclerosis, benign tumors, prior inflammation, herpes zoster (shingles) and post-herpetic neuralgia and trauma.

There are many types of treatment options, ranging from medical therapy to interventional pain management (IPM) to surgical or radiosurgical options.

In the beginning of the disease, more than 80% patients respond to medical management, though they may need more than one medication in escalating doses. The medications may have to be taken for a long period of time, maybe lifelong. The drug of choice is carbamazepine.
Those not getting relief with medication or having side effects/ allergy with medication, may be referred to a Pain Physician by GP for Minimally Invasive Pain & Spine treatments (MIPSI) like Radio-frequency Ablation/ Balloon decompression of the Trigeminal Nerve.
Young patients with vascular conflict may be a good candidate for Micro-vascvular decompression (MVD) surgery.

For an accurate solution to this disease, ISSP: Indian Society for Study of Pain, who has more than 3500+ registered Pain Physicians, are dedicated to providing their services in all states and all cities across India. We are committed to help patients return to their active/pain free life.

Thank you

Dr Pravesh Kanthed

Interventional Spine and Pain Physician Central India, Indore
Secretary: ISSP
Founder Director – Meru Spine and Pain Centre, Indore, India