Trigeminal Neuralgia: Facial Pain Evoked By Touch

The Trigeminal nerve supplies sensation to the lower face, forehead, and jaw. Trigeminal Neuralgia is associated with a sharp, stabbing, recurrent, electric shock-like jolt of excruciating pain.
TN usually affects one side of the lower face and jaw. Initial attacks are mild whereas they can progress to more serious and frequent attacks. The episodes of pain can last from a fraction of seconds to minutes to even hours. The assaults arise in succession with PAIN-FREE intervals several times during the day(Image Source- Unsplash)
TN usually affects one side of the lower face and jaw. Initial attacks are mild whereas they can progress to more serious and frequent attacks. The episodes of pain can last from a fraction of seconds to minutes to even hours. The assaults arise in succession with PAIN-FREE intervals several times during the day(Image Source- Unsplash)

Trigeminal Neuralgia also called 'tic douloureux' (painful tic) is a chronic condition that affects the 5th cranial nerve, the nerve responsible for the sensations in the face.

Trigeminal, tri= three derived from Latin "trial" and geminus meaning "twin."

The Trigeminal nerve supplies sensation to the lower face, forehead and jaw. This disorder of the fifth cranial nerve is associated with sharp, stabbing, recurrent, electric shock-like jolts of excruciating pain. TN usually affects one side of the lower face and jaw and at times area above nose or eye. Initial attacks are mild whereas they can progress to more serious and frequent attacks. The episodes of pain can last from a fraction of seconds, minutes to even hours. These paroxysmal (spasm/seizure-like) attacks are triggered by daily actions like talking, chewing, smiling, brushing etc. This pain is evoked by the mildest stimulation of touch or even a gush of air on the cheek. The assaults arise in succession with PAIN-FREE intervals several times during the day. It is the most common and severe form of facial pain.

The intensity of pain is very severe and patients who suffer from it, describe it as debilitating and worse than any other pain. Patient fear eating, shaving or brushing teeth due to the fear of an impending attack.

Trigeminal neuralgia can be caused due to compression of trigeminal nerve by the blood vessels, tumors or other space occupying lesions.The compression can result in wearing away of the coating (myelin sheath) of the nerves, leading to hyperactivity of neurons  (Image Source- Unsplash)
Trigeminal neuralgia can be caused due to compression of trigeminal nerve by the blood vessels, tumors or other space occupying lesions.The compression can result in wearing away of the coating (myelin sheath) of the nerves, leading to hyperactivity of neurons (Image Source- Unsplash)

It is characterized into IDIOPATHIC, CLASSICAL and SECONDARY trigeminal Neuralgia. The condition is more common in women than men. It is usually experienced by people older than 50 years of age. It is often misdiagnosed by Doctors.

That’s one disease that basically has the highest rates of suicides. Over education, over everything. There is so much of pain...I suffered that...
Salman Khan, Bollywood Actor

The Trigeminal nerve gives off three branches to the lower face, forehead and jaw.

BRANCHES OF TRIGEMINAL NERVE:

OPTHALMIC- The first branch of this nerve regulates sensation in the eye, upper eyelid, and forehead.

Maxillary nerve- The second branch of nerve controls sensation in the lower eyelid, cheek, nostril, upperlip, and upper gum.

Mandibular Nerve- The third branch of the mandibular nerve controls sensation in the jaw, lower lip, lower gum, and some chewing muscles.

The pathophysiology of Trigeminal neuralgia is still disputable but the science behind the pain is clear.

WHAT CAUSES TRIGEMINAL NEURALGIA?

Trigeminal neuralgia can be caused due to compression of trigeminal nerve by the blood vessels, tumors or other space occupying lesions. The compression can result in wearing away of the coating (myelin sheath) of the nerves, leading to hyperactivity of neurons, making the nerves sensitive. The nerves interpret every sensation as PAIN. Injury to trigeminal neuralgia or multiple sclerosis can also give rise to this recurrent neurofacial pain. It is also associated with facial trauma and may come with certain dental procedures.

Trigeminal neuralgia attacks can be sudden,with a sharp and stabbing type of pain. Simple acts like brushing can initiate pain. It is best to use an extra-soft manual or power toothbrush. Patients often have more control with a power toothbrush. During a severe episode, soft cotton cloth soaked in chlorhexidine could be used instead of brushing. Avoiding triggers and anticonvulsant medicines like Carbamazepine are the first line of therapy. But these offer transient relief and have drug-dose related complications. Microvascular decompression (MVD) surgery is gaining popularity in TN and has a high initial success rate.
Dr. Satabdi Saha, MDS

DIAGNOSIS OF TRIGEMINAL NEURALGIA-

TN diagnosis is done based on patient's detailed medical history and a series of physical and medical examinations. It is often diagnosed based on patient's history ,description of trigger factors and clinical examination to rule out other facial pains. Clinicians deduce the diagnosis after identifying the trigger factors, location, distribution and nature of pain. Neurological examinations, and MRI (Magnetic Resonance Imaging) scans are performed to rule out tumors or multiple sclerosis. Special MRI imaging procedures can reveal the presence and severity of compression of nerve by blood vessels.

Trigeminal Neralgia is often diagnosed based on patient's history ,description of trigger factors and clinical examination. Clinicians deduce the diagnosis after identifying the trigger factors, location, distribution and nature of pain (Image Source- Unsplash)
Trigeminal Neralgia is often diagnosed based on patient's history ,description of trigger factors and clinical examination. Clinicians deduce the diagnosis after identifying the trigger factors, location, distribution and nature of pain (Image Source- Unsplash)

LAB TEST

Apart from history, physical and neurological examination, complete blood count and liver function tests are also advised if carbamazepine therapy is started. Carbamazepine can cause hyponatremia (low blood sodium level) hence the sodium levels should be measured after therapy. Blood monitoring should be done for patients with other health ailments.

TN usually affects one side of the lower face and jaw. Initial attacks are mild whereas they can progress to more serious and frequent attacks. The episodes of pain can last from a fraction of seconds to minutes to even hours. The assaults arise in succession with PAIN-FREE intervals several times during the day(Image Source- Unsplash)
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TREATMENT OF TRIGEMINAL NEURALGIA-

Treatment of trigeminal neuralgia includes surgical methods, non-surgical (medications) and other therapies to alleviate symptoms. Over-the-counter (painkillers) medications do not work for TN. Anticonvulsive/ antiepileptic medication is the first line of treatment for patients with TN disorder. Although Trigeminal Neuralgia doesn't have a cure but pain can be reduced with the help of the antiepileptic drugs carbamazepine and oxcarbazepine as these cause decrease in neuronal activity. Other drugs may be useful for pain control in trigeminal neuralgia like gabapentin, pregabalin, lamotrigine and phenytoin etc. Physician can help select the most appropriate drug and dosage. About 50% of cases develop treatment resistance to oral drugs over the subsequent years of therapy and require surgical options. Some medicines can lose effectiveness with time. Drugs are started with low doses and gradually increased to eliminate pain. Patients should be empathetically offered surgical options if there is poor response to medicines. Early surgical treatments can save patient from adverse side effects that come with drugs and put a stop to this inevitable pain. Experienced surgeon can help to find the best surgical approach for the bearer.

CELEBRITIES WITH THE DISEASE

Trigeminal Neuralgia is also known as 'Suicide Disease' due to the gnawing, unbearable pain it causes. Salman Khan displayed TN symptoms for 7 years and was on medication. He flew to the United States of America to undergo treatment for the same in 2011 when the pain progressively worsened in the jaws.

That’s one disease that basically has the highest rates of suicides. Over education, over everything. There is so much of pain...I suffered that,” Salman added at the launch event for a song 'Radio' from his film, Tubelight in Dubai. In a video posted by Gulf News he contorted his face and described how agonizing his facial pain was.

COMPASSION CURES ANY DISEASE

People living with the World's Most Painful Disease i.e. TN often suffer from anxiety and depression. It is important to treat them with compassion and empathy. Encourage them to get treatment, explore surgical options and coordinate appointments with dentists and doctors if the medicines fail to work. Trigeminal Neuralgia degrades quality of life, nevertheless it isn't life threatening and the success rate with early surgical intervention is 80-90% which dwindles with delay. There are countless surgeries for trigeminal neuralgia but HOPE AND TIMELY MEDICAL INTERVENTION can help you rebuild pain-free life you have always wanted.

EMBRACE SURGERY AND NEVER FACE THE PAIN!

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(With Inputs from various media reports)

DISCLAIMER: No content in this article should ever be used as a substitute for direct medical advice from your doctor, dentist or other qualified clinician.

References

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