When you’re living with trigeminal neuralgia (also known as TN or tic douloureux), it may seem like there’s no answer to the pain and emotional turmoil it can cause. Whether you suffer intermittent bouts or constant pain, it’s often difficult to get out of bed in the morning and go about your normal activities. The good news is, there are ways you can lessen or even eliminate the pain symptoms altogether. With modern treatments and protocols, such as medication, injections and surgery, trigeminal neuralgia can become a manageable condition.
Seek Help
In the last decade or so, great advancements have been made in pain management and intervention. In addition, more and more doctors are aware of the symptoms of trigeminal neuralgia, making it possible to receive a diagnosis and begin treatment sooner. Nonetheless, even with a diagnosis in hand, you will need the help of an experienced facial pain specialist to determine the best course of treatment to put you on the road to a trigeminal neuralgia-related pain-free life.
There are organizations that provide support and a sounding board for those living with trigeminal neuralgia. Many have online forums in addition to live meet-ups, where TN sufferers can exchange ideas and discuss life with this condition. You need to remember that you’re not alone — an estimated 140,000 people in the United States struggle with trigeminal neuralgia.
Make a Plan
With the guidance you receive from your facial pain specialist, you can begin to formulate a plan that will put you on track to getting the treatment you need to address your TN medically. Since the options are numerous, it’s important that you explore all avenues before making a decision. Whether you decide to go the pharmaceutical or surgical route, be sure you are aware of every facet of that treatment so there are no surprises when you embark on your journey back from living with trigeminal neuralgia.
The Options
Only you can decide what will ultimately work for you and your lifestyle when considering your options for TN relief. Your doctors can help guide you and give you some insight into the pros and cons of each treatment and what kind of impact it will have on your day-to-day life. Some of the most widely used options for treating trigeminal neuralgia include:
Medication
This may be the quickest way toward relief, but may not be a long-term option for some people. Anticonvulsant medications such as Oxcarbazepine (Trileptal) and Carbamazepine (Tegretol) are the most commonly used. Some drugs, such as clonazepam (Klonopin) are also used but can be habit-forming and often dampen the ability to function at an optimal level.
There are two main reasons that drugs typically won’t work long-term for those living with trigeminal neuralgia. The first is due to the common occurrence of “breakthrough” symptoms when using medication. Many people find they need more and more, or their drugs stop working altogether. The second common problem with using drugs for trigeminal neuralgia is the likelihood that they may cause unbearable side effects, such as fatigue, dizziness and nausea, that make it difficult to use these particular medications for an extended period of time.
Injections
Some relief has been found through trigeminal nerve-blocking injections using agents such as the botulinum toxin (Botox), and to a lesser extent phenol, alcohol and glycerol. Botox injections can be effective for a couple of months at a time but frequently diminish in efficacy. Some people may need multiple injections to get the desired effect, or won’t experience any relief at all. The downside to these treatments is that they only last a few months and patients can experience some undesirable side effects.
Surgery
For those who are living with trigeminal neuralgia, surgery can often provide permanent, drug-free relief from the symptoms and debilitating effects of this condition. It may not be appropriate for everyone, but with many different techniques, surgery provides the widest range of options for TN pain intervention. The most common surgical procedures include:
Microvascular decompression (MVD)
MVD is an excellent option for those who don’t wish to experience the numbness that can be associated with glycerol or Botox injections or other surgical procedures that neutralize or damage nerve tissue.
This procedure starts with a FIESTA-MRI to determine if you’re a good candidate. MVD is most helpful for those that have compression or impingement of their trigeminal nerve caused by pressure from an artery or vein. Your surgeon makes a small opening your skull behind your ear to access the nerve and blood vessel. He or she then gently locates the area of nerve compression and carefully inserts a small Teflon sponge between the nerve and artery to absorb the impact and prevent further irritation. The best part about MVD is that no facial sensation is lost and most patients experience immediate relief of the pain they’ve experienced while living with trigeminal neuralgia.
Gamma Knife Radiosurgery:
The face of radiosurgery changed forever with the introduction of Gamma Knife Radiosurgery. The leading treatment in the realm of stereotactic brain surgery, it uses around 200 beams of radiation (without a knife at all). Each of these beams is low in concentration so that the tissues they pass through are not damaged. The focal point where the beams meet very accurately targets the area of the trigeminal nerve requiring treatment.
A therapeutic dose of radiation is then delivered. There are very few side effects and minimal-to-no damage is done to surrounding tissues and structures. This makes it a great option for targeting and neutralizing the trigeminal nerve when MVD is not a viable treatment option.
Percutaneous rhizotomy (PSR)
Minimally invasive, PSR is typically an outpatient procedure performed by a neurosurgeon. Using an electrode passed through the cheek, branches of the trigeminal nerve are isolated using x-rays to guide the electrode to the right point. A small pulse of energy is used to destroy part of the nerve fibers in the trigeminal nerve, thus blocking the pain signals to the brain. This procedure is often done under local anesthetic.
Pain stimulator placement
Often the go-to for patients who have found no relief through other surgical options, pain stimulator placement involves placing electrodes that interrupt pain signals to the brain at the trigeminal nerve. A trial run is done to make sure that pain stimulator placement is the right choice for you, then a more permanent stimulator will be installed. Stimulator placement is a minimally invasive procedure with a short recovery time and results are often seen almost immediately.
Complementary Care
Many people living with trigeminal neuralgia have reported that they find additional relief through activities such as yoga, low-impact exercise, meditation acupuncture and nutritional therapy. While none of these are alternatives to seeking medical intervention for your on-going pain, they may help contribute to your overall well-being, making the medical treatments you choose all the more effective.
As you can see, you have options. You don’t have to live with the pain and debilitation associated with trigeminal neuralgia. We’ll work closely with your facial pain specialist to determine the best course of action and help you reach your goal of reduced pain to achieve a higher quality of life.
