Trigeminal neuralgia is a chronic pain disease affecting the fifth cranial nerve, or trigeminal nerve, which innervates a broad portion of the face. If you’ve been diagnosed with this affliction, you’re familiar with the physical and mental incapacitation that results from constantly enduring intense suffering. The practice of medicine offers both nonsurgical and surgical options for trigeminal neuralgia pain relief.
Several maladies can cause your disorder. They include pressure on the nerve by a blood vessel or damage to the nerve’s protective coating as well as injury to the nerve from some type of facial trauma. Another cause involves nerve compression due to a tumor or a tangle of arteries and veins, called an arteriovenous malformation.
Symptoms will vary, depending on whether you have the classic type of trigeminal neuralgia or the atypical type. Patients with the classic variety have severe sudden episodes of stabbing pain, while those with the atypical variety experience a continuous burning or aching sensation. Your pain may be triggered by contact with the face through normal daily activities such as eating, shaving or brushing your teeth. Unfortunately, the disease can be progressive, with the intensity and duration of the pain increasing over time.
While the disorder may occur at any age, people 50 and older are most commonly affected. The diagnosis will be based on your history and symptoms along with the results of magnetic resonance imaging (MRI) and other neurological examinations. Here are a surgeon’s recommendations for the condition’s remediation.
Nonsurgical Route
Your nonsurgical route to trigeminal neuralgia pain relief is limited to medications, which doctors will try before neurosurgical procedures are considered. Anticonvulsants, such as Tegretol and Trileptal, are the drugs of choice because they aren’t addictive like narcotics, agents that are not recommended for the disorder. Management of pain through medication can fail because the side effects, such as fatigue, dizziness and a drunk feeling, become intolerable. Drug therapy can also be unsuccessful if the highest permitted dose doesn’t alleviate pain. If for any reason this option doesn’t work for you, it’s time to make an appointment with a neurosurgeon.
Microvascular Decompression
Of the four neurosurgical interventions suited for trigeminal neuralgia pain relief, microvascular decompression is the best approach if you meet the following two conditions: You are young and healthy, and an MRI reveals a blood vessel is compressing your nerve. Although this procedure is invasive and requires general anesthesia, patients who undergo it have the lowest probability of recurring pain. It involves moving the blood vessel that is exerting pressure on your nerve.
The treatment necessitates a hospital stay of several days and a recovery period of several weeks. While it has best efficacy, it comes with the risk of impaired hearing, facial numbness and facial weakness, along with stroke and other serious effects. However, the majority of patients who have this procedure experience no facial numbness afterward.
Gamma Knife Radiosurgery
If your doctor doesn’t think you’re a good candidate for microvascular decompression, the second treatment choice for trigeminal neuralgia pain relief is Gamma Knife Radiosurgery. The procedure is called surgery, but no incision is required, a benefit that gives it a high rate of safety. It involves the deliverance of multiple beams of radiation to the precise spot where your trigeminal nerve leaves the brainstem.
Consequently, a lesion forms on your nerve, hindering the transmission of pain signals to the brain. This process takes several weeks to several months, so the alleviation of your pain comes gradually. According to the International Radiosurgery Association, 50 to 78 percent of patients who have this intervention receive excellent pain reduction. Of these successful cases, approximately half have recurring pain within three years. If this happens to you, the treatment can be repeated.
Percutaneous Rhizotomy
Several noninvasive nerve-damaging techniques are used for trigeminal neuralgia pain relief, one of which is percutaneous rhizotomy. In this procedure, a needle is passed through your cheek and into the trigeminal nerve. Heat is applied to slightly harm the nerve, an effect that should help reduce pain signals to your brain. It may result in some numbness, but this is preferable to the suffering associated with the disorder. The pain may return, but the treatment can be repeated.
Pain Stimulator Placement
An intervention involving mild electrical stimulation is used for trigeminal neuralgia pain relief when other treatments don’t produce satisfactory results. In pain stimulator placement, your face will be numbed with a local anesthetic, after which a small electrode will be inserted under the skin. The electrode is attached to an external stimulator device that sends electrical pulses to your nerve. A trial period will begin in the hospital and continue at home to ascertain the treatment’s effectiveness. If it works well, the temporary device will be removed and replaced with a permanent one.
As trigeminal neuralgia is an extremely painful disorder, the above treatments have made a profound difference in the lives of many patients. Each option comes with pros and cons, but a neurosurgeon can determine the approach appropriate for you. Statistics show it’s likely that one of the procedures will provide you with a welcome respite from your suffering.
