Alternative names: Tic douloureux.
Trigeminal Neuralgia (TN) is a condition that affects the trigeminal nerve (the 5th cranial nerve), one of the largest nerves in the head. It is characterized by a sudden, severe, electric shock-like or stabbing pain typically felt on one side of the jaw or cheek. In some patients, the eye, the ear or the palate may be affected. In many patients, the attacks are less frequent at night or when the patient lies down.
The trigeminal nerve is responsible for sending impulses of touch, pain, pressure and temperature to the brain from the face, jaw, gums, forehead and around the eyes.
Several syndromes are closely related to TN, but have specific unique features as well. These include post-herpetic neuralgia, atypical facial pain (ATFP), and TN resulting from multiple sclerosis (MS). Glossopharyngeal neuralgia is another neurological disturbance potentially related which causes throat pain and difficulty in swallowing. Some patients complain of sensation of burning or of having a fish-bone in the throat.
The disorder is more common in women than in men and usually affects those over 50 although it does exist in many younger individuals including children.
The attacks of pain, which generally last several seconds and may be repeated one after the other, may be triggered by talking, brushing teeth, touching the face, shaving, applying makeup, chewing or swallowing. The attacks may come and go throughout the day and last for days, weeks or months at a time, and then disappear for months or years.
In the initial stages, before the symptoms develop completely, TN is often confused with other diseases or dental problems. Some patients experience "atypical" trigeminal neuralgia, with more constant pain at a level generally of lower intensity. The rarity of these disturbances and the variability of these symptoms have caused some patients to undergo endodontic treatment of multiple root canals or other oral or sinus surgeries before a neurological disturbance is recognized.
The diagnosis of trigeminal neuralgia may be made by obtaining a history of paroxysmal one-sided facial pain activated by several facial stimuli. A slight stimulation of the trigger point provokes pain. The relief of pain by carbamazepine gives more credit to the diagnosis of trigeminal neuralgia and treatment by a neurosurgeon.
NICO (Neuralgia-Inducing Cavitational Osteonecrosis): Many patients who have been diagnosed with trigeminal neuralgia turn out in fact to have neuralgia pain from NICO lesions. Most NICO lesions are found in the alveolar arches where teeth have been extracted. If your teeth have been extracted, there may be unhealed, necrotic lesions in your jawbone.
Conventional treatment for TN typically includes anticonvulsant medications such as carbamazepine or phenytoin. Baclofen, clonazepam, gabapentin, and valproic acid may also be effective and may be used in combination to achieve pain relief. If medication fails to relieve pain, surgical treatment may be recommended.
The disorder is characterized by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal.
Capsaicin is not considered a standard treatment for trigeminal neuralgia although at least one article in the literature indicates that it may be useful. In one trial, an ointment containing capsaicin was applied over the painful area three times a day. Six of 12 patients had complete pain relief, 4 patients reported a decrease in pain, and 2 patients reported no benefit. [Anesthesia and Analgesia 74: pp.375-7, 1992]
Capsaicin has been used to treat atypical facial pain, especially when a specific pain "trigger point" (a place which, if touched, causes or exacerbates facial pain) is involved. Capsaicin is applied directly to this "trigger point" several times daily. If the trigger point is inside the mouth, a plastic dental splint is used to apply the capsaicin cream. If on the face, it is topically applied. In some cases, pain reduction only occurs after several weeks of application. There is anecdotal evidence that a course of capsaicin treatment can result in long-term pain remission for some patients with atypical facial pain.
For facial neuralgias, the evidence for acupuncture appears to be mostly anecdotal. Some have reported pain relief for long periods of time; others have had their pain worsen. People with classical trigeminal neuralgia (TN) seem to have very little success, whereas people with atypical TN report success slightly more often. Anecdotal information also suggests that acupuncture has been used for TN connected with multiple sclerosis with some success, but reliable statistics cannot be found.
There are a vast number of aches and pains that are often described as neuralgic. Many of these occur as facial pain and most of them cause severe discomfort. It is always worthwhile to attempt to alleviate these pains by using acupuncture. Some people respond and others do not; it is impossible to give figures for success – or even estimates – without going into great detail about the exact cause and type of neuralgia being treated.
One report evaluated the effect of meridian acupuncture treatment on TN. Ten patients aged 26 to 67 years (mean 55.4 years) with TN who visited the outpatient Dental Anesthesiology Clinic at Tsurumi University Dental Hospital from 1985 to 1990 were studied. The patients underwent meridian treatment by acupuncture alone or acupuncture combined with moxibustion. The acupuncture method used was primarily basic treatment employing only needles without electrical stimulation. Meridian acupuncture treatments were repeated from two to four times per month.
Five patients were restored to a pain-free state. The other five patients noted a decrease in pain, but with some level of pain remaining (significant pain in one patient). It is concluded that meridian acupuncture treatment is useful and can be one therapeutic approach in the management of TN. [Practical application of meridian acupuncture treatment for trigeminal neuralgia. Anesthesia and Pain Control in Dentistry, 1992 Spring, 1(2): pp.103-8]
By using the techniques of neural therapy, combined with detoxification and nutritional supplementation, some doctors claim to significantly reduce facial pain and disability safely without any further surgery and without other medications.
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