This week we'll cover trigeminal neuralgia, also known as tic douloureux, which causes facial pain. Sounds like medical mumbo-jumbo, I know, but this term is easily explained. Neuralgia is simply nerve pain. The trigeminal nerve is responsible for sensation in your face; "tri" because it has three branches - upper to the forehead, middle between the eyes and the lips, lower the lips and the chin. Thus, trigeminal neuralgia is pain caused by damage to this nerve, and you feel it in the portion of your face which corresponds to the branch of the nerve involved.
What you feel is severe, sharp, maybe burning pain that comes in spasms and may only last a few minutes, but is a chronic problem. It can happen while you're doing something as simple as talking, shaving, or brushing your teeth.
This disorder is rare in young adults but older people are quite familiar with it. Unfortunately, it becomes more severe as times goes by.
You may believe at first that the pain comes from your teeth, and a visit to the dentist is certainly advisable to rule that out. TMJ syndrome (see my article of 12/21/99) is another possible cause of facial pain which should be ruled out.
There are various treatments used for this painful condition, normally beginning with drugs such as an anticonvulsant called carbamazepine, antidepressants, or antiepileptics. Antidepressants are thought to work because they increase the level of serotonin and that inhibits the pain-conducting ability of the nerve. Antiepileptics presumably work because the pain is caused by damage to the nerve and this type of drug calms the brain's SOS calls which you feel as pain.
If medication fails, as it eventually does in about half of trigeminal neuralgia patients, surgery is possible to correct the problem. One type of surgery destroys the nerve which is causing the pain. In another, used if pressure from blood vessels in the brain is causing the pain, the surgeon inserts a tiny sponge between the blood vessels and the nerve to relieve the pressure.
Another procedure is thermocoagulation which uses heat from electrical current to destroy nerve cells. This is less damaging to other structures in the area than some other treatments.
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