Pain is an indicator of disease and signifies something irritating the well-being of human body. Persistent pain often brings disruption in daily living and most of the times prevents delivering performance in activities of daily living and work place. This also causes loss of money and absenteeism.
Trigeminal neuralgia is one such pain, which comes as a very distressing shock like pain involving a part of face; mostly one side. It typically comes as an electric shock like, episodic pain. The patient is pain free in between two episodes. There are several trigger factors for the pain like cold wind, cold water, washing face and talking. Even chewing also can lead to pain. If persistent, this can cause additional problems like hypertension, depression and suicidal tendencies.
Trigeminal neuralgia is caused by irritation of the trigeminal nerve. Most common reason is a blood vessel causing compression over the nerve at the junction with brainstem. Other reasons are tumor, stroke, multiple sclerosis etc.
Most of the times, patients mistake it for dental pain and visit dental surgeons before coming to diagnosis.
Whenever the patient comes for evaluation of trigeminal neuralgia, a detailed history is recorded. MRI of brain is performed to look for the cause of irritation of the trigeminal nerve at the level of junction of brainstem. Based on the cause of irritation, treatment is planned.
In case of tumor, surgery is the first option. However in cases like multiple sclerosis and stroke, it is medical management, which takes the priority.
The most common cause of trigeminal neuralgia is compression by vascular loop. Initially the pain is managed by medication. In cases, where the pain increases or recurs, surgery should be performed. The gold standard surgery for the treatment of trigeminal neuralgia is Microvascular Decompression. This surgery is performed from behind the ear and involves separating the vascular loop from the trigeminal nerve and placement of muscle piece or Teflon piece. This surgery can in fact give the life of the patient back. If selection is proper, the results are almost 100 percent.
I do not believe in severing the connections of trigeminal nerve as is done in radiofrequency ablation and glycerol injection.
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