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Trigeminal Neuralgia

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Radiofrequency Ablation for Trigeminal Neuralgia

Trigeminal neuralgia is a condition that causes painful sensations similar to an electric shock on one side of the face. This chronic pain condition affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain.

FAQS

Know everything about Trigeminal Neuralgia and its treatment options.

There are a few commonly seen trigger points, which when stimulated start the attack. These trigger points could be: • Upper lip, Ala of the nose • Forehead just above the eye, just below the lower eyelid. • Just in front of the ear, Upper or lower gum Touching one or more of these points, blast of cold, even a gentle breeze against the face, brushing teeth (the toothbrush touching the gums), washing face, shaving, jaw movements while talking or chewing etc bring on the attack.

In the initial phase, the attacks are short and there is a long gap between them. Progressively the attacks tend to become longer, more severe and more frequent. There may be sudden disappearance of the attacks for a few days or months, but gradually these attack ‘Holidays’ also become rare and then disappear. In patients who are not treated in time, the attacks become almost continuous and the sufferer is reduced to a miserable person, begging for relief.

The diagnosis of TN is made on the basis of a good medical history. Usually, the description of pain and the patient’s severe agony while talking, typical facial contouring and defensive facial posturing to avoid an attack immediately give away the diagnosis. A good quality MRI with Trigeminal nerve sequences is the next step, primarily to rule out tumours. An MRI-demonstrable vessel compressing the nerve is helpful, but is not a pre-requisite for surgical decision. This is because, severe vascular compression does exist, demonstrable at surgery even when MRI does not show it.

In the initial phase of the disease, some medicines like Carbamazepine (Tegretol) and Gabapentin are useful. However, they are nerve-numbing medicines and act only for a short time. They do not treat the root-cause of the disease. At our Trigeminal neuralgia centre, we have been relieving these patients of pain, with a surgery known as Microvascular Decompression (MVD). This surgery is performed with a neurosurgical microscope, and if done in time and by an experienced team it gives excellent results in more than 95% of the patients. MVD surgery has a great potential to give a long-term relief from pain and may permanently cure the patients. More importantly, the patient can stop their brain-numbing anti-epileptic medicines.

Pain is very severe and it comes as electric shock like pain. It is felt on one side of face. Pain is triggered by even touch. It comes for few seconds to few minutes. The pain is so distressing that sometimes it is also called “suicidal pain”

Management starts with medications to suppress the abnormal pain signals. The medicines used are in class of anti convulsant and anti depressants, as these medicines also have role in pain medicine. If medical management fails that means, if there is not much relief or the doses are causing some side effects, the pain specialist or the pain doctor may advise you for some minimally invasive brain procedure to block the pain signals.

Use soft tooth brush and avoid irritating tooth pastes containing mint and salt. At times it is not possible to even shave. You may use anti septic mouth wash if u are not able to brush your teeth.

Most of the patients respond to medical management by pain specialists. Pain doctors will start titrating the doses of medicine till you have significant relief. At times, they may add another class of medicine. The dose adjustment usually takes 4-6 weeks. It may even take longer. When medical management fails, minimally invasive pain procedures like Radiofrequency ablation of trigeminal nerve is the best and the safest technique, if surgery is not indicated.

Radiofrequency ablation or RFA blocks the pain signals from reaching brain. You may feel slight numbness in the area of pain after the procedure but that usually doesn’t affect your activities. RFA takes 2-4 weeks for its affect and during this time your pain specialist will start tapering the doses of medications. The pain may come back after 6 months to one and half year and the same procedure can be repeated. Surgical microvascular decompression MVD , is considered when the blood vessels is compressing the trigeminal nerve or Trigeminal Root.

Most often trigeminal neuralgia is confused with dental pain. At times dental infection leads to swelling over face and pain is felt on the cheeks too. Your pain specialist, will be able to detect the exact cause of pain. Many times patient undergo multiple tooth extraction without any relief.

Pain specialist are trained in diagnosing acute and chronic pain states. This is especially important, because if the diagnosis is not established, it is difficult to treat conditions and at times lead to unnecessary treatments too. Pain doctors not only manage pain with medications but they also are experts in minimally invasive procedures for pain management.

Face pain is also caused by tooth aches, herpes infection, parotic gland inflammation or infection, migraine, sinusitis.

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