Trigeminal Neuralgia (TN) is quite possibly the most painful disorder known to medical science. TN is defined as pain along the Trigeminal Nerve, the 5th cranial nerve of the skull. This pain is usually very sharp and severe. People with TN describe the pain as stabbing, electrical or like a burning sensation. It can be triggered by temperature change, a slight breeze, brushing the teeth and other seemingly simple activities. The pain comes and goes with periods of excruciating pain followed by weeks and possibly months of being pain-free. Most often this pain occurs during the day.
What Causes Trigeminal Neuralgia?
There are several theories on the cause of TN. The most agreed upon cause is injury or damage to the myelin sheath that insulates the Trigeminal nerve. The affect of the damage to this sheath is similar to dmange to the outer covering of an electrical cord. Though the power may still reach the appliance, if you were to touch the cord where the covering was damaged you would receive quite a jolt. Causes of the injury to this myelin sheath vary. Among them are compression by a tumor, aneurysm, vascular malformation or other vessels. Other possible causes are Multiple Sclerosis, toxins, viral infection, injury or just aging in general. There is some evidence that TN runs in families. When it does it normally occurs on the same side of the face, and has a tendency to begin at an earlier age. Commonly it occurs in in people ages 50 - 60, and slightly more in women than in men.
What are the Common Medical Treatments?
Treatment of TN varies. Generally there are two accepted types. The first is medication. Anti-epileptic drugs have proven effective in many cases, the most effective being Tegretol. As with any other drug therapy, it is important for the patient to follow the physician's directions, and keep in touch with the nurse or physician if they experience any negative side-effect of the drug.
In some cases medication is not effective and the patient must pursue other modes of treatment. Fortunately there are several neurosurgical procedures that are available. Each of these procedures have advantages and disadvantages. The TN patient needs to investigate each of the procedures and discuss with their physician which would be the most effective for them. Things to consider are the ease of the procedure, its effectiveness, the long-term results, recurrences, and possible complications. The choice of procedures will also depend on the patient's physical well-being, general health, previous surgeries, presence of MS, and the area, or branch, of Trigeminal nerve involvement. Some surgical procedures are indicated if certain areas of the Trigeminal nerve are effected. The neurosurgical procedures that have been used effectively are as follows:
Radiofrequency Rhizotomy (RF) - Percutaneous Stereotactic Tadiofrequency Rhizotomy (or Electrocoagulation) - This is an outpatient procedure and is done under local anesthesia and sedation. A needle is placed through the face trhough which an electrode is inserted to heat the nerve and destroy the pain fibers.
Glycerol Rhizotomy - Glycerol Injection or Installation - This is a surgical procedure similar to the Radiofrequency Thizotomy. The surgeon injects glycerol (an alcohol substance) into the cavity where the Trigeminal ganglion lies. The nerve in bathed with the glycerol to damage the pain fibers.
Balloon Compression - Percutaneous Trigeminal Ganglion Compression - Like the previous "through the cheek" procedures, the physician inserts a catheter up to the Trigeminal ganglion and inflates a tiny balloon to compress the nerve and damage the pain fibers.
Microvascular Decompression (MVD) - A small opening is made in the back of the skull on the side where pain occurs. The Trigeminal nerve is viewed so taht the compressing blood vessels can be removed and the nerve cushioned with a small pad. A Teflon pad is normally used.
Stereotactic Radiosurgery - Gamma Knife and LINAC Radiosurgery - This procedure requires no incision of any kind. A highly focused beam from cobalt or LINAC (Linear Accelerator) radiation is directed at the root of the Trigeminal nerve creating a lesion (an area of controlled damage) that will interrupt the pain transmission.
As a general rule, all of these precedures have proven to be about 85% successful in creating long-term relief from the pain of TN. About 25% of these cases will have some level of recurrence of pain in 1 - 5 years.
Is Therapeutic Massage Indicated for Trigeminal Neuralgia?
Alternative treatments that have given some relief to those afflicted with TN are acupuncture, chiropractic adjustment, nutritional supplements, self-hypnosis and meditation. Because the pain associated with this disease makes the area affected hypersensitive, massage is not often done to relieve the patient's suffering. Massaging the head and face can be done if the patient can tolerate the therapist touching the area involved, however it is not recommended that too much time be spent in the area as touch can often create even more of a sensitivity. General relaxing massage can help the stress that a patient endures when suffering with a bout of TN, but only to the patient's tolerance level.
The painful nature of Trigeminal Nerualgia, combined with the unsurety of the cause, occurrence of misdiagnosis and lack of threatments that bring 100% disappearance of pain can bring about a feeling of helplessness. The Trigeminal Neuralgia Association, based in Barnegat Light, NJ, is a national non-profit organization that provides information and support to patients and their families.
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