Health and Healing with Emmanuel Birstein

Trigeminal Neuralgia: A Pain Like No Other

Jan 2018

Trigeminal neuralgia (TN) is considered to be one of the most painful conditions. But one that we know very little about.

What is trigeminal neuralgia? It is a chronic pain disorder that affects the trigeminal nerve. This is a branching cranial nerve that controls sensation of the face (Branch 1 & 2) and movement of the muscles used for chewing (Branch 3). Problems with the sensory part of the trigeminal nerve can result in pain or loss of sensation in the face. The typical form of trigeminal neuralgia (Type 1) is experienced as severe, sudden, shock-like facial pain lasting for seconds to a few minutes or groups of these episodes extending over a few hours. The intensity of the pain can be physically and mentally incapacitating, leading to severe depression and panic disorder.

What causes trigeminal neuralgia? There are a number of conditions or events that can lead to TN.  Pain can occur as a result of a blood vessel pressing on the trigeminal nerve as it exits the brain stem. This compression can wear away or damage protective coating around the nerve (myelin sheath). Rarely, symptoms of TN may be caused by nerve compression from a tumor, or a tangle of arteries and veins called an arteriovenous malformation. Injury to the trigeminal nerve as a result of sinus surgery, oral surgery, stroke, or facial trauma may also produce neuropathic facial pain.

According to a 2016 article in the Oral Maxillofacial Surgical Clinics of North America Journal, painful traumatic trigeminal neuropathy (PTTN) can follow major oral trauma and even minor dental interventions. This condition has often been termed "phantom tooth pain." The onset of PTTN, following identical procedures can vary from patient to patient. Dental implants pose a significant risk. A common complication following implant insertion is damage to adjacent nerves, altered sensory perception, and possibly pain. Wisdom tooth extraction is often associated with transient numbness. Sensory changes related to root canal therapy may be due to infection, inflammation, chemical injury, or extrusion of filling materials. Local anesthetic injections also may induce nerve injury secondary to physical trauma by the needle or by chemical damage from the anesthetic solution.

What are the symptoms of trigeminal neuralgia? For those who suffer from TN or PTTN, pain can vary from sudden, severe, and stabbing to a more constant, aching, burning sensation. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, smiling or being exposed to the wind. The pain may affect a small area of the face or may spread. Bouts of pain rarely occur at night, when the affected individual is sleeping, but falling asleep as a result of pain may be difficult.

Emmanuel Birstein is a skilled and gifted practitioner and healer at PIMH. His extensive training in craniosacral therapy and his broad anatomical knowledge lends to his high success rate in relieving pain and dysfunction. Emmanuel has a particular insight into the role of the trigeminal nerve not only in neuropathic pain, but as it relates to mental health issues, especially depression and panic disorder.

Recently, a client came in presenting with severe face pain on the right side related to long-term trigeminal neuralgia. After one session with Emmanuel client reported:
"The day after, I felt very sleepy and ill at ease. The pain is still there but greatly decreased.
What surprised me was the great decrease in my clinical depression."
How is trigeminal neuralgia treated? TN and PTTN are extremely difficult to manage. TN is typified by attacks that stop for a period of time and then return, but the condition can be progressive. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. Eventually, the pain-free intervals disappear and medication to control the pain becomes less effective. The disorder is not fatal, but can be debilitating. Due to the intensity of the pain, some individuals may avoid daily activities or social contacts because they fear an impending attack.

Pain medication is generally the first line of defense. The mainstays are antiepileptic drugs and tricyclic antidepressants. Surgical approaches may focus on release of scar tissue, decompression and neuroma excision. Overall, however, the benefit of surgery for painful trigeminal neuropathies is unclear. They may, in fact, lead to more pain. Sub-dermal nerve blocks, botox injections, fat grafting, balloon compression, and radiofrequency ablation are among other treatment interventions. Because TN, like many other chronic pains, is associated with depression and anxiety, psychosocial therapy (e.g. cognitive behavioral therapy) may be beneficial. However, to date, research has not shown a significant effect on pain intensity and quality of life measures.

Non-medical approaches and coping strategies can be helpful in managing the TN pain. Examples include: acupuncture, yoga, breathing techniques, mindfulness and meditation. Some people do find enough relief to live normal lives, but for many, TN is a hugely debilitating, disabling condition. It’s not something people can just deal with when the pain hits. It also can be hard on family and friends, as they don’t always know how to help.

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