The Facial Pain Syndrome
Thursday, November 4, 2004
Dear Dr. Mady: I have been experiencing pain in my face off and on for years and no doctor or dentist has been able to figure out what is causing it. I recently went to the emergency room because the pain was intolerable and the doctor there thinks that I have something called Trigeminal Neuralgia. He said I have to see a specialist for this. What is it and do you think anything can be done to help me end the pain and suffering?-Melinda in Kingston, Ontario
Dear Melinda: The emergency room physician may be right! Trigeminal Neuralgia could actually be described as among the most acute pain known to us. It is also called Tic Douloureux and is a facial pain syndrome characterized by sharp, excruciating, stabbing facial pain. It may even feel like electric shocks at times and the pain is distributed in the areas of the face that are innervated by a nerve known as the trigeminal nerve.
The trigeminal nerve is the fifth and largest cranial nerve and it is responsible for pain, pressure, touch and temperature to the face, jaws, gums, forehead, cheeks nose, lips, ears and area around the eyes. The pain is often spontaneous and usually occurs on one side of the face, jaw or cheek only. However there have been many reported cases of pain on both sides of the face, simultaneously. It is not often evident as to whether or not a bilateral pain situation such as this is actually a bilateral neuralgia or merely referred pain from the opposite side of the face. The pain is usually caused by compression of the trigeminal sensory nerve in the scull by a small artery or vein at the point where the nerve joins the brainstem.
This syndrome usually affects women more than men and especially if they are above the age of fifty. The attacks generally last several seconds and may keep repeating one after the other. There is usually no associated numbness unless multiple sclerosis co-exists with the neuralgia. Many things can initiate the pain response, but the most common actions that provoke the attacks are chewing, talking, touching the face, temperature changes and swallowing. Even stimulation from brushing of the teeth, putting on makeup or shaving can cause the electric shock-like pain to begin.
The attacks may come and go throughout any particular day and last for days, weeks, or months at a time, and then disappear for months or years . Diagnosis can often be difficult, but most individuals with this type of pain first present to their dentist because the pain is in the facial area and it is often confused with a toothache or abscess. Headaches are also very common. The pain can often become unbearable, but there are a variety of treatment modalities available. You are not doomed to a life of pain. Doctors can usually manage the situation effectively with medication therapy or even surgery. Tic Douloureux is never fatal.
The oral drug of choice that seems to have helped the most is called Tegretol, however there are other drugs that can help. Tegretol is an oral anticonvulsant medication also known as carbamazepine. Some antidepressant drugs and muscle relaxants (in combination with anticonvulsants) have also had success in treating this disorder. Oral meds are usually effective by way of lessening or blocking the pain signals sent to the brain. If a medication loses its effectiveness or causes too many side effects, there is always the potential to switch to another one.
Should medications become ineffective, or if they produce undesirable side effects, surgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity. There have been reports of relief from alternative medical treatments such as chiropractic adjustment, acupuncture, meditation or hypnosis. Your doctor, dentist or specialist will guide you as soon as a definite diagnosis is made.
This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5