Medicine Information

Facial Pain: When a Nerve Is a Live Wire


Of all the places in the body that can hurt, the face might seem the strangest. But for some people, that's exactly where the agony occurs, and the cause is a nerve gone haywire.

How peripheral nerves involve themselves in pain is sometimes confusing. Here's a handy way to think of the two basic patterns:

#1: The nerve is the messenger. If you have a dental abscess, a facial sunburn or a sinus infection, you can count on pain being present. Where does it come from? Special nerve endings detect the tissue-injury and generate electrical impulses. The peripheral nerves carry these impulses into the brain. The peripheral nerves didn't CAUSE the pain, they're just carrying the bad news. (Don't shoot the messenger!)

#2: The nerve itself is the mischief-maker. In some cases the nerve generates abnormal impulses on its own. The nerve is still capable of carrying normal impulses, like those informing the brain that the skin of the face is warm or cold-or that you cut yourself shaving-but generates signals of its own as well that the brain can only interpret as painful.

When peripheral nerves generate bolts of pain in the forehead, eye, cheek or jaw, it's called trigeminal neuralgia. This technical term can be broken into its parts, starting at the end and working forward. "Algia" means pain. A "neur-algia" means nerve-pain. Finally, "trigeminal" is the name of the nerve involved. So "trigeminal neuralgia" means pain caused by the trigeminal nerve. We have two trigeminal nerves, one for each side of the face. They are among the largest nerves in our heads.

An older term for trigeminal neuralgia was "tic douloureux." This bears explaining. A "tic" is a sudden, brief movement. "Douloureux" is the French word for "painful." So a "tic douloureux" means that a sudden, brief movement and a pain occur together. However, this terminology was largely abandoned because it implies that movement is an essential feature. It isn't. When movement is present, it's just as a reaction to the pain.

So what are the usual features of trigeminal neuralgia? First of all, it almost always occurs on just one side of the face. If one of our trigeminal nerves gets involved in this unfortunate condition, it's rare indeed that the second trigeminal nerve would be so unlucky to get involved, too. Or another way of looking at it is this: if the pain switches sides or crosses the midline, then it's probably not trigeminal neuralgia.

Trigeminal neuralgia usually involves brief, but intense jabs of pain, though is sometimes more steady and continuous. It can also get revved-up by external stimuli, like washing the face, putting on make-up, brushing teeth, chewing-and sometimes just talking.

The most usual form of trigeminal neuralgia begins after the age of 50. And, once present, it tends to hang around. Its course-like that of the stock market-fluctuates.

Treatment is not usually curative, but help is still available. Most patients obtain relief through one or a combination of medications that either simmer down the extra nerve-impulses or reduce the effects of the barrage of extra signals that arrive in the brain. Some of their generic names are carbamazepine, gabapentin, baclofen, clonazepam and lamotrigine.

A minority of patients with this condition undertake surgery for it. One surgery involves purposely damaging the trigeminal nerve-fibers where they gather together in a structure called a ganglion. This approach is fairly safe, but produces partial numbness on the face.

Another surgery goes straight to where the trigeminal nerve fibers meet the brain. The surgeon gently separates the nerve from its surrounding tissues. The good part of this procedure is that it doesn't seek to damage tissue. The downside is that the location for the surgery is at an important cross-roads for many nerve and brain pathways, so a complication can be devastating. While some people get long-lasting relief from the surgeries, others obtain just temporary respite.

While the foregoing summary of treatments sounds gloomy, it's important to realize that most people who seek medical treatment for their trigeminal neuralgia are able to arrive at a happy point where pain is minimized and quality of life is maximized. The neuralgia no longer rules their lives; instead, they're in control of the neuralgia.

(C) 2005 by Gary Cordingley

Gary Cordingley MD, PhD, is a clinical neurologist, teacher and researcher. For more health-related information, see his website at: http://www.cordingleyneurology.com


MORE RESOURCES:
This RSS feed URL is deprecated, please update. New URLs can be found in the footers at https://news.google.com/news


Forbes

Five Winners -- And One Loser -- From Medicine's Big Meeting About Blood
Forbes
Matthew Herper , Forbes Staff I cover science and medicine, and believe this is biology's century. Johnny Wolf. Kite Founder Arie Belldegrun and BlueBird CEO Nick Leschly talk gene therapy at the Forbes Healthcare Summit. For the past two days, doctors ...



STAT

Your smartphone as medicine: Digital therapy is here to stay
STAT
The FDA recently approved 1 the first prescription digital therapy, Pear's Reset app 2 and program, which is focused on substance abuse. Others 3 are likely to follow. That means your next trip to the doctor could include a prescription for a mobile ...



DesMoinesRegister.com

Tips for administering medicine to children
DesMoinesRegister.com
As infants and young children grow and gain weight rapidly in early life, a medicine's dose often increases quickly. The dose of a medicine for an infant or child may be greater just several months later, as more weight is gained. Administering the ...



Community Advocate

Metrowest practice offers Functional Medicine
Community Advocate
Hopkinton – If you're sick of feeling unwell and you're looking for a practice that won't just push more pills, you might consider looking into the 4 Better Health Functional Medicine practice in Hopkinton. The practice is owned by Dr. Patti Zub and ...



Cystic Fibrosis News Today

Ontario Researcher Awarded Grant to Develop Precision Medicine Tool for CF
Cystic Fibrosis News Today
Hirota, a respiratory researcher at St. Joseph's and an assistant professor in the department of medicine at McMaster University in Canada, will receive $280,183 over three years under the grant. “Unfortunately, currently approved drugs fail to work in ...



Pharmacists warn of medicine scarcity in Sudan
ReliefWeb
While medicine prices increase, some life-saving medicines have become scarce in Khartoum and other states. Patients and their attendants complained that medicines have become unaffordable. Some medicines prices have exceeded the price issued that the ...

and more »


RowAnalytics' Giro Initiative Brings Precision Medicine Perspective to Neurodegenerative Disorders
GenomeWeb
NEW YORK (GenomeWeb) –RowAnalytics, the Martinos Center for Biomedical Imaging, and Envision Genomics are partnering on a new initiative called Giro Health, which they describe as an open initiative in precision medicine that seeks to improve diagnosis ...



Salt Lake Tribune

Commentary: The Tribune was wrong. Medicine often involves a risk to the patient.
Salt Lake Tribune
(Courtesy of the Utah Department of Health) A health department initiative called Talk to Your Pharmacist placed stickers on bottles to prompt prescribers to talk to their pharmacist about the risk of using opioids. By Lynn Webster | For The Tribune ...



UAB News

Celebrating 25 years of psychiatric medicine at UAB
UAB News
CPM groundbreaking ceremony, 1989. Photo provided by UAB Archives.On Sept. 27, 1989, the University of Alabama at Birmingham broke ground for a new building. The Center for Psychiatric Medicine, as the edifice on Sixth Avenue South was to be called ...



CBC.ca

Why adding beds might not solve the problem of 'hallway medicine' anytime soon
CBC.ca
Beds announced at the end of October to alleviate overcrowding at some hospitals may be slow to come on stream as hiring staff takes time, but some doctors say the move also doesn't address the underlying cause. Dr. Paul Pageau, President of the ...

and more »

Google News

home | site map | Dr. Thad Thomas
© 2006