#LetsTalkPain: All About Trigeminal Neuralgia or ‘Suicide Disease’
Trigeminal neuralgia affects women more often than men, & it’s more likely to occur in people who are older than 50.
Trigeminal Neuralgia (TN) is universally considered to be the ‘worst known pain to mankind’, nicknamed as “suicide disease”.
Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. You may initially experience short, mild attacks. But trigeminal neuralgia can progress and cause longer, more-frequent bouts of searing pain.
Trigeminal neuralgia affects women more often than men, and it’s more likely to occur in people who are older than 50.
Causes of Trigeminal Neuralgia
- 50% of trigeminal neuralgia cases occur due to a problem between the normal blood vessel and the nerve, this contact puts pressure on the nerve resulting in nerve malfunction.
- 40% cases do not have this blood vessel compressing and are catergorised as ‘Idiopathic Trigeminal Neuralgia’, since the cause is not known.
- 10% happen due to a disease called ‘Multiple Sclerosis’ or due to an infection called ‘Herpes Zoster’ or due to tumors in the trigeminal region.
There are various treatment options available for this condition:
These are used to block nerve firing and are generally effective in treating cases of trigeminal neuralgia type 1 but often less effective in trigeminal neuralgia type 2.
Eventually, if medication fails to relieve pain or produces intolerable side effects such as cognitive disturbances, memory loss, excess fatigue, bone marrow suppression, or allergy, then surgical treatment may be indicated.
Since trigeminal neuralgia is a progressive disorder that often becomes resistant to medication over time, individuals often seek surgical treatment.
Several neurosurgical procedures are available to treat this condition, depending on the nature of the pain; the individual’s preference, physical health, blood pressure, and previous surgeries; presence of multiple sclerosis, and the distribution of trigeminal nerve involvement.
Some procedures are done on an outpatient basis, while others may involve a more complex operation that is performed under general anesthesia.
Some degree of facial numbness is expected after many of these procedures, and trigeminal neuralgia will often return even if the procedure is initially successful.
A rhizotomy (rhizolysis) is a procedure in which nerve fibers are damaged to block pain. A rhizotomy for trigeminal neuralgia always causes some degree of sensory loss and facial numbness.
All forms of rhizolysis are invasive except stereotatic radiosurgery with success rates ranging from 80-90%.
Radiosurgery involves the lesioning (operating on small area of the brain) of the trigeminal neuralgia. It has several advantages:
- No need for anesthesia
- No blood requirement for surgery
- No risk of any infections
- Delivery accuracy is sub-millimetre and sub-degree
You do NOT have to live with trigeminal neuralgia pain and you do not have to live a life being heavily drugged.
(Dr. Shankar Vangipuram is the HOD of Radiation Oncology at the HCG-Apex Center in Mumbai.)
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