Trigeminal neuralgia (TN)( also known as suicide or Fothergill’s disease) is an extremely painful, some say among the most painful conditions known to man! 1 in 15,000 are estimated to suffer and more commonly women than men and usually not starting till over 50.
Existing medical and surgical therapies are moderately effective in many cases, but for a considerable number of patients, these are less than satisfactory and are fraught with failure to respond, considerable side effects of the medications, complications of surgery, and postoperative relapses. Acupuncture has a long-standing reputation of being helpful in various pain syndromes and reportedly has been effective in TN.
The electric shock-like pain generally is on one side of the face and is spasmodic, coming in short bursts lasting a few seconds. It is estimated however that 10-12% of sufferers experience bilateral pain. Several attacks can follow each other within minutes. There are often trigger points, places on the face that, if touched, trigger an attack. Eating, shaving, applying makeup and talking can be triggers as well as wind, high pitched sounds, loud noises such as concerts or crowds! However, in many patients the pain is generated spontaneously without any apparent stimulation.
There can be periods of remission when pain is completely absent. These periods of remission, which can last days, weeks, months, even years, are unpredictable and without medical treatment, the pain usually returns.
The trigeminal nerve is a large paired facial nerve that has three major branches: the ophthalmic nerve (V1), the maxillary nerve (V2), and the mandibular nerve (V3). One, two, or all three branches of the nerve may be affected. 10-12% of cases are bilateral (occurring on both the left and right sides of the face). Trigeminal neuralgia most commonly involves the middle branch (V2) and lower branch (V3) of the trigeminal nerve, but the pain may be felt in the ear, eye, lips, nose, scalp, forehead, cheeks, teeth, or jaw and side of the face.
Signs and symptoms
This disorder is characterized by episodes of intense facial pain that last from a few seconds to several minutes or hours. The episodes of intense pain may occur paroxysmally. To describe the pain sensation, patients may describe a trigger area on the face so sensitive that touching or even air currents can trigger an episode; Individual attacks usually affect one side of the face at a time, lasting from several seconds to a few minutes and repeat up to hundreds of times throughout the day. The pain also tends to occur in cycles with remissions lasting months or even years. Pain attacks are known to worsen in frequency or severity over time, in some patients. Many patients develop the pain in one branch, then over years the pain will travel through the other nerve branches. Some patients also experience pain in the index finger.
It may slowly spread to involve more extensive portions of the trigeminal nerve. The spread may even affect all divisions of the nerve, and sometimes simultaneously. Cases with bilateral involvement have not indicated simultaneous activity. The following suggest a systemic development: rapid spreading, bilateral involvement, or simultaneous participation with other major nerve trunks. Examples of systemic involvement include multiple sclerosis or expanding cranial tumor. Examples of simultaneous involvement include tic convulsive (of the fifth and seventh cranial nerves) and occurrence of symptoms in the fifth and ninth cranial nerve areas.[1
Outwardly visible signs of TN can sometimes be seen in males who may deliberately miss an area of their face when shaving, in order to avoid triggering an episode. Successive recurrences are incapacitating and the dread of provoking an attack may make sufferers unable to engage in normal daily activities.
There is also a variant of TN called atypical trigeminal neuralgia (also referred to as "trigeminal neuralgia, type 2"). In some cases of atypical TN the sufferer experiences a severe, relentless underlying pain similar to a migraine in addition to the stabbing shock-like pains. In other cases, the pain is stabbing and intense but may feel like burning or prickling, rather than a shock. Sometimes the pain is a combination of shock-like sensations, migraine like pain, and burning or prickling pain. It can also manifest as an unrelenting, boring, piercing pain.
The trigeminal nerve is a mixed cranial nerve responsible for sensory data such as pressure ,temperature, and pain originating from the face above the jaw line; it is also responsible for the motor function of , the muscles involved in chewing but not facial expression.
Several theories exist to explain the possible causes of this condition. It was once believed that the nerve was compressed in the opening from the inside to the outside of the skull; but newer leading research indicates that it is an enlarged blood vessel - possibly the superior cerebellar artery - compressing or throbbing against the microvasculature of the trigeminal nerve. Such a compression can injure the nerve's protective myelin sheath and cause erratic and hyperactive functioning of the nerve. This can lead to pain attacks at the slightest stimulation of any area served by the nerve as well as hinder the nerve's ability to shut off the pain signals after the stimulation ends. This type of injury may rarely be caused by an aneurysm (an outpouching of a blood vessel); by a tumor; by a cyst or by a traumatic event such as a car accident.
Short-term peripheral compression is often painless, with pain attacks lasting no more than a few seconds. Chronic nerve entrapment results in damage to the nerves insulating coat. This can cause a malfunction in the nerves ability to conduct and to generate pain.
Two to four percent of patients with TN, usually younger patients, have evidence of multiple sclerosis, which may damage either the trigeminal nerve. Trigeminal pain has a similar presentation in patients with and without MS.[
Postherpetic neuralgia, which occurs after shingles, may cause similar symptoms if the trigeminal nerve is damaged.
When there is no [apparent] structural cause, the syndrome is called idiopathic.
Orthodox first line treatment is prescription medication. If this is not satisfactory then surgical intervention is usually considered.
The anticonvulsant carbamazepine is the first line treatment.
Low doses of some antidepressants such as amitriptyline are used for this and other neuropathic pain.
In severe cases Opiates such as morphine can be prescribed.
The drugs often have unpleasant side effects, which can cause lise style changing effects negating some of the pain relieving benefits of the medication.
The evidence for surgical therapy is poor and it is thus only recommended if medical treatment is not effective. While there may be pain relief there can be numbness post procedure Microvascular decompression appears to result in the longest pain relief.
Can Acupuncture help Trigeminal Neuralgia?
Acupuncture is a safe, risk-free treatment when done by a qualified professional, and it is not uncommon for qualified doctors to suggest it for pain treatment. This is especially true when traditional medicine fails to work. The inherent qualities of acupuncture suggest that a reasonable to good benefit can come from treatment, with patients often reporting success after several appointments.
Some patients have reported pain relief for long periods of time, while others have seen little improvement. Anecdotal information also suggests that acupuncture has been used for TN connected with multiple sclerosis, with some success; truly reliable statistics cannot always be found.
While some pain may remain I have found it often beneficial producing worthwhile results. For that reason I have tended to favour its treatment as It gives me such satisfaction when I can help with such a painful condition.
Because of the sensitivity of the condition, treatment is very minimal to start, perhaps only one needle. This helps prevent the risk of causing an attack. As the condition is brought under control additional needles may be used if needed.
Acupuncture is also often a great adjunct to conventional treatment often reducing the dose of drug needed to control the condition.
It may take 6 or more treatment to obtain the maximum relief which may last for several months.