Functional Pain: Trigeminal Neuralgia

By | November 18, 2011

Treating Trigeminal Neuralgia with local anesthetic injections is a little like hitting the power or reset buttons on your computer.

Trigeminal Neuralgia is a fascinating chronic pain condition involving recurrent attacks of facial pain.  Patients describe a burning pain or a lancinating pain in the distribution of one or more branches of the fifth cranial nerve. The cause is unknown in most cases. Gross and microscopic examination of the involved nerves is typically unremarkable.

Medical treatment is often ineffective. Alternatively, destruction of the involved branches either surgically or with irradiation (Gamma Knife) often yields temporary improvement followed by a recurrent deafferentiation pain that is even worse than the original problem.

Nerve blocks have been used both diagnostically and therapeutically. Patients who respond to this therapy will experience significant pain relief as well as numbness in the distribution of the nerve for the duration of action of the local anesthetic. The really interesting part is that in responders the duration of pain relief outlasts the pharmacologic duration of action of the local anesthetic and the numbness.  On subsequent injections the duration of pain relief gets longer and longer until finally the pain does not recur. Treating neuropathic pain this way sounds a little bit like hitting the reset button or the power switch on a malfunctioning computer.

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