Neuralgia is a term for pain caused by an abnormality in a particular nerve, occurring for reasons that are often not fully understood.
Nerve pain can affect almost any nerve in the body. Its cause is poorly understood. Some researchers have suggested that the pain results from an electrical problem in the nerve, much like a loose or damaged electrical wire. The fifth cranial nerve gives sensation to almost the entire face, explaining why the disorder can cause pain in different areas of the face. Fortunately, treatment can help stop the pain for most people.
The pain is usually described as sudden, severe, or stabbing. It is commonly felt on one side of the lips, gums, cheek, or jaw. The pain usually lasts for only a few seconds, but it can last for a few minutes. Repeated bouts of pain may occur over a period of minutes. It can recur as often as 100 times a day. Talking, chewing, brushing the teeth, cold temperatures, touching the face, or even swallowing may trigger the pain. The pain can be minor or severe.
This disorder is more common in women than men. It rarely affects people younger than 50 years old. In most cases, the exact cause is unknown.
In a minority of cases, a cause is found for this disorder. These causes include: injury to the face or oral surgeryautoimmune disorders, in which the immune system attacks the person's own body. Autoimmune disorders include multiple sclerosis and scleroderma.herpes zoster, often called shingles, which is a viral infection that can irritate nervesabnormal arteries or blood vessels, which can compress the nerve. One example is an aneurysm, an abnormally widened area in an artery. Malformations of normal blood vessels, called arteriovenous malformations, are another cause.benign or malignant tumors, which may also compress the nerve. In these cases, there are usually other symptoms in addition to nerve pain.
There is no known prevention for trigeminal neuralgia.
There are no specific tests that can diagnose trigeminal neuralgia. The characteristic pain in this condition often allows a healthcare professional to make the diagnosis. Testing may be done to rule out other possible causes of facial pain, such as diseases of the jaw, teeth, or sinuses. For example, an x-ray of the sinuses may be done to rule out a sinus infection.
Without treatment, the person may have long-term pain and discomfort. The pain, and fear of the pain, can be so severe that some people cannot perform everyday tasks.
In the rare cases in which the cause is known, other long-term effects can result. For example, cancer can result in death. Multiple sclerosis can cause weakness, paralysis, and permanent disability in some cases.
There are no risks to others.
Treatment for this condition usually involves anti-seizure medications. These are thought to work by stabilizing the nerve. Carbamazepine (i.e., Tegretol) is usually tried first. If this medication does not work or it causes severe side effects, phenytoin (i.e., Dilantin), baclofen (i.e., Kemstro), clonazepam (i.e., Klonopin), or valproic acid (i.e., Depakene) can be tried.
If medication fails to control the pain, surgery may be needed. In the rare case of a known cause, treatment of the cause may stop the nerve pain. For example, surgery may be used to remove a tumor or abnormal blood vessels.
Side effects of the medications may include nausea, loss of sleep, and headaches. Surgery can be complicated by infection, bleeding, an allergic reaction to the anesthetic, or numbness in the face if a nerve is cut intentionally.
Medication usually makes the pain go away. If surgery is needed, it also usually stops the pain. In the rare case of a known cause, other monitoring or treatment may be needed..
The person can monitor the pain at home, and report any new or worsening symptoms to the healthcare professional. The medications used often need monitoring. If a medication cannot control the pain, the dose may be changed.
If pain cannot be controlled with medications, surgery may be needed. In the rare case of a known cause, other monitoring may be needed, such as X-rays or other tests to check for progression of a tumor.
Mayo Clinic Family Health Book, 1996.