Chronic Pain

Trigeminal Neuralgia and Facial Pain

Trigeminal neuralgia is a type of severe, intermittent facial pain which has often been described as one of the most painful syndromes known to mankind.The pain is usually brief, sharp and stabbing, and can often be triggered by touch, chewing or even a light breeze. Patients may have long pain-free periods followed by severe bouts of recurrent pain which are unpredictable.

Trigeminal neuralgia is thought to be due to loss of the insulation (myelin) around the nerve fibers in the trigeminal nerve, which supplies sensation to the face. This loss of insulation, also called demyelination, causes a "short circuit' in the nerve, producing abnormal nerve impulses which are perceived by the brain as pain. In many cases, demyelination is caused by compression of the nerve by a blood vessel, near where it exits the brain.

Not all facial pain can be classified as trigeminal neuralgia. Constant, burning facial pain from injury to or disease of the trigeminal nerve is known as trigeminal neuropathic pain. This type of pain is much more difficult to treat than trigeminal neuralgia and requires special expertise to diagnose and treat effectively. 

Many treatments which are effective for trigeminal neuralgia can actually worsen trigeminal neuropathic pain. Patients with facial pain should therefore seek evaluation with physicians who can distinguish these various types of facial pain and who can offer a broad range of medical and surgical treatments.

Treatment at Stanford

Although the majority of patients with trigeminal neuralgia receive pain relief from medication, in persistent cases surgical treatment may be very effective. Surgical treatments fall into two main categories: decompressive and destructive.
 
Decompressive procedures are aimed at removing the compressing blood vessel from the trigeminal nerve. This surgery is effective in more than 85 percent of patients and in many cases can be curative.

Destructive procedures use heat, chemicals or radiation to produce mild damage to the nerve, decreasing or stopping the "short-circuited" nerve impulses. These surgical options are also effective in 80 - 90 percent of patients, although pain recurrence is more common.

For trigeminal neuropathic pain, these decompressive or destructive procedures are usually inappropriate, producing either no benefit or causing an increase in the pain. For these patients, advanced neuromodulation procedures such as trigeminal stimulation or brain stimulation can often provide relief where other treatments fail.

Clinical Neurosciences

The Clinical Neurosciences Department at Stanford has unique expertise in the treatment of trigeminal neuralgia and other facial pain syndromes. Jaimie Henderson, MD, Director of Stereotactic and Functional Neurosurgery, is a nationally-recognized expert in the treatment of chronic pain, including trigeminal neuralgia and facial pain.

The Clinical Neurosciences Department offers the full range of decompressive and destructive procedures for trigeminal neuralgia and is one of the few locations in the United States offering motor cortex stimulation for the treatment of trigeminal neuropathic pain. Our physicians are not only experts in surgically placing implants, but also in reprogramming implants for patients who had initial pain relief that did not last.

Other Treatment Options at Stanford If, as part of your pretreatment evaluation, we determine that you have not yet received less invasive treatments that may be helpful, we may refer you to the Stanford Pain Management Center. In addition, the Pain Center may be involved in your follow up care.
 
Also outside of the department of Clinical Neuroscience, physicians in the Stanford Radiosurgery program are using the CyberKnife(TM) for stereotactic radiosurgery to treat trigeminal neuralgia.
 
By coming to Stanford for treatment, you will be assured that you have access to the best and most advanced treatment options available.

Resources

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