Trigeminal Neuralgia

The pain of TN is often intense and short-lived. Patients often describe the pain as electrical in quality. While often the pain occurs in a burst that lasts for seconds, sometimes the pain can occur in repetitive bursts that last for hours to days. The intermittent frequency of pain can often lead patients to a persistent sense of vigilance and alarm in anticipation of the next burst of pain. This combination of intermittent pain and persistent fear can lead to difficulties with coping. In turn, these difficulties can lead to impairments, such as staying home from work or other activities as a way of attempting to cope with it all.

There is no single cause of TN. Moreover, the known possible causes are not clearly defined. It is thought that compression of the trigeminal nerve by an enlarged blood vessel can cause it. It is also associated with aging. Multiple sclerosis is also sometimes associated with it. Central sensitization may also play a role in the progression TN.^{1, 2} Central sensitization is a highly reactive state of the nervous system, which amplifies pain. It can occur with most any pain disorder.

Is there a cure trigeminal neuralgia?

Typically, there are no cures for TN. Healthcare providers and their patients focus on management of the chronic pain. Chronic pain management has two broad goals:

• Reduce symptoms to the extent possible
• Reduce the emotional distress and functional impairments that are associated with the symptoms

The first goal involves reducing pain and any other symptoms associated with TN. The second goal is two-fold: to reduce the fear, anger, anxiety, depression or sleep problems that tend to go along with living with TN, and reducing the sense of disability that tends to occur with pain. Overall, these goals amount to assisting the patient to live well, work, and be involved in life, despite having TN.

The healthcare system has different ways it pursues chronic pain management. Broadly speaking, there are three different types of pain clinics in our healthcare system:

• Pain clinics that focus on surgeries
• Pain clinics that focus on interventional procedures (steroid injections, nerve blocks, nerve-burning procedures, implantable pain management devices)
• Pain clinics that focus on long-term medication management (such as long-term use of narcotic pain medications)
• Pain clinics that focus on chronic pain rehabilitation (such as interdisciplinary chronic pain rehabilitation programs)

All three types of clinics treat TN.

Therapies & procedures for trigeminal neuralgia

Common treatments for TN are anticonvulsant medications, neuroablation procedures, surgery, and chronic pain rehabilitation programs.

Anticonvulsant medications

Anticonvulsant medications, particularly carbamazepine, is typically a first-line treatment. A recent Cochrane Review concluded that carbamazepine is effective in reducing TN pain.³ Gabapentin, another anticonvulsant medication, may also reduce the pain of TN.⁴ However, the long-term efficacy of these medications remains largely unknown.

Yang, et al.,⁵ reviewed clinical trials for other medications, which are not anticonvulsants. They found clinical trials only for tizanidine, tocainide, and pimozide. They concluded that none of these medications provide substantial benefit over carbamazepine.

Neuroablation Procedures & Surgeries

Zakrzewska & Akram⁶ reviewed clinical trials of different neuroablation procedures as well as decompression surgeries. They found no clinical trials for decompression surgeries, despite how commonly they are done. In terms of neuroablation procedures, they concluded that established studies showed reductions in pain, though sensory side effects were common. They also observed that the published studies were of poor quality and often demonstrated bias.

Chronic Pain Rehabilitation Programs

Failing to obtain sufficient pain reduction through the use of medications or surgical/interventional procedures, patients with TN often seek care in chronic pain rehabilitation programs. TN pain can easily lead to suffering in terms of emotional distress and functional impairments.⁷ Chronic pain rehabilitation programs are designed to reduce such distress and impairments for patients with any type of chronic pain, including TN. They are effective in doing so, and there is high quality research evidence demonstrating their effectiveness.⁸ However, there are no clinical trials assessing the effectiveness of chronic pain rehabilitation programs solely for TN.

References

1. Hu, W. H., Zhang, K., & Zhang, J. G. (2010). Atypical trigeminal neuralgia: A consequence of central sensitization? Medical Hypotheses, 75, 65-66.

2. Watson, J. C. (2007). From paroxysmal to chronic pain in trigeminal neuralgia: Implications of central sensitization. Neurology, 69, 817-818.

3. Wiffen P. J., Derry S., Moore R. A., McQuay, H. J. (Updated September 15, 2011). Carbamazepine for acute and chronic pain in adults. In Cochrane Database of Systematic Reviews, 2011, (1). Retrieved May 11, 2011, from The Cochrane Library, Wiley Interscience.

4. Moore, R. A., Wiffen P. J., Derry S., & McQuay, H. J. (Updated February 16, 2011). Gabapentin for chronic neuropathic pain and fibromyalgia in adults. In Cochrane Databaseof SystematicReviews, 2011, (3). Retrieved May 11, 2011, from The Cochrane Library, Wiley Interscience.

5. Yang, M., Zhou, M., Chen, N., & Zakrzewska, J. M. (Updated April 30, 2010). Non-epileptic drugs for trigeminal neuralgia. In Cochrane Databaseof SystematicReviews, 2011, (1). Retrieved May 11, 2011, from The Cochrane Library, Wiley Interscience.

6. Zakrzewska, J. M., & Akram, H. (Updated May 13, 2010). Neurosurgical interventions for the treatment of classical trigeminal neuralgia. In Cochrane Databaseof SystematicReviews, 2011, (9). Retrieved May 11, 2011, from The Cochrane Library, Wiley Interscience.

7. Carlson, C. R. (2007). Psychological factors associated with orofacial pain. Dental Clinics of North America, 51, 145-160.

8. Gatchel, R., J., & Okifuji, A. (2006). Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic non-malignant pain. Journal of Pain, 7, 779-793.

Date of publication: April 27, 2017

Date of last modification: October 23, 2015