Neuralgia/ATFP

Trigeminal Neuralgia (TN), also known as Tic Douloureux, is considered by many to be the "most terrible pain known to man."  The electric shock-like pain generally is on one side of the face and is spasmodic, coming in short bursts lasting a few seconds.   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.  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.

TN is a very rare condition. Statistics vary, but TN occurs in approximately 150 per million people per year. Medical literature notes that this condition is rare for anyone under age 50, but in reality TN is known to exist in many younger individuals including children. There are some relatively effective treatments for TN. But unfortunately, although some of the treatments are becoming standard, there is no single treatment that is effective for all sufferers.

What exactly is Neuralgia?

Trigeminal Neuralgia is a disorder of the trigeminal nerve, one of twelve pairs of cranial nerves on each side of the head.  The cranial nerves control movement and sense pressure, touch, pain and temperature in the head and neck. These cranial nerves are numbered from 1 to 12.

Description of ATFP - a broader spectrum of the disorder

Atypical Facial Pain (ATFP) is a syndrome encompassing a wide group of facial pain problems. ATFP can have many different causes but the symptoms are all similar. Facial pain, often described as burning, aching or cramping, occurs on one side of the face, often in the region of the trigeminal nerve and can extend into the upper neck or back of the scalp. Although rarely as severe as trigeminal neuralgia, facial pain is continuous for ATFP patients, with few, if any periods of remission. Recent studies propose that ATFP is an early form of trigeminal neuralgia. Indeed, some patients have components of both ATFP and TN symptoms.  Earlier literature has linked ATFP to "psychological pathology." Recent studies however have shown no such link exists.

Possible causes

ATFP has many possible causes. In some cases, infections of the sinuses or teeth appear to be involved. Some studies postulate a low-grade infectious and inflammatory process occurring over a long period can result in nerve damage and be the triggering factor for ATFP pain. Some believe that vascular compression of the trigeminal nerve in the same area that is postulated to lead to trigeminal neuralgia is a cause of ATFP although studies have shown that micro vascular decompression rarely leads to pain relief in ATFP patients. Dental or some sort of physical trauma is also linked to ATFP.

Symptoms

Facial pain, often described as burning, aching or cramping, pinching, pulling, occurs on one side of the face, often in the region of the trigeminal nerve and can extend into the upper neck or back of the scalp. Although rarely as severe as trigeminal neuralgia, facial pain is continuous for ATFP patients, with few, if any periods of remission.

Diagnosis

Diagnosing atypical facial pain is not an easy task. It's not unusual for ATFP patients to have undergone numerous dental procedures, seen multiple doctors and undergone many medical tests before being successfully diagnosed and treated. A diagnosis of ATFP is usually a process of elimination. When a patient complains of constant facial pain restricted to one side of the face, the physician must first rule out any other conditions. Tests include roentgenograms of the skull, MRI and/ or CT scan with particular attention to the skull base, careful dental and otolaryngolgic evaluation, and thorough neurological examination. Only after tests rule out other factors can a diagnosis of ATFP be made.

Treatments

Treatment of ATFP can be difficult and perplexing for both doctor and patient. Medication is usually the first course of treatment. Surgical procedures such as micro vascular decompression are generally not successful with ATFP patients.

Treatment for trigeminal neuralgia typically includes anticonvulsant medications such as carbamazepine or phenytoin. Baclofen, clonazepam, gabapentin, and valproic acid may also be effective and may be used in combination to achieve pain relief. If medication fails to relieve pain, surgical treatment may be recommended.

Can Acupuncture help?

Acupuncture is a safe, risk-free treatment when done by a qualified professional, and it is common 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.

What is the prognosis?

The disorder is characterised by recurrences and remissions, and successive recurrences may incapacitate the patient. Due to the intensity of the pain, even the fear of an impending attack may prevent activity. Trigeminal neuralgia is not fatal.

In such cases a small vessel (usually an artery but occasionally a vein) is often found to be compressing the root entry zone of the trigeminal nerve at the brainstem.

Repositioning this vessel using microsurgery is an effective method of treating many people with this disorder. The majority of patients who have this procedure performed by a qualified neurosurgeon have no facial numbness and are pain free, requiring no further medications. The first line of therapy is medical and consists of anticonvulsants such as Tegretol (carabamazepine) and related medications.

Surgery is reserved for those who are unable to tolerate the side effects of these medications or for whom these medications are no longer effective.

Always seek health advice from your doctor, or local  Health Outlet. AcuMedic will be very pleased to offer advice regarding difficulties with this condition. Please see our Clinic

Please note that although we are confident that our treatments will help the majority of our patients, we cannot absolutely guarantee a cure as the needs and difficulties of each patient can differ greatly