Neuropathic Pain

Trigeminal Neuralgia (Facial Pain)

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What are the Symptoms of Trigeminal Neuralgia (Facial Pain)?

Pain arises from the trigeminal nerve (fifth cranial nerve) and manifests as sharp, shooting pain lasting for a few seconds to minutes. It typically occurs in one side of the face, often around the cheek, jaw, or lower part of the face. The episodes can occur several times a day, and in some cases, the pain can become constant. The intensity and frequency of the pain can be debilitating, severely impacting the quality of life.

Symptoms to Watch For:

• Sharp or stabbing facial pain
• Pain localised to one side of the face
• Pain triggered by touch or everyday activities like eating or speaking
• Intense bursts of pain lasting a few seconds to minutes
• Pain radiating from the cheek, jaw, or lower face

When to See a Doctor:

• Sharp or stabbing facial pain
• If the pain is affecting your quality of life
• If the episodes of pain become more frequent or intense
• If over-the-counter pain medications are not providing relief
• If the symptoms are causing you distress or are affecting your ability to eat, speak, or perform daily activities

What Causes Trigeminal Neuralgia (Facial Pain)?

In many cases, trigeminal neuralgia is caused by pressure on the nerve. This can happen due to a blood vessel pressing against the trigeminal nerve as it exits the brain stem, causing it to malfunction. Ageing and certain diseases like multiple sclerosis, can damage the myelin sheath protecting the nerves and cause trigeminal neuralgia.

Types of Trigeminal Neuralgia (Facial Pain) Treatment

• Diagnosis and Evaluation
• Diagnosis of trigeminal neuralgia involves clinical evaluation, including a detailed patient history and physical examination. An MRI scan may be necessary to rule out possible compression of the trigeminal nerve by a blood vessel or, rarely, a tumour. Should this occur, a referral to a neurosurgeon is essential for further evaluation and possible surgical intervention.
• Treatment
• For primary trigeminal neuralgia – where there is no identifiable cause for the pain – first-line treatment options often include medications such as carbamazepine, gabapentin, or pregabalin. These medications work by slowing down nerve signals, effectively reducing the speed at which pain messages are sent to the brain. Other medications like muscle relaxants or certain antidepressants may also be considered depending on the specific case.
• Radiofrequency (RF) Ablation
• When medication therapy fails to provide sufficient relief or produces intolerable side effects, Radiofrequency Ablation can be an option. This is a minimally invasive treatment that uses high frequency waves to produce heat, which is then used to damage specific nerves and interrupt their ability to transmit pain signals to the brain. A special RF needle is inserted into the trigeminal ganglion, the main part of the nerve that is causing the pain.
  
  RF energy is then generated through a machine to create heat. This heat is transmitted through the needle tip to destroy the painful division of the trigeminal nerve. This is a day surgery procedure that is performed using CT scan guidance under mild sedation. It is a safe and efficient method that can effectively reduce facial pain in more than 90% of patients. Patients can usually return home the same day of the procedure.
• Gamma Knife Radiosurgery
• Another option for those who are not responding well to medications is Gamma Knife Radiosurgery. This treatment uses focused radiation beams to target the trigeminal nerve, disrupting the transmission of pain signals without the need for an incision.
• Microvascular Decompression
• Microvascular Decompression is a surgical procedure that involves relocating or removing blood vessels that are in contact with the trigeminal root. This alleviates the pressure that is causing the nerve to malfunction and transmit pain signals.
  
  Each of these treatment options has its own set of risks and benefits, which should be thoroughly discussed with your pain medicine physician to determine the most appropriate treatment for you.

Neuropathic Pain

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What is the treatment for neuropathic pain?

Besides treating the underlying problem, neuropathic pain should be managed early and aggressively. Neuropathic pain responds poorly to common painkillers such as paracetamol and anti-inflammatory medications. Anti-depressants, anti-convulsants as well as opioids are frequently used. Severe cases of neuropathic pain will benefit from spinal cord stimulation.

What is spinal cord stimulation?

Spinal cord stimulation uses implanted electric wires (or leads) placed onto the spinal cord to block pain signals. A battery – known as an implantable pulse generator – generates tiny electric current to stimulate the spinal cord. When the stimulator is switched on, the painful part of the body is replaced with a comfortable tingling sensation.

For more information, see https://www.pain.com/en/chronic-pain-solutions/spinal-cord-stimulation.html

Diabetic Neuropathy

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What are the symptoms of DPNP?

The hands and feet may experience sharp pricking pain, burning or cold sensation, numbness, tingling, hypersensitivity to touch or temperature changes. Symptoms may be worse at night. Walking barefooted, wearing socks or shoes may be unbearable.

How is DPNP treated?

Treatment is focused on relieving pain and slowing the progression of the disease through good blood sugar control.

Common pain medications do not work for neuropathic pain. Antidepressants, anticonvulsants or even opioids are required.

Spinal cord stimulation is a possible treatment for DPNP that is severe and persistent.

Shingles Pain (Herpes Zoster)

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How is shingles treated?

Antiviral drugs should be started within 48 hours from the onset of the rash. Usually, strong painkillers are needed, as the pain from shingles can be severe.

What is post-herpetic neuralgia?

When the pain from shingles persists for more than 3 months after the onset of the rash, the condition is called post-herpetic neuralgia (PHN). This results from permanent damage to the nerves, leading to continuous pain, hypersensitivity and numbness in the area of the body where the rash used to be.

How is post-herpetic neuralgia (PHN) treated?

Strong painkillers, drugs that specifically treat nerve pain and local anaesthetic plasters are used to treat PHN. In severe cases, sympathetic nerve blocks, spinal injections of steroid or spinal cord stimulation may be required to alleviate the pain from PHN.

In patients older than 50 years old, the risk of developing shingles and PHN can be reduced through vaccination.