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Patient Bill of Rights

  • The right to have your report of pain taken seriously and to be treated with dignity and respect by doctors, nurses, pharmacists and other healthcare professionals.
  • The right to have your pain thoroughly assessed and promptly treated.
  • The right to be informed by your doctor about what may be causing your pain, possible treatments, and the benefits, risks and costs of each.
  • The right to participate actively in decisions about how to manage your pain.
  • The right to have your pain reassessed regularly and your treatment adjusted if your pain has not been eased.
  • The right to be referred to a pain specialist if your pain persists.
  • The right to get clear and prompt answers to your questions, take time to make decisions, and refuse a particular type of treatment if you choose.
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Monday, 13 September 2010 23:38

Trigeminal Neuralgia

nerve pain

Trigeminal Neuralgia: What is it?


Trigeminal neuralgia (TN) is a chronic pain disorder of the trigeminal nerve or the fifth cranial nerve, which is one of the largest nerves in the head. TN often appears suddenly as a sharp, shooting, lightning-like pain lasting a few seconds up to several minutes. You may have TN pain once during the day or have a series of painful attacks that occur one after the other. People with TN are often unable to shave, comb their hair or touch their face because they are afraid they might trigger pain. Although it is a rare condition, TN is likely the most common cause of severe facial pain and one of the most painful disorders known. TN is also called "tic douloureux."

The trigeminal nerve supplies sensation to the face, mouth, and the front half of the scalp and controls the muscles used for chewing. There is one trigeminal nerve on the right side of your face and one on the left. Each trigeminal nerve has three branches. You can have TN pain in one or more of the nerve branches. TN more commonly occurs in the middle and/or lower branches of the trigeminal nerve.

 

The three branches of the trigeminal nerve carry sensations of touch, pain, temperature, and movement from the face and mouth to the brain. They join together at the base of the skull bone in an area called the trigeminal or Gasserian ganglion. From there, the main trigeminal nerve root enters the brain in an area of the brainstem called the pons (which serves as a communications and coordination center between the two hemispheres of the brain).

 

Who is affected?
• Age — TN most often affects people between 50 and 70 years of age, but it can occur in younger adults and children.
• Gender — Women have TN almost twice as often as men.
• Other family members with TN — A small number of people with TN (1 to 5 percent) have other family members with TN. Some researchers think that TN could be genetic in a small number of people.
• Certain medical conditions — Trigeminal neuralgia occurs in about 1 percent of people who have multiple sclerosis (MS). In rare cases, TN is the first symptom of MS. A health care provider may suspect MS if the person has TN on both sides of the face and the eye, forehead, and the front part of the nose are affected. Rarely, TN can occur due to nerve compression by a tumor or an aneurysm.

 

Causes
Experts do not completely understand how trigeminal neuralgia (TN) pain occurs. However, they do strongly suspect that TN is often caused by one or more blood vessels "compressing" or pressing against the trigeminal nerve. The nerve is most commonly compressed by an artery (or arteries). Less commonly, it can be compressed by a vein. The compression usually occurs where the trigeminal nerve enters the brainstem, or the trigeminal root entry zone.

 

Normally, the trigeminal nerve consists of several different types of nerve fibers that carry sensations such as pain, touch and heat to the brain. These nerve fibers are covered by a protective layer called myelin. Myelin keeps nerve signals for pain, touch, and temperature separate from each other. Many experts believe that repeated pressure or pulsing of blood vessels against the trigeminal nerve can wear away the myelin and irritate the nerve. If the myelin is damaged, the different nerve signals mix together instead of remaining separate. For example, mixed nerve signals may cause a person with TN to feel pain when he/she lightly touches his/her face.

 

What can trigger TN pain?
TN pain can happen without any warning or reason. It can be triggered when certain areas of your face are touched. Things that trigger pain may include:
• Blowing your nose
• Brushing your teeth or hair
• Eating and drinking
• Lightly touching your face or having air blow against it
• Putting on make-up
• Shaving
• Smiling or talking

 

Symptoms
TN is somewhat more common on the right side of the face. It most often affects the side of the nose, lower eyelid, cheek, and the upper jaw, teeth, gums, and lip and/or the lower jaw, teeth, gums, and lip. You may have typical or atypical TN. People who develop typical or type I TN tend to have the following symptoms:
• Pain that feels like an "electrical shock" or "lightning bolt"
• Pain that occurs on and off — attacks of pain usually last from a few seconds up to several minutes and then get better. Some people may have many attacks of pain that occur one right after another.
• Pain-free periods between attacks
• Pain that occurs spontaneously or is "triggered" by certain factors such as chewing, brushing your teeth, washing your face, applying make-up and even by wind blowing on your face
• Pain that almost always occurs only on one side of the face
• Periods of remission and recurrence. TN pain may come more frequently or become more severe over time. You may have TN in one of the three branches of the trigeminal nerve that, over time, spreads to one or both of the other branches. The periods of remission can last from months to years but the pain eventually returns.
• No loss of sensation or feeling on the face
Individuals are considered to have type 1 TN if more than 50 percent of the pain they experience is sudden, intermittent, sharp and stabbing, or shock-like. They may also have some burning sensation.
Atypical TN or type 2 TN is a term often used to describe pain that is somewhat different than classic or typical TN. Type 2 TN involves pain that is constant, aching, or burning more than 50 percent of the time.

 

TN is typified by attacks that stop for a period of time and then come back. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The disorder is not fatal, but can be debilitating. Due to the intensity of the pain, some people may avoid daily activities because they fear an impending attack.