Trigeminal neuralgia - Pain Clinic

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Trigeminal neuralgia

   The long history on the study of this severe illness, received its name as trigeminal neuralgia in 1671, manifested by recurrent acute attacks of facial pain, but it roots go deep in the XI - XII century (Wilkins RH et al., 1990,2001).

   Prevalence of trigeminal neuralgia is quite large and is up to 30 - 50 patients per 100 000 population, and the incidence according to the WHO is in the range of 2 - 4 people per 10,000 population.

   Most commonly trigeminal neuralgia occurs in women between 50 - 69 years of age and have rightside laterality.
The disease can develop after -  a tooth extraction (alveolar nerve is affected) - odontogenic neuralgia;  due to impaired circulation in the brain stem; as a result of herpes infection;  rarely due to trigeminal nerve demyelination in multiple sclerosis. The pain of trigeminal neuralgia is characterized by: Paroxysmal character, duration of attack no more than 2 minutes. Between the two attacks is always a "refractory" period. Is of considerable intensity, sudden, resembles an electric shock. Localization is strictly limited to the area of innervation by the trigeminal nerve, often 2 or 3 branches (5% of the 1st branch).

  The presence of trigger points (zones), even a slight irritation of these causes typical paroxysm (may be in pain or pain-free zone). The most common trigger points are located in the oro-facial area, on alveolar bone, in the medial corner of the eye due to injury of the first branch.

  The presence of trigger factors more often like washing, talking, eating, brushing teeth, shaving the face, the movement of air, a simple touch.

  The typical pain behaviour. A patient tries to wait out the attack, freezes in the pose that gave them painful paroxysm. Sometimes they rub the painful area or make smacking movement.
During the attack patients answer the questions in monosyllables, barely opening his mouth. At the height of the paroxysm there may be twitching of the facial muscles (tic douloureux).

   The last 8 years, we have often used intraosseous blockade on patients with trigeminal neuralgia of duration more than 10 years and inefficiency of the other conservative methods treatment. After the course of these blockades in 35-40% of patients pain completely stopped and in 35-40% - pain decreased by more than half. Intraosseous blockade can achieve pronounced therapeutic outcome, even in patients proven by so-called central mechanisms of trigeminal neuralgia and trigeminal status.

Photos of intraosseous blockades used to treat trigeminal neuralgia:

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