By Dr Tan Chuey Chuan

“DOCTOR, I have excruciating pain on my face, it’s like electric shock and last for several minutes every hourly for the past one week. I experience the pain whenever I touch my face, eat or talk. I am depressed as my life is severely affected by this condition. Please help me, Doctor.”

My patient has complained about this in my Oral and Maxillofacial Surgery clinic. She has previously visited several doctors and dentist without discovering any tooth issues; she also taken pain killers and antibiotics, but the pain is not resolved.

After a series of examinations and investigations, she was diagnosed with Trigeminal Neuralgia (TN).

Pain, in its various forms, is a common human experience, but there exists a condition that stands apart as one of the most agonizing disorders known to medicine. TN, often referred to as the “suicide disease” due to its excruciating pain, which may affect daily activities and lead to depression even with suicidal thought remains a mysterious and under-discussed ailment.

TN is a neurological disorder that affects the trigeminal nerve, which is responsible for transmitting sensations from the face to the brain. World widely, the incidence of TN is estimated to be 5.5 per 100,000 persons.

The hallmark of TN is sudden and severe facial pain, often described as electric shocks or stabbing sensations. This pain can be triggered by even the simplest of activities, such as eating, talking, tooth brushing or light touching the face. Sometimes, the pain can occur without a trigger too.

One of the most challenging aspects of TN is that the pain is often invisible to others. Those who endure it might appear perfectly fine externally, leading to misunderstandings and misconceptions about the severity of their condition.

However, the pain experienced by TN patients is debilitating, frequently causing them to withdraw from social interactions and impacting their quality of life.

The exact cause of TN is not always clear, but it’s believed to result from pressure or damage to the trigeminal nerve particularly for those in 50-60 years old. Blood vessels or intracranial lesions pressing on the Trigeminal nerve can lead to TN.

Certain conditions like multiple sclerosis can also damage the trigeminal nerve. Genetic predisposition is also believed to play a role in the formation of TN.

The hallmark symptom of TN is severe facial pain, often on one side of the face. Occasionally the pain can affect both sides of the face which might not at the same time. The pain can be sudden and electric shock-like, lasting for a few seconds to several minutes. It can occur in bursts throughout the day, making it a profoundly distressing experience.

Seeking medical help is essential if you experience the frequent or persistent facial pain as described above, particularly the pain not resolved with standard pain killers such as paracetamol or diclofenac acid, and dentist has ruled out any underlying dental issues.

Diagnosis usually involves a thorough medical history, neurological examinations, and sometimes, imaging tests like MRI to rule out other potential causes.

Treating TN is challenging. Medications such as anticonvulsant drugs (e.g. carbamazepine, gabapentin, pregabalin), muscle relaxants (baclofen), and sometimes opioids are prescribed to alleviate pain. In severe cases, surgical interventions like percutaneous glycerol/alcohol injection, percutaneous radiofrequency rhizotomy, microvascular decompression or nerve ablation may be considered.

Lifestyle changes such as avoiding triggers like cold temperatures or certain foods, stress management and sleep therapy may help reduce the frequency of pain attacks. Even though multiple treatment options are available for TN, the treatment outcomes can vary and long-term management remains a challenge.

In conclusion, TN is an often-underestimated condition that inflicts unimaginable pain on those affected. Early diagnosis and timely intervention can make a substantial difference in improving the quality of life for those grappling with this facial torment.

As for the patient mentioned earlier in the article, she was given carbamazepine and the facial pain is now in better control and with less occurrence. Now she can return to her normal life with regular follow up at the clinic.