Intense Pain of Trigeminal Neuralgia is Treatable

Q:  Last year I was diagnosed with tic douloureux, which I understand is a damaged facial nerve. The pain runs from my cheek to the middle of my face - my upper lip, lower lip and chin on the right side of my face. Eating and talking are very painful.

In the beginning I was treated with small dosages of Tegretol (carbamazepine), but as time went on and the pain increased, the dosage also increased. I believe I have now reached the limit of how much Carbamazepine I can handle, since side effects from a recent dosage increase took me to the emergency room.

Is there any other treatment or new medication for this condition? I would appreciate any help you can give me.

A:  Tic douloureux, also called trigeminal neuralgia, affects the trigeminal nerve, (the 5th cranial nerve), one of the largest nerves in the head. The trigeminal nerve is responsible for sending impulses of touch, pain, pressure, and temperature to the brain from the face, jaw, gums, forehead, and around the eyes.

In trigeminal neuralgia, the nerve is not really damaged, but hypersensitive for some unknown reason. As you noted, it is a very painful condition characterized by a sudden, severe, electric shock-like or stabbing pain typically felt on one side of the jaw or cheek.

The attacks of pain, which generally last several seconds and may be repeated one after the other, may be triggered by talking, brushing teeth, touching the face, chewing, or swallowing. The attacks may come and go throughout the day and last for days, weeks, or months at a time, and then disappear for months or years.

Treatment for trigeminal neuralgia includes anti-convulsant medications such as carbamazepine or phenytoin, but sometimes their side effects may exceed their benefits. Baclofen, clonazepam, gabapentin, and valproic acid may also be effective and may be used in combination to achieve pain relief. Nerve blocks and surgery can also be tried if medications fail.

This article includes information from the National Institute of Neurological Disorders and Stroke.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.