Category: Treatments

This pain occurs in branches of the trigeminal nerve that courses along the sides of the face. The trigeminal nerve arises at the side of the head and has three branches that extend on the upper aspect of the face, around the eye, the cheek and along the jaw. Trigeminal neuralgia involves irritation along one or more of these branches of the trigeminal nerve. These symptoms of trigeminal neuralgia result in development of highly sensitive areas, usually along the side of the cheek or jaw.

Diagnosis

Physicians will examine the face to determine the sensitive points in an effort to help determine which branch or branches of the trigeminal nerve are involved. They will be careful to distinguish this disorder from other disorders that cause facial pain, such as shingles. Doctors should complete a comprehensive ear, nose and throat exam to eliminate the possibility of other disease processes. X-ray studies that are used to diagnose TMJ (Temporomandibular Joint Disorder) are often used. An MRI may find an underlying cause within the head such as multiple sclerosis or other disorders. Sometimes laboratory studies will be used to rule out the possibility of an underlying infection. In many cases, the use of nerve block procedures or the injection of anesthetic medicine around the branches of the trigeminal nerve will help confirm the diagnosis of trigeminal neuralgia.

Treatment

For some patients the use of oral medications is typically used to relive the symptoms. Nerve block treatments, usually containing a combination medication with anti- inflammatory medications are used independently or in conjunction with oral medications. For some patients with trigeminal neuralgia, surgery is utilized to treat the affected branches of the nerve giving rise to the symptoms and offer more permanent relief.

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While surgery and surgical procedures have become specialized and involve as little tissue damage as possible, they nonetheless involve the cutting, removing and suturing of skin, muscles, nerves and other structures. Therefore some surgical procedures can cause chronic pain due to the trauma of the procedure. Post thoracotomy pain is an example of pain associated with the surgical procedure. Doctors define post thoracotomy pain as pain that returns or persists around the surgical incision for at least two months after the surgery. The pain is generally located along the chest wall. Patients who have post thoracotomy pain describe it as achy-like, burning or sharp. Pain can result from entrapped nerve fibers in the area of the scar tissue.

Sometimes a neuroma or painful lump of nerve tissue can form at the tip of a nerve in the chest wall where it has been cut during surgery. Pain from the muscles in the chest or shoulder may contribute to post thoracotomy pain syndrome as well. If the thoracotomy was performed to remove a tumor involving the lining of the chest or the chest wall, continued pain may indicate tumor recurrence.

Diagnosis

Doctors will use a physical examination to confirm a painful area near the surgical scar and to map the area of irritation. A CT scan of the chest sometimes helps determine if a tumor has reoccurred. Doctors may use a kind of nerve block or injection of anesthetic medications around a neuroma or nerve in the chest wall to help confirm the diagnosis.

Treatment

Some patients benefit from oral non-steroidal anti-inflammatory medications with the addition of pain medicine. Long-term relief is often obtained from the use of nerve blocks given into a neuroma, local anesthetics and anti-inflammatory medications. Other nerve block treatments can be given along the path of the various nerves in the chest, which contribute to the pain after thoracotomy surgery. Sometimes nerve stimulation procedures are used to help relieve pain along the chest wall. Physical therapy exercises may be utilized to regain the ability to perform normal daily activities.

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Shingles is an infection of an individual nerve root by the same virus that causes chicken pox, also known as the herpes zoster virus. The disease can be painful and can develop almost anywhere in the body, but is most commonly displayed on the face, chest and abdomen.

A day or two after the pain begins; a characteristic rash erupts, which is composed of small fluid-filled blisters on top of reddened skin. The blisters are limited to a band on the right or left side of the body. If the rash crosses over the middle of the body it is not shingles because the virus affects one nerve corresponding to an area of the skin. Each cutaneous or skin nerve in the human body stays on the right or left side and does not cross over. Initial infection of the shingles virus occurs when chicken pox is contracted as children or young adults. The body’s immune system forces the virus to settle in an inactive form inside the nerve cells. When the chicken pox virus reactivates, it moves down the nerve fibers to the skin and the rash erupts. In addition to the skin, the nervous system is involved. In fact, if the virus attacks the optic nerve of the eye, it may leave the patient with temporary blindness.

In most patients, after the eruption of shingles, the rash will heal and the pain will subside after a period of three to five weeks. However, there are exceptions. In older patients there is a greater risk the virus can actually leave permanent nerve damage, causing pain long after the rash is healed. In some patients, the pain may persist for the rest of their lives.

Treatment

Medical science is now developing antiviral drugs. These are similar to antibiotics that were developed in the 1950’s to treat bacterial infections. One of the first antiviral drugs developed was acyclovir. This drug can help resolve herpes infections. As soon as the rash breaks out, acyclovir is prescribed in large doses for a period of approximately 10 days. This can help alleviate the attack and prevent permanent nerve damage in some patients.

Additionally, early intervention with nerve blocks done by pain physicians can also prevent the development of post-herpetic neuralgia. Post-herpetic neuralgia is the name given to the painful condition that exists long after the viral infection is over. Combination therapy of the acyclovir and nerve blocks is the most effective treatment strategy for preventing this painful development.

There is treatment for patients suffering from post-herpetic neuralgia. Drugs used to treat seizures, such as Tegretol and Dilantin, can be of some help. Antidepressants are used to treat post-herpetic neuralgia as well. The antidepressants raise levels of chemicals in our brain that are the body’s natural mood elevators. These mood elevators also raise levels of endorphins in the brain, which are the body’s natural narcotics. Consequently, by taking antidepressants, we can elevate the body’s internal narcotics without having to rely on narcotics prescribed by the doctor.  Therefore, antidepressants are superior to narcotics because dependence can develop in narcotics.

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Temporal neuralgia involves irritation of the temporal nerve, which originates at the sides of the head and rises to the top of the head. The irritation is most commonly related to muscle tension around the temporal nerve itself. This can be caused from various muscular disorders in the head, including irritation of the temporomandibular joint (TMJ) in the jaw. It is often characterized as sharp or spasm-like. It tends to occur in episodes and may be severe enough to cause a person to alter their day-to-day lifestyle. A more serious but relatively rare disorder, temporal arteritis, can occur with inflammation of the temporal nerve itself.

Diagnosis

Doctors will concentrate the physical examination on muscular disorders in the head, neck and jaw. A behavioral evaluation is sometimes needed as well. Doctors may use X- ray and/or laboratory studies in the evaluation of temporal neuralgia. Injections of anesthetics, sometimes in combination with anti-inflammatory medications, around the temporal nerve can help diagnose the disorder. If the block works and completely resolves the symptoms, the diagnosis of temporal neuralgia is confirmed. If the nerve block of the temporal nerve is only partially effective, there may other disorders causing or involved with the symptoms.

Treatment

Nerve block treatments around the temporal nerve may give relief that lasts for several weeks at a time. These may be used on an ongoing basis to manage the pain from temporal neuralgia. If excess tension in the muscles around the temporal nerve are involved in the symptoms, biofeedback or muscle relaxation techniques may be used as an additional treatment.

If the disorder arises from irritation in the temporal mandibular joint, dental treatment through the use bite splints in conjunction with physical therapy exercises may be used to relieve symptoms. Traditional headache medications, both preventative and abortive, can be used to provide some relief in temporal neuralgia.

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