TRIGEMINAL NEURALGIA
- or Tic douloreux, Prosopalgia, the Suicide Disease
or Fothergill’s Disease.
- Condition of the 5th CRANIAL NERVE that is
characterized by paroxysms of pain in the face .
TRIGEMINAL NERVE – has 3 branches:
*OPTHALMIC, MAXILLARY, MANDIBULAR
mostly affected
Causes:
• Vascular compression and pressure.
- As the brain changes with age, a loop of a cerebral
artery or vein may compress the nerve root entry
point
Occurrence:
- occurs most often before 35 years of age & women
- common in people with MS compared with the
general population
Clinical Manifestations:
- Episodes of sudden, intense stabbing or shock like
facial pain.
- Cheek twitch
- Tearing eye or salivation on the same side of the
face.
- Pain typically felt on one side of the jaw or cheek.
- Intense flashes of pain can be triggered by vibration
or contact with the cheek such as when shaving,
washing the face or applying makeup, brushing teeth,
eating, drinking, talking, or being exposed to the
wind.
Medical Management:
• Pharmacologic Therapy
* Antiseizure agents: Carbamazepine (Tegretol)
- FIRSTLINE, Serum levels: 5-12 mcg/mL.
- Relieve pain by reducing the transmission of
impulses at certain nerve terminals
- Should be taken with meals
- Serum levels should be monitored
- Monitor for bone marrow depression during long-
term therapy
s/e: nausea, dizziness, drowsiness and aplastic
anemia
* Muscle relaxants: Gabapentin (Neurontin) & Baclofen
(Lioresal)
- Pain control
- Sedatives
- Antidepressants
* Pain is INTRACTABLE
* Pain is UNILATERAL
- Air draft can trigger pain (AVOID WALKING
SWIFTLY near the patient)
States: “I didn’t want to eat; didn’t want to open my
mouth; didn’t want to talk; I didn’t want to do
anything.”
Diagnostics:
* X-rays of the skull, teeth and sinuses
* MRI
Surgical Management: If pharmacologic management
fails to relieve pain.
• Microvascular decompression of the trigeminal nerve
- Artery loop is lifted from the nerve using silicon
foam.
• Radiofrequency thermal coagulation
- Produces thermal lesion on the trigeminal nerve.
• Percutaneous balloon microcompression
- Disrupts large myelinated fibers in all the
branches of the trigeminal nerve
• Retrogasserian Rhizotomy
- Sensory root of CNV is surgical severed
• Radiosurgery with stereotatic technique
- Uses GAMMA KNIFE to severe CNV 5
• Alcohol or phenol block
- Injection of alcohol into a CN5 branch for pain
relief (transient: 1 yr)
Nursing Management: Preventing Pain
• Instruct the client to avoid hot or cold foods and fluids
• Providing room temperature water for rinsing
• Avoid jarring of the patient’s bed or chair
• Instruct the patient to rinse with mouthwash after
eating if tooth brushing causes pain
• Perform personal hygiene during free pain intervals
• Instruct the client to chew on the unaffected side and
ingest soft food
Providing Postoperative Care:
- Instruct the client not to rub the eye
- Assess eye for irritation or redness
- Artificial tears may be prescribed in the affected eye
- Patient is cautioned not to chew on the affected side
- Observe patient for any difficulty in eating or
swallowing foods of different consistencies