Trigeminal neuralgia and neuropathic pain

The trigeminal nerve carries sensation from the face, teeth and mouth. When the nerve itself is the source of pain, we speak of neuropathic pain. It is different from tooth or muscle pain and has different treatments, so the right diagnosis is essential.

Trigeminal neuralgia

It shows as attacks of very strong, short pain, like an electric shock or a stab, usually on one side of the face (cheek, jaw, lip, sometimes around the eye). Attacks can be triggered by light touch: washing the face, brushing the teeth, eating, talking, a breeze.

Because the pain is often felt in the teeth, many patients see a dentist first and sometimes have root canals or extractions that don’t help. If a “toothache” comes in short attacks triggered by touch and the teeth are healthy, neuralgia should be considered.

Neuropathic pain after an injury or a procedure

Rarely, after an extraction, a root canal, an implant, surgery or an injury, a persistent pain can remain, often with burning, tingling or numbness, in an area that seems to have healed normally. It is pain of the injured nerve (post-traumatic trigeminal neuropathic pain) and isn’t solved by more dental treatment.

Diagnosis

• a careful description of the pain (what it is like, how long it lasts, what triggers it) and testing of facial sensation
• ruling out dental causes and other sources of pain
• tests, usually an MRI, recommended together with the neurologist, to rule out other causes of neuralgia

Treatment

• medication that calms the nerves; not the usual painkillers, which usually don’t help with this pain
• nerve blocks with local anaesthetic, for diagnosis and sometimes treatment (see therapeutic injections)
• working with the neurologist and, when medication isn’t enough, with the neurosurgeon, for interventional options
• avoiding unnecessary dental treatment

Dr. Raluca Draghici has presented at national and international congresses on trigeminal neuralgia, post-traumatic neuropathy and the International Classification of Orofacial Pain (ICOP). Book a consultation.