Trigeminal neuralgia – the world's first pain

Expert Profile: Gao Feng, Chief Physician of Neurosurgery, Yinzhou People's Hospital of Ningbo City, Doctor of Medicine, Master Tutor of Ningbo University, Director of Neurosurgery/Discipline Leader of Yinzhou Hospital Affiliated to Ningbo University School of Medicine.

The most painful thing under the heavens is trigeminal neuralgia, which is called "the first pain in the world", which shows the degree of pain.

1. What is trigeminal neuralgia?

Trigeminal neuralgia is a common disease in the elderly, the main range of pain is in the distribution area of the trigeminal nerve, and the trigeminal nerve is distributed in the face, divided into left and right sides, each side is divided into three branches, so clinically also called "trigeminal" nerve. These three branches are spread throughout almost the entire face and are mainly responsible for the sensation of the face. Therefore, most patients have pain sites in the forehead, eyes, nose, and mouth.

The reason why this pain is called the world's first pain is because its pain time is relatively short, but it is often repeated, and the pain is very intense, such as electrocution pain, knife cutting pain, tearing pain and other types of pain, although the pain time is only a few seconds or even minutes. After each episode, there will be a period of relief, during the two episodes, there is no symptom of discomfort, sleep at night will not appear pain attack phenomenon, but the pain is often unbearable, and the degree of pain with the aggravation of the disease is gradually aggravated, the number of pain is gradually frequent, serious can affect normal life.

2. What is the cause of trigeminal neuralgia?

Trigeminal neuralgia is clinically divided into two types: primary trigeminal neuralgia and secondary trigeminal neuralgia.

At present, the cause of primary trigeminal neuralgia is not clear, but according to clinical investigations, the main cause of its lesions is that patients with trigeminal neuralgia have abnormally deformed blood vessels in the skull, which compresses the place where the cranial nerve root enters the brain stem, resulting in pain in the trigeminal nerve.

Secondary trigeminal neuralgia refers to the phenomenon of trigeminal plexus brainstem to the face, stimulated by a foreign body, causing pain in the trigeminal nerve. Common is the herpes virus caused by trigeminal neuralgia, in addition, when the surrounding area of the trigeminal nerve appears growing tumors, such as meningiomas, gliomas, etc., these tumors can cause compression of the trigeminal nerve, making it painful.

3. Is all pain in the face trigeminal neuralgia?

Trigeminal neuralgia is very easy to attack, sometimes when the patient is talking, eating, brushing teeth, washing face and other random activities of the face, or accidentally touching a certain place on the face, it is possible to induce the appearance of trigeminal neuralgia. This phenomenon of attacking as soon as it touches a certain position is called the "trigger point" by doctors. Because the pain is more intense, patients in the attack, often rub the face with their hands, in order to try to alleviate the degree of pain, over time the skin of the face will become rough, thickened and eyebrows fall off, etc., there are also some patients to avoid the seizure, do not dare to eat and do all facial activities, and eventually poor spirits, face haggard.

4. How to treat trigeminal neuralgia?

On examination, patients diagnosed with secondary trigeminal neuralgia need to be removed before trigeminal neuralgia can be cured. If primary trigeminal neuralgia is diagnosed, the following treatment modalities are commonly used:

(1) Drug treatment: drug treatment for trigeminal neuralgia, the purpose is to nourish the nerves, play an analgesic role.

(2) Microvascular decompression: Modern medical research believes that the main cause of trigeminal neuralgia lies in the presence of abnormally deformed blood vessels in the skull, causing compression on the root of the cranial nerve into the brainstem, and microvascular decompression (MVD surgery) is a treatment technique for the cause, and has become the preferred method for treating trigeminal neuralgia internationally. The specific method is to make an incision of about 5 cm behind the ear, drill a 3 cm bone hole, open the dura mater, use the unique minimally invasive technique of microsurgery to find the responsible blood vessel along the natural space of the brain tissue, and isolate it from the trigeminal nerve with teflon material, so that it no longer touches the root of the trigeminal nerve to achieve the purpose of decompression.

(3) Other methods: For patients who are older and unwilling to undergo surgical treatment or patients with postoperative recurrence, balloon compression, occlusion therapy, radiofrequency ablation and other methods can be selected.

5. How to reduce the number of recurrences of trigeminal neuralgia?

Usually we say that instead of treating diseases, it is better to prevent diseases, in daily life, patients with trigeminal neuralgia should be gentle when performing facial activities, the amplitude should not be too large, to avoid causing seizures. Maintain a good state of mind, a pleasant mood, maintain a good rest time, ensure adequate sleep, and avoid overwork. Pay attention to the diet is light, and it is not advisable to eat too hard food.

Expert introduction

Gao Feng, Chief Physician of Neurosurgery, Ningbo Yinzhou People's Hospital, MD, Master Supervisor of Ningbo University, Director of Neurosurgery/Discipline Leader of Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Director of Trauma Center of Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Executive Director of Ningbo Diagnosis and Treatment Center of Shanghai Institute of Cranial trauma. He specializes in gliomas, pituitary tumors, meningiomas, schwannomas, hydrocephalus, facial muscle spasms, trigeminal neuralgia and aneurysms.