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Nerve malfunction leads to facial pain

Dear Dr. Gott: I occasionally suffer from pain in my jaw that has been diagnosed as tic douloureux or neuralgia of the jaw. Not many doctors or dentists know about this ailment, and even fewer know how to treat it.

My last dentist referred me to a neurologist for treatment. I am presently taking gabapentin, the generic for Neurontin. I have to take it three times a day, and it seems to help. It does not take away all of the pain, although I am now able to live with it.

I know several others with this condition. We are all 50 or older, and some of us think that it is related to receding gum lines because we have been told that it is caused by the nerves in the brain that lead to the jaw.

Please help me to understand this condition and what I can do to cure it.

Dear Reader: Tic douloureux, more commonly known as trigeminal neuralgia, is a condition that causes sharp, lightning-like pain to shoot though the face. According to the National Institutes of Health, it can happen for no reason or may be triggered by simple, everyday tasks, such as eating, brushing your teeth, applying makeup, smiling or even exposure to a breeze.

Trigeminal neuralgia occurs when the trigeminal nerve, located at the base of the brain, becomes disrupted. In most cases, the cause is contact between the nerve and a nearby artery or vein that puts pressure on the nerve, causing it to malfunction.

Symptoms depend on the severity of the reaction. Pain usually affects one side of the face at a time and may be in one specific area or may be more widespread. “Attacks” may occur occasionally, but some people may experience several episodes lasting days, weeks or longer, which may be followed by a period in which there is no pain. Over time, the frequency of attacks and pain intensity may increase.

It is important to inform your physician of all symptoms. He or she may order imaging studies, such as an MRI, to determine the cause of the facial pain.

If trigeminal neuralgia is the cause, treatment is available. The most widely used is medication, such as anticonvulsants, which reduce or block nerve-pain signals. In most cases, this will suffice, but for those who do not improve, other options are available.

Alcohol injections may provide temporary relief by numbing the affected areas of the face. This procedure is done by a physician who injects alcohol directly into the area of the face where the trigeminal nerve branch is located.

There are also several surgical procedures. Depending on the cause of the nerve malfunction, a surgeon may inject a substance directly into the area at the base of the brain where the nerve lies or may even destroy the nerve. In many instances, any surgical procedure on the trigeminal nerve will lead to temporary or permanent facial numbness and may cause some muscle weakness.

I urge you to be seen by a neurologist familiar with trigeminal neuralgia and its many possible treatments. He or she will be your best option for getting lasting pain relief.

To provide related information, I am sending you copies of my Health Reports “Managing Chronic Pain” and “Medical Specialists.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a check or money order for $2 per report to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dr. Peter Gott is a retired physician. He writes for United Media. If readers would like to contact Dr. Gott, they may write to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, NY 10016.
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