Anesthesia Dolorosa

Anesthesia dolorosa is a facial pain disorder in which there is both severe pain and a loss of sensation over part of the face. The face is both numb to the touch as well as exquisitely painful. There are numerous causes of anesthesia dolorosa, including an injury to the trigeminal nerve or one of its branches. Importantly, anesthesia dolorosa is a feared complication of treatments for trigeminal neuralgia.

Anesthesia dolorosa is not to be confused with trigeminal neuralgia, which is treated very differently. There is no blood test or brain scan to diagnose these disorders; rather, a facial pain expert distinguishes between them by taking a careful history of your symptoms and performing a physical exam. An MRI scan can be helpful, but these scans are rarely definitive. The presence of constant pain (often burning in quality) and the loss of sensation over part of the face are both suggestive of anesthesia dolorosa.

For patients with anesthesia dolorosa who have not found relief with medications, there are several surgical options that can be considered: trigeminal nerve stimulation, motor cortex stimulation, trigeminal tractotomy, and nucleus caudalis DREZ, among others. These are uncommon procedures that should only be performed by a neurosurgeon with a background and training in specialized treatments for facial pain. A good resource for locating such a doctor in your area is the Facial Pain Association.

If you live near Denver and have anesthesia dolorosa or another facial pain disorder, please consider meeting me in consultation to learn more about treatment options.