Trigeminal Neuropathic Pain

Trigeminal neuropathic pain refers to pain that develops over part of the face and is often constant and aching or burning in quality. It can be debilitating, and I have met patients who are so severely affected that they have considered suicide. There is some variability in the use of the diagnosis; some providers may refer to it as "atypical facial pain." I regard these as two different problems.

Trigeminal neuropathic pain usually develops as a consequence of damage or injury to the trigeminal nerve. Example causes include a previous shingles (zoster) eruption on the face, facial trauma, previous treatments for trigeminal neuralgia, dental or sinus surgery, and tumors or inflammation at the base of the skull, among others. In some cases, no obvious cause is identified.

A variety of medicines can be used to treat trigeminal neuropathic pain, though effectiveness varies from person to person. Those with disabling pain despite medication should consider surgery.

In deciding on a surgical treatment strategy, it is important to distinguish between intermittent attacks of pain (brief zaps/shocks/jolts) and pain that is constant. Attacks of intermittent pain may occur frequently (sometimes even seeming to be constant), but there are intervals between them without pain. Constant pain may wax and wane but is always present. Some patients may have both types of pain.

Procedures aimed at damaging the trigeminal nerve, such as those commonly used for trigeminal neuralgia, may not be effective for trigeminal neuropathic pain. In fact, they may risk causing numbness without alleviating the pain, a feared condition known as anesthesia dolorosa. Instead, I generally use neuromodulation therapies, namely trigeminal nerve stimulation, motor cortex stimulation, and occasionally cervical spinal cord stimulation. In addition to being effective, these therapies are flexible, non-destructive to the nerves, and reversible. Unfortunately, due to a lack of sufficient coverage by most insurance carriers, I am only able to offer this procedure on a very limited basis, and I carefully screen referrals.

If you live near Denver and have severe facial pain, please consider meeting me in consultation to learn about treatment options.