Q: About a year and a half ago I began experiencing a shooting, shocking pain in my right lower jaw. The pain would come on when chewing, brushing my teeth, and when I merely touched certain parts of my face on the right side.
I went to my dentist, thinking that it was a dental problem. He did an exam and X-rays. He did find a superficial crack in a tooth, one that seemed to be at the site of the pain. He commenced to do a crown on that tooth. During the procedure my lower jaw was completely deadened with Novocain. I could still feel the shocking, raw nerve sensation. I informed my dentist of this and he has no clue as to the origin of the pain.
Then I went to my doctor who is an internist for help. He had me have a CT scan. It came back negative. Next, I have been getting treatments from a chiropractor. So far, no improvement. Now I have researched this phenomenon on the internet and am sure now that I have trigeminal neuralgia because I have all the classic symptoms. I reviewed the traditional treatments for TN and have no desire to try these “treatments”. I have also come across information that suggests a specific chiropractic care for TM. What is your advice?
A: Trigeminal neuralgia, a/k/a tic douloureux, is characterized by pain on one side of the face following the sensory distribution of cranial nerve V that radiates to the mandibular or maxillary area of the face in 35% of affected patients. It is often accompanied by a short-lived tic or spasm – thus the name. The pain most often is present on the right side of the face that may erupt from less than one and up to 100 times each day.
The condition can present by drinking hot or cold fluids, chewing, smiling, talking, blowing the nose, or even from touching the face as you have noted. The pain most frequently runs along the mandibular or maxillary nerves or the mandibular and ophthalmic areas of the nerve. In the greatest percentage of cases, the pain will shoot from the corner of the mouth to the angle of the jaw. It is severe, begins to subside within seconds, and begins with what we imagine an electric shock would be like. Pain attacks rarely occur during sleep. During waking hours, a patient will avoid touching his or her face and may attempt to hold the jaw still even when speaking to avoid triggering an attack.
There is no radiologic, lab or electrophysiologic testing that will diagnose the condition. Rather, strict criteria as defined by the International Headache Society stresses, in part, that a) the patient must have paroxysmal attacks of pain that last from a fraction of a second to two minutes, affecting one or more divisions of the trigeminal nerve; b) the pain must have one of the following characteristics – stabbing, superficial, intense or sharp or be precipitated from trigger areas of by trigger factors; and c) the attacks are stereotyped in the individual patient. .
If therapy with carbamazepine is contemplated, a liver function test and blood count is required. Further, because oxcarbazepine can cause hyponatremia (a less than optimal amount of sodium in the blood), a serum sodium level should be measured once therapy is instituted. Treatment is in the form of medication, percutaneous procedures (i.e.: biopsy), surgery, or radiation therapy. As you might expect, a trial of medication is the initial step and is sufficient in ¾ of all patients with idiopathic or neurovascular TN treated with a single-dose. Immediate relief is often realized. Surgical treatment follows with percutaneous procedures, gamma knife surgery, or microvascular depression. Ninety percent of patients are pain-free immediately or soon after any of the procedures noted, with microvascular decompression lasting the longest. The type of procedure used will depending on the patient’s age and other considerations, a choice that should be the surgeon and patient.
I recommend you make an appointment with your physician to determine if you do, indeed have trigeminal neuralgia, or if something else is going on that hasn’t been appropriately diagnosed. Only then will you know which direction to proceed toward.