Trigeminal Neuralgia
Myths and Misconceptions
Myth: All facial pain is trigeminal neuralgia.
Truth: There are actually many causes of facial pain that have nothing to do with TN. Disorders that affect the eye, eye socket, nose, sinuses, teeth, temporomandibular joint, gums, tongue, inside of the mouth, and ear can ALL produce facial pain. However, the pain symptoms that occur with these problems are usually significantly different from those caused by TN. Also, all of these other conditions usually have other findings that help to differentiate them from TN. However, it is true that the symptoms caused by many of these conditions do overlap somewhat and it is therefore of the utmost important that you provide your doctor with as detailed and accurate description of your pain as possible.
Myth: Microvascular decompression is not indicated in patients over 65 years of age.
Truth: The fact is, there is evidence in the medical literature to suggest that MVD is just as safe and effective for patients over the age of 65 as for patients younger than 65 years of age. Elderly patients who are otherwise in excellent health should not be denied consideration for MVD simply based on age alone.
Myth: There is no risk to stereotactic radiosurgery (gamma knife).
Truth: Although stereotactic radiosurgery is in fact a non-invasive treatment, it must be remembered that it is still a destructive procedure, whose goal is to damage the trigeminal nerve using radiation. The fact is that any procedure that damages the nerve can produce sensory loss on the face and occasionally bothersome sensations known as dysesthesias. The these problems are more commonly associated with the use of higher doses of radiation. Unfortunately, higher doses of radiation are also associated with better outcomes in terms of pain relief.
Myth: All patients with trigeminal neuralgia have classic symptoms.
Truth: Many patient with trigeminal neuralgia do not in fact have typical symptoms. Also, for patients who have had TN for many years, the symptoms tend to become less typical as time goes by.
Myth: Even patients whose pain goes away, need to stay on medications indefinitely.
Truth: This is not necessarily the case. Trigeminal neuralgia is often characterized by periods of spontaneous remission. For some patients, these periods may last many years. There is no absolute way to manage medications for patients with TN. Therefore, it is essential that you have excellent communication with your doctor and nurse in order to monitor the medications. When you are prescribed a medication, you must take it regularly for it to be effective. Once you have been pain free for perhaps 6 -12 weeks, it may be possible to reduce the medication or even taper off of it completely without the pain returning. However, this should be done in consultation with your doctor. You should not abruptly stop the medications since doing so can cause serious side effects with certain medications.
Truth: There are actually many causes of facial pain that have nothing to do with TN. Disorders that affect the eye, eye socket, nose, sinuses, teeth, temporomandibular joint, gums, tongue, inside of the mouth, and ear can ALL produce facial pain. However, the pain symptoms that occur with these problems are usually significantly different from those caused by TN. Also, all of these other conditions usually have other findings that help to differentiate them from TN. However, it is true that the symptoms caused by many of these conditions do overlap somewhat and it is therefore of the utmost important that you provide your doctor with as detailed and accurate description of your pain as possible.
Myth: Microvascular decompression is not indicated in patients over 65 years of age.
Truth: The fact is, there is evidence in the medical literature to suggest that MVD is just as safe and effective for patients over the age of 65 as for patients younger than 65 years of age. Elderly patients who are otherwise in excellent health should not be denied consideration for MVD simply based on age alone.
Myth: There is no risk to stereotactic radiosurgery (gamma knife).
Truth: Although stereotactic radiosurgery is in fact a non-invasive treatment, it must be remembered that it is still a destructive procedure, whose goal is to damage the trigeminal nerve using radiation. The fact is that any procedure that damages the nerve can produce sensory loss on the face and occasionally bothersome sensations known as dysesthesias. The these problems are more commonly associated with the use of higher doses of radiation. Unfortunately, higher doses of radiation are also associated with better outcomes in terms of pain relief.
Myth: All patients with trigeminal neuralgia have classic symptoms.
Truth: Many patient with trigeminal neuralgia do not in fact have typical symptoms. Also, for patients who have had TN for many years, the symptoms tend to become less typical as time goes by.
Myth: Even patients whose pain goes away, need to stay on medications indefinitely.
Truth: This is not necessarily the case. Trigeminal neuralgia is often characterized by periods of spontaneous remission. For some patients, these periods may last many years. There is no absolute way to manage medications for patients with TN. Therefore, it is essential that you have excellent communication with your doctor and nurse in order to monitor the medications. When you are prescribed a medication, you must take it regularly for it to be effective. Once you have been pain free for perhaps 6 -12 weeks, it may be possible to reduce the medication or even taper off of it completely without the pain returning. However, this should be done in consultation with your doctor. You should not abruptly stop the medications since doing so can cause serious side effects with certain medications.