My 80-year-old brother has gone from being a vibrant man to a recluse in just two-and-a-half years, due to extreme pain in both cheeks (trigeminal neuralgia). It is getting worse, despite two operations, and his lips and chin have gone numb. Can you advise a treatment to help?
Trevor Jones, Widnes, Cheshire.
This is a worrying story, and I think your brother really needs care from a neurologist who specialises in treating this type of condition.
For the benefit of readers, trigeminal neuralgia is a condition characterised by abrupt episodes of electric shock-like pain on one side of the face.
These severe, and in some cases almost unbearable, stabbing pains occur without warning and can be triggered by harmless actions, such as splashing water on to your face or stepping into a breeze.
Sore point: Trigeminal neuralgia is a condition characterised by abrupt episodes of electric shock-like pain on one side of the face
Between five and ten in every 100,000 people in the UK are diagnosed with the condition each year. It is more common in older adults, especially women, and raised blood pressure and migraines increase your risk.
Attacks can occur for days, weeks or months at a time, with the most severely affected feeling hundreds of ‘bolts’ of pain a day. This has a huge effect on quality of life, and your brother is not alone in choosing to shut himself off from the world.
The pain occurs when one branch of the trigeminal nerve — which transmits sensations from the eyes, forehead, cheeks, lips and jaw to the brain — is compressed, usually by a blood vessel. The initial treatment for most patients is preventative medication. Surgery is reserved for those who find this ineffective.
Carbamazepine, primarily used to treat epilepsy, can slow the electrical impulses in the nerve, reducing its ability to transmit pain messages. Lamotrigine, gabapentin, pregabalin and baclofen are other options.
If medication does not help, the involvement of a neurosurgeon is essential — and I assume this was the path followed by your brother.
A number of different procedures can help. One involves passing a needle into the cheek under anaesthetic and injecting a substance, such as glycerol, that can destroy the offending nerve.
This interrupts the pain signals, but can leave part or all of that side of the face permanently numb. This procedure is not always effective.
Facts: Between five and ten in every 100,000 people in the UK are diagnosed with the condition each year., which is more common in older adults, especially women
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