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Fulltext Pain intervention for Trigeminal Neuralgia

Hadi, M.A., Nor Zamzila, A., Rasydan, A.G.M., Suhaila, N., Nizamuddin, I.M.

International Medical Journal Malaysia, 2017;16(11):53-53.
MyJurnal

In the management of chronic pain, stepwise oral analgesics of graded strength are
considered as first-line therapy. Minimally invasive interventional procedures remain an
option for its treatment when pharmacological therapy fails to control the pain. We
reported three classical cases of chronic trigeminal neuralgia that were managed with
two types of pain intervention approaches after failing conservative management. (Copied from article).

Matched MeSH terms: Trigeminal Neuralgia
Fulltext Trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome: an update

Khan M, Nishi SE, Hassan SN, Islam MA, Gan SH

Pain Res Manag, 2017;2017:7438326.
PMID: 28827979 DOI: 10.1155/2017/7438326

Neuropathic pain is a common phenomenon that affects millions of people worldwide. Maxillofacial structures consist of various tissues that receive frequent stimulation during food digestion. The unique functions (masticatory process and facial expression) of the maxillofacial structure require the exquisite organization of both the peripheral and central nervous systems. Neuralgia is painful paroxysmal disorder of the head-neck region characterized by some commonly shared features such as the unilateral pain, transience and recurrence of attacks, and superficial and shock-like pain at a trigger point. These types of pain can be experienced after nerve injury or as a part of diseases that affect peripheral and central nerve function, or they can be psychological. Since the trigeminal and glossopharyngeal nerves innervate the oral structure, trigeminal and glossopharyngeal neuralgia are the most common syndromes following myofascial pain dysfunction syndrome. Nevertheless, misdiagnoses are common. The aim of this review is to discuss the currently available diagnostic procedures and treatment options for trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome.

Matched MeSH terms: Trigeminal Neuralgia/diagnosis; Trigeminal Neuralgia/physiopathology*; Trigeminal Neuralgia/therapy
Trigeminal neuralgia. A retrospective survey of a sample of patients in Singapore and Malaysia

Loh HS, Ling SY, Shanmuhasuntharam P, Zain R, Yeo JF, Khoo SP

Aust Dent J, 1998 Jun;43(3):188-91.
PMID: 9707784

This survey was undertaken to study the clinical features of trigeminal neuralgia in an Asian population. Demographic data of 44 patients treated at the Dental Faculty of the National University of Singapore and at the University of Malaya were reviewed. The results of the survey were analysed and comparisons made with those of Caucasian patients as reported in other studies where there was a general similarity in the clinical findings. Trigeminal neuralgia presented predominantly in females. Right-sided involvement occurred at a greater frequency, and the peak age at onset was between the sixth and seventh decades of life. The only significant variant in the present sample was the greater involvement of the mandibular branch of the trigeminal nerve rather than the maxillary division. In addition, there was a much greater representation from Chinese patients over Malays as compared with their ratios in the general population.

Matched MeSH terms: Trigeminal Neuralgia/ethnology; Trigeminal Neuralgia/epidemiology*
Clinical Characteristics, Pain, and Quality of Life Experiences of Trigeminal Neuralgia in a Multi-Ethnic Asian Cohort

Tan CY, Shahrizaila N, Goh KJ

J Oral Facial Pain Headache, 2017 10 27;31(4):e15-e20.
PMID: 29073667 DOI: 10.11607/ofph.1793

AIMS: To describe the clinical characteristics of trigeminal neuralgia (TN) in a multi-ethnic Malaysian population and to relate them to standardized measures of pain severity, anxiety, depression, and quality of life (QoL).
METHODS: Patients fulfilling the International Headache Society (IHS) criteria for TN were prospectively interviewed for their demographic and clinical data. Pain intensity was rated with a visual analog scale (VAS), anxiety and depression were determined by the Hospital Anxiety and Depression Scale (HADS), and QoL was assessed by the Short-Form 36 (SF-36) questionnaire. Chi-square, Mann-Whitney U, and Spearman correlation tests were used to test for differences considering a significance level of P < .05.
RESULTS: Of the 75 included patients, 52 (69.3%) were women with a mean ± standard deviation (SD) onset age of 52.0 ± 12.7 years, and 57.3% were Chinese, 24.0% Malay, and 18.7% Indian. Pain was more common on the right side (69.3%) and in the maxillary and mandibular divisions. VAS scores for pain at its worst were higher in anxious/borderline anxious patients compared to non-anxious patients (89.5 ± 15.9 vs 80.9 ± 17.2, respectively; P < .05), and VAS scores for pain at its least were higher in depressed/borderline depressed subjects compared to non-depressed subjects (38.4 ± 25.8 vs 23.0 ± 19.2, respectively; P < .05). Chinese patients had lower VAS scores for pain at its least compared to Indian patients (19.7 ± 16.1 vs 39.9 ± 24.7; P < .01). TN patients scored lower in all eight domains of the SF-36 compared to the general population. Indian patients had lower scores in role limitations due to physical health (8.9 ± 23.2 vs 49.4 ± 43.8; P < .01) and social function (56.3 ± 13.6 vs 76.5 ± 23.6; P < .01) than Chinese patients, and Malay patients had lower mental health scores compared to Chinese patients (59.1 ± 19.5 vs 73.0 ± 21.0; P < .01).
CONCLUSION: Clinical characteristics of TN patients were similar to those of other populations. There were differences in pain ratings and QoL between TN patients of different ethnicities, as well as between those with anxiety and depression.

Matched MeSH terms: Trigeminal Neuralgia/ethnology*; Trigeminal Neuralgia/physiopathology; Trigeminal Neuralgia/psychology*
Fulltext Lamotrigine for trigeminal neuralgia: efficacy and safety in comparison with carbamazepine

Shaikh S, Yaacob HB, Abd Rahman RB

J Chin Med Assoc, 2011 Jun;74(6):243-9.
PMID: 21621166 DOI: 10.1016/j.jcma.2011.04.002

BACKGROUND: Anticonvulsants are regarded as useful for the treatment of neuropathic pain. In this study, we evaluated the efficacy and occurrence of side effects of lamotrigine (LTG) in comparison with carbamazepine (CBZ), in trigeminal neuralgia (TN) patients.
METHODS: The study was an interventional and crossover comparison. Twenty-one patients with TN were administered with LTG in comparison to CBZ. The clinical trials comprised two phases of 40 days each, with an intervening three-day washout period. The final titration in dose for LTG was 400 mg and 1,200 mg for CBZ. Efficacy of the medications involved was determined by visual analog scale (VAS) and verbal rating scale (VRS). Side effects were recorded through marking of the profiles of side effects encountered on administration of LTG and CBZ, together with baseline haematological, hepatic and renal investigations.
RESULTS: Both on VAS and VRS assessments, in terms of proportion of patients, CBZ benefitted 90.5% (19/21) of the patients with pain relief (p 0.05). Meanwhile, LTG inflicted 14% (3/21) of the patients with haematological, hepatic and renal derangements, as compared with 48% (10/21) on CBZ.
CONCLUSION: LTG is generally an effective and safe treatment for management of TN, compared to CBZ.

Matched MeSH terms: Trigeminal Neuralgia/drug therapy*
Orbital apex syndrome due to trigeminal perineural spread of sinonasal leprosy: a case report

El Beltagi AH, El-Nil H, Alrabiah L, El Shammari N

Clin Imaging, 2012 Mar-Apr;36(2):142-5.
PMID: 22370135 DOI: 10.1016/j.clinimag.2011.07.004

Leprosy is a granulomatous disease primarily affecting the skin and peripheral nerves caused by Mycobacterium leprae, but also significantly involving sinonasal cavities and cranial nerves. It continues to be a significant public health problem, and despite multidrug therapy, it can still cause significant morbidity. The awareness of cranial nerve, intracranial and orbital apex involvement as in our case is important for appropriate treatment measures.

Matched MeSH terms: Trigeminal Neuralgia/diagnosis; Trigeminal Neuralgia/microbiology*
Injection of botulinum toxin type A (BOTOX) into trigger zone of trigeminal neuralgia as a means to control pain

Ngeow WC, Nair R

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010 Mar;109(3):e47-50.
PMID: 20219585 DOI: 10.1016/j.tripleo.2009.03.021

This article illustrates a case of persistent trigeminal neuralgia in a medically compromised 65-year-old female who did not respond to pharmacotherapy. She had undergone several peripheral neurectomies as well as a failed right posterior fossa exploration that resulted in a cerebrospinal fluid leak. Persistent pain over the right external nasal area and right mental region was relieved for several hours after daily injections of bupivacaine. A trial of a single dose of 100 units of botulinum toxin type A (BOTOX) diluted in 2.5 mL saline was injected into the external nasal trigger zone (60 units) and to the mental nerve region (40 units). She achieved complete pain relief in the external nasal region for 5 months. Pain recurred and the site was again injected with 100 units of botulinum toxin type A (BOTOX). Pain relief at the mental region was partial. This was finally controlled with peripheral neurectomy. The patient was pain free with a maintenance dose of 200 mg carbamazepine daily for about 1 year, after which she elected to undergo stereotactic gamma knife radiosurgery when pain recurred at the external nasal region.

Matched MeSH terms: Trigeminal Neuralgia/complications; Trigeminal Neuralgia/drug therapy*
Atypical Isolated Infections of the Infratemporal Fossa: A Diagnostic Challenge

Tan SH, Chong AW, Prepageran N

Iran J Otorhinolaryngol, 2015 Sep;27(82):391-4.
PMID: 26568944

INTRODUCTION: Atypical infratemporal fossa infections are rare and potentially fatal.
CASE REPORT: A case of an aspergillosis localized in the infratemporal fossa and another case of tuberculosis of the infratemporal fossa originating from the maxillary sinus, is described. The first patient was immunocompromised and showed symptoms of facial numbness; whereas the other was an immunocompetent man who complained of trigeminal neuralgia type pain. It was difficult to differentiate between infection and tumour despite the utilization of computed tomography scans and magnetic resonance imaging.
CONCLUSION: These cases illustrate the need for a high index of suspicion; in addition to endoscopic confirmation and histopathology to establish precise diagnosis and early intervention.

Matched MeSH terms: Trigeminal Neuralgia
Improvement of trigeminal neuralgia after massage therapy and dry needling

Wan Adnan Wan Omar, Nur Liana Abu Bakar

Malaysian Journal of Medicine and Health Sciences, 2020;16(102):81-83.
MyJurnal

Trigeminal neuralgia is a debilitating disease that can lead to depression and even suicide. Trigeminal neuralgia is usually treated using carbamazepine; however, many patients are refractory to such medical treatment. Thus, other treatment modalities are required, such as physical treatment and dry needling. The objective of this case report is to describe the management of trigeminal neuralgia in a 35 years old Malay housewife, who had left side atypical trigeminal neuralgia involving V2 region in the last four years, which was refractory to medical treatment. The appli- cation of Malay massage, combined with dry needling executed along the distribution of trigeminal nerve showed an improvement of pain on the Visual Analog Scale (VAS) from 7–8/10 to 0-1/10 after 11 sessions. Therefore, Malay massage combined with dry needling can be used as a non-pharmaceutical approach to managing trigeminal neu- ralgia.

Matched MeSH terms: Trigeminal Neuralgia
Fulltext Classical trigeminal neuralgia, purely paroxsymal with vascular compression - a case report

B, Elamathi, R, Vijaya, V, Valliappan, A, Ramanathan

Ann Dent, 2014;21(1):33-37.
MyJurnal

According to the 3rd edition of the international
classification of headache disorders (ICHD3 2013),
Trigeminal Neuralgia (TN) is classified into two types:
1. Classical TN, purely paroxysmal 2. Classical TN
with concomitant persistent facial pain. In this article,
the authors describe a 47 year-old, male with unilateral,
severe, recurring, electric shock-like pain involving left
lower jaw, teeth and gingiva. Diagnosis of classical TN
of the left 3rd division of the trigeminal nerve was made.
The patient was treated with pharmacotherapeutic agents
but without relief. Magnetic resonance imaging (MRI)
of the brain showed medial vascular compression of left
trigeminal pontine root entry zone caused by superior
cerebellar artery. A microvascular decompression (MVD)
surgery was done at the left trigeminal pontine root entry
zone resulting in good relief of pain. This article highlights
the differential diagnoses to be considered with TN and
also emphasize the difference between the two types of
the TN according to ICDH3 (2013). It also highlights the
difference between classical TN purely paroxysmal with
and without vascular compression by imaging techniques
and their differing treatment modalities, which therefore
should be reflected in future ICDH classification.

Matched MeSH terms: Trigeminal Neuralgia
Fulltext Hot towel massage relieved a 7 years orofacial pain – a case report

Ma MS

Ann Dent, 2012;19(2):66-69.
MyJurnal

Diagnosis and management of orofacial pain of non-odontogenic origin has always been a challenge to dentists. Inaccurate diagnosis would result in delay of treatment and in cases of orofacial pain, affects patient’s quality of life. Temporomandibular pain dysfunction syndrome is the most common temporomandibular disorder that presents to dental clinics. Trigeminal neuralgia, also known as ticdouloureux is a relatively rare condition that causes electric shock-like pain when the trigger zone is stimulated by triggering factor. Case report: A case of temporomandibular pain dysfunction syndrome in a 52 years old Indian lady that was managed as trigeminal neuralgia for 7 years is presented. Conclusion: The aim of this case report is to make dentists aware of the signs and symptoms of different orofacial pain, so that early and accurate diagnosis can be made and appropriate treatment instituted.

Matched MeSH terms: Trigeminal Neuralgia
Fulltext Florid cemento-osseous dysplasia as a possible aggravating factor in a case of trigeminal neuralgia.

Siar, C.H., Ibrahim, N., Omar, A.N., Abdul Rahman, Z.A.

Ann Dent, 2010;17(1):21-24.
MyJurnal

Differential diagnosis of orofacial pain is crucial, as the course of each process and its clinical management varies markedly. A case is illustrated here of trigeminal neuralgia in a 49-year-old Indian female whose complaint was initially diagnosed as dental pain leading to sequential extractions of her right mandibular and maxillary molars but with no pain abatement. Subsequent neurological assessment diagnosed her complaint as trigeminal neuralgia but pain remained poorly controlled even with high doses of carbamazepine and gabapentin. A dental referral and orthopantomographic examination revealed multifocal sclerotic masses in her jaws, suggestive of florid cemento-osseous dysplasia (FCOD). Right mandibular incisional biopsy confirmed the diagnosis. A decision was made to curette the right mandibular masses and lateralised the right inferior dental nerve. Follow-up disclosed considerable pain reduction. This case raises the issue as to whether the sclerotic bone masses in FCOD may have caused nerve compression which
aggravated her neuralgic pain.

Matched MeSH terms: Trigeminal Neuralgia
Fulltext A cross sectional study of chronic pain relief after bekam (traditional malay "cupping") therapy

Lim KG, Chuah SW, Ee MST, Wong ZG, Murugesan A, Syed Azman SA

International e-Journal of Science, Medicine & Education, 2015;9(2):32-36.
MyJurnal

Introduction: Bekam, an Islamic variant of cupping, is an ancient form of traditional medicine still practised today in Malaysia. There are published findings indicating that cupping benefits patients with low back pain, other musculoskeletal pain and even pain from cancer, herpes zoster and trigeminal neuralgia when pain is measured on an analogue scale. We proposed to investigate whether in addition to pain improvement on an analogue scale we could show if pain relief might be demonstrated in terms of reduction of analgesic use.

Methods: We carried out a retrospective cross sectional study on subjects who had been for outpatient clinic treatment with chronic pain of at least one month and who completed at least two bekam therapy sessions. In addition to documenting a pain score before and after therapy we documented their analgesic consumption.

Results: A total of 77 respondents, with overlapping symptoms of headache, backache and joint pains were included. The mean pain score before bekam therapy was 6.74±1.78, and was 2.66±1.64 after two sessions of therapy. Twenty eight respondents completed six sessions of bekam therapy and had a mean pain score of 2.25±1.32 after. Thirty-four patients consumed analgesic medication before starting bekam therapy and only twelve did so after. The consumption of analgesics was significantly lower after bekam therapy.

Conclusions: Bekam therapy appears to help patients experience less pain and reduce the amount of analgesic medication they consume. Nevertheless only a randomised prospective study will eliminate the biases a retrospective study is encumbered with and we believe would be worth doing.

Matched MeSH terms: Trigeminal Neuralgia

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