Glyzerol Rhizotomy Trimeninal Neuralgia Tips

Trigeminal Neuralgia is a type of chronic pain disorder, which affects the trigeminal nerve. There are mainly two types:

Typical Trigeminal Neuralgia and Atypical Trigeminal Neuralgia.

The typical form or this disorder results in certain episodes of severe, sudden, shock-like pain in one side of the face, which lasts for seconds to few minutes.

Symptoms

Trigeminal Neuralgia may have symptoms which include one or more of patterns like the following:

• Some episodes of severe,
• Shooting pain which may seem like an electric shock.

A person might come across spontaneous attacks of pain or even attacks which might get triggered by certain things like touching the face, chewing, speaking or even while brushing the teeth.

Causes

When trigeminal neuralgia occurs, the trigeminal nerve’s function gets disrupted. The problem occurs through a contact between an artery or a vein and the trigeminal nerve at the base of one’s brain. This contact puts pressure on the nerve, thus causing it to malfunction.

Trigeminal Neuralgia can occur due to people getting aged or due to any kind of disorder that causes damage to the myelin sheath that protects certain nerves. A number of triggers can lead to the pain of trigeminal neuralgia, which include:

• While shaving
• When someone touches one’s face.
• When a person is eating something.
• While brushing teeth
• Smiling
• Washing one’s face.

What Is Radiofrequency Ablation for Trigeminal Neuralgia?

Radiofrequency Ablation or RFA is a technique by way of surgery, which helps to direct high-frequency heat on to the targeted areas of the body, such as tumors and tissues. When a person suffers chronic pain that means the high-frequency heat is getting targeted to the nerves.

A person suffering from trigeminal neuralgia, would have his or her doctor, who is a neurosurgeon, uses radiofrequency ablation to hit the trigeminal nerve, thereby destroying the nerve’s ability to get the pain signals transmitted to one’s brain.

Medication is the first line of treatment for trigeminal neuralgia by a neurosurgeon, to see how the patient reacts. If that person suffers from severe pain in the face and does not show any improvement through medication, then the doctor might recommend him/her to go for radiofrequency ablation surgery.

How Is The Procedure Conducted?

During the radiofrequency ablation for trigeminal neuralgia, people remain awake and asleep at different times. The process includes:

When the patient is asleep under the influence of general anaesthesia, a neurosurgeon would carefully place a needle through the corner of one’s mouth in order to reach the trigeminal nerve, which lies at the base of the skull. Then, once the X-rays confirm the needle is right in place, the neurosurgeon would wake the patient up, stimulate the nerve and ask the patient if he or she could feel the stimulation exactly at the place where the pain is experienced. This particular step confirms that the doctor has hit the right location. Once, the patient gets back to sleep, the doctor uses radiofrequency heat to minimally injure the nerve, sufficiently enough to induce a numb feeling on the face along with tingling, thus take the pain away.

The condition of persistent pain in the body, where an outbreak of the Varicella Zoster virus has caused Shingles, is termed as post-herpetic neuralgia. It is a debilitating complication of the herpes zoster virus. The blisters that occur in shingles develop a crust formation and neuralgia begins after these crusts are formed. It may also occur in people who do not produce the crustaceous lesions. A burning pain that is long-lasting, even after the rash and the blisters disappear, is observed. There is a criteria of the pain to be persistent for around three months for the confirmation of post herpetic neuralgia.

The cause of this condition is damage of the sensory nerves that can occur due to the movement of the reactivated Herpes Zoster virus from the nerves to the skin. In an individual affected with chickenpox, the infection can involve dorsal root ganglia, where the virus lies dormant. Under conditions like stress due to infection or in an immuno-compromised individual, after a period of time, reactivation of the virus takes place. This reactivation causes production of Shingles on the body. The dormant virus reaches the skin and reactivates to produce lesions.

With an increase in age, the chances of developing post-herpetic neuralgia also increase. It primarily affects older individuals in the age group of 60 to 70 years. Treatment is aimed at pain management and providing symptomatic relief, with improvement of the neuralgia over a period of time. Symptoms of this condition are limited to the area of shingles’ outbreak. Trunk is commonly affected on a unilateral site. It can also occur on face. Common symptoms include pain lasting 3 months or longer after healing of the shingles rash, allodynia, numbness over the affected area and itching. Even a slight touch of cloth over the affected area can cause alleviated pain to the individual. Disturbed sleep and development of clinical depression is usually associated with post herpetic neuralgia. The medications given for post herpetic neuralgia are aimed at pain relief and resolving of symptoms. Management of chronic pain can be brought about by the use of a combination of pain relieving drug classes.

Some commonly used drugs for treatment of post-herpetic neuralgia are as follows:

1. Topical Agents: Numerous topical agents have been effectively used in the treatment of post-herpetic neuralgia. In patients with allodynia or an alleviated pain sensation, topical lidocaine patches are very effective. The nociceptive activity of small nerve fibers is decreased by use of Lidocaine. Also, the brush of clothing is avoided by the patch serving as a protective barrier itself. Another topical agent that has proved effective in pain relief is Capsaicin. Its clinical use is limited due to the burning sensation caused by its application. With regular use, however, the burning sensation gradually reduces. Capsaicin should be used for a minimum period of a month to aid pain relief. Low systemic absorption of the topical agents ensure few side effects caused by them.
2. Antidepressants: The standard drug therapy for treatment of post-herpetic neuralgia include the use of antidepressant drugs. Drugs like Nortriptyline, Amitriptyline are the most commonly used drugs amongst the tricyclic antidepressants for pain relief in post-herpetic neuralgia. These drugs are however associated with various adverse effects like sedation and cardiac dysrhythmias. Other drug classes like Serotonin reuptake inhibitors are used in individuals with low tolerance to the tricyclic antidepressants. Depression symptoms are relieved by the use of this drug class. Specific relief of the chronic pain of post-herpetic neuralgia is not achieved much efficiently though.
3. Anticonvulsants: Neuropathic pain can be relieved by many anticonvulsant drugs. Drugs like Pregabalin have lesser side effects and also require a lesser monitoring than previously used anticonvulsant drugs like Carbamazepine.
4. Opioids: Long term use of opioids shows significant risks like sedation and mental clouding. These drugs are considered safe for use without causing cardiac or hepatic adverse effects. When opioids are prescribed, stool softeners and laxatives should also be given to avoid constipation. Other pain management protocol includes cryotherapy, ablation of the affected roots of nerve, anterolateral cordotomy and even the use of electrical nerve stimulation. The physician should evaluate the best suitable pain management option and provide treatment accordingly.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Trigeminal neuralgia can be best described as an ongoing condition that affects a group of nerves called the fifth cranial nerve which is responsible for sensation in the face. Individuals suffering from this pain say that the pain feels like that of an electric shock and sometimes it becomes unbearably severe. According to medical experts, the trigeminal neuralgia is the acutest pain that an individual can suffer from where the pain mostly affects the lower portion of the face along with the jaw and may also affect the lips, nose, ears and eyes. Trigeminal neuralgia is thought to affect over 1 million people across the world and 1 person in every 15,000 people suffers from this disease.

Understanding the causes of trigeminal neuralgia
The human face comprises of two trigeminal nerves, one on each side of the face and each splits into 3 branches which aid in transmitting sensations of pain as well as a touch from the teeth, mouth, and face to the brain. Most cases of trigeminal neuralgia are said to be triggered by the blood vessels, which sometimes presses the root of the trigeminal nerve. This is known to make the nerve transmit signals which lead to the feeling of stabbing and throbbing pain in the facial regions.

The exertion of pressure on the nerves is mostly caused by multiple sclerosis and tumor and some other suspected causes of trigeminal neuralgia include, pressing of the blood vessel against the root of the trigeminal nerve, demyelization of the trigeminal nerves during the advanced stages of multiple sclerosis, physical damage to the nerve caused by an injury, a surgical procedure or a severe infection, although rare, pressing of a tumor against the trigeminal nerve may also cause it and family history and genetic conditions are also responsible for causing trigeminal neuralgia

Diagnosing trigeminal neuralgia:
If the primary health care provider feels that the symptoms of facial pain are indicative of trigeminal neuralgia, then the patient’s face is required to be examined and evaluated more carefully to detect the affected parts with precision. Other conditions which may have similar symptoms including tooth problems and sinusitis would be eliminated first. Then an MRI scan would be performed which would help understand whether the trigeminal neuralgia is triggered by some underlying medical issues. But the MRI would not be able to reveal the reasons behind the irritation of the nerve unless tumor or multiple sclerosis is the cause. This is because it is not possible to visualize the blood vessel that stands next to the nerve root.

Getting the right treatment for trigeminal neuralgia:

1. Interventional Treatments: 
   • Percutaneous Radiofrequency(RF) Ablation of Gasserian Ganglion 
   • Percutaneous Glycerol Rhizolysis 
   • Percutaneous Baloon Micro compression 
2. Surgical Microvascular Decompression (MVD) 
3. Gamma Knife Stereotactic Radiation Therapy

If you wish to discuss any specific problem, you can consult a pain management specialist.

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain.

Home Remedies

Fried Methi (Fenugreek)                 100gm

Haldi (Turmeric)                               100gm

Ganthoda (Granthik)                       10gm

___________________________

Mix it properly

Dose: one tea Spoon Morning & Evening

Castrol oil – one tea spoon with warm water/ milk /tea at bed time once or twice in weak

Fried Lahsun- with ghee and take one two prices every day morning.

Fried Methi (Fenugreek)                 100gm

Sunthi-                                             100gm

Gud (Jagarry)                                   50gm

Ghee                                                 30gm

____________________________

Mix it properly and take two tea spoons early morning.

Trigeminal neuralgia is a condition that affects certain nerves of the face and results in terrible pain. In most of the cases, it is seen that the individual affected with this condition feel like an electric shock passing through the face. It can sometimes be too intense, and the affected one might feel an unbearable pain. One thing that is to be remembered here is that not all types of facial pain would indicate the presence of trigeminal neuralgia. If you feel consistent pain on your face for a long duration of time, it is recommended that you consult a specialist as there may be an underlying condition that needs to be attended.

What could lead to trigeminal neuralgia?
It is extremely important to understand the causes of the condition as it will give you a clear picture of the reasons for facial pain. At the same time, the proper identification of the symptoms is quite crucial to know whether the reason for facial pain is due to trigeminal neuralgia.

This condition starts with the irritation and discomfort of the trigeminal nerve. This might be resulting from a blood vessel pressing on the nerve which damages the protective coating around it known as the myelin sheath. Certain types of diseases like multiple sclerosis can cause injury to the myelin sheath which can result in the symptoms of the trigeminal neuralgia. Moreover, the presence of a tumor or a tangle of the arteries can also create pressure on the nerve giving rise to the pain. Trigeminal neuralgia can also be caused by the injury of the trigeminal nerve due to any accident, surgery or a stroke.

Signs and Symptoms of Trigeminal neuralgia
For the proper identification of the facial pain and to confirm that it is trigeminal neuralgia, you need to look out for the symptoms. The first symptom is brief periods of shooting or stabbing pain in the face. The pain can just be triggered by the brushing of teeth, washing the face or shaving and similar other activities. The attacks of the episodes of the pain happen several times in a day, or it might happen that no pain is experienced throughout the whole week.

The pain is experienced on only one side of the face. The duration of pain ranges from a few seconds to several minutes. In some severe cases, they might turn unbearable, and the episodes of attacks are significantly increased. The pain is also experienced in the cheek, jaws, teeth, lips and even the gums. Thus, it is extremely important to seek medical advice on an immediate basis so that the condition does not further worsen. The doctor would be able to assess the signs and symptoms and give you an insight into the the the causes of facial and decide on the treatment options based on the diagnosis.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Chronic pain in the lower back is intolerable. Treating it with interventional pain medicine ensures you can have a pain-free life. The best part happens to be the multiple alternatives offered by this system and it does not recommend surgery. Chronic lower back pain disables more people than cancer or cardiovascular diseases. This not only affects the quality of life but can also lead to depression. Affected people cannot concentrate on career, and not all nature of jobs is apt for them.

Interventional pain medicine creates a program and routine for various treatments.

Facet injections: Diagnosis and pain relief are offered by facet injections. It diagnoses if the pain emanates from the facet joints of the spine. To identify this, a numbing medicine is injected in the facet joints of the spine. If these joints are where the pain originates, then you will be satisfied for the relief is instant. If the problem is severe, the relief is temporary and if the degeneration is mild, then the relief is long-lasting. The steroid cortisone with the numbing agent is injected, which helps in offering the pain-relieving effect. When only the numbing agent is injected, the pain relief is temporary. Using the steroids helps in bringing down the inflammation. This improves the quality of treatment. Facet blocks, as these facet injections are called, got this name because they block the facet pain. If you are not responding to the facet injections, radiofrequency rhizotomy is recommended.

Radiofrequency Rhizotomy: This advanced treatment helps in alleviating pain caused by progressive degeneration of the facet joints. The pain-sensing nerves in the facet joints are targeted in this treatment. A radiofrequency-generated heat is used to alleviate the pain. The key factor is that your doctor should be aware of the place of origin of your pain. To identify the right nerves, an MRI scan, discography, or facet injection might be used by your doctor. Lumbar discography comes into picture when patients do not respond to the other conventional treatment methods. You need to be awake and guide the radiologist when radiofrequency rhizotomy is performed. An electrode needle is used close to the facet joint that suffers degeneration. After the nerve is numbed with an anesthetic, this thin needle is used to apply heat. The connection between the brain and the nerve is cut down. During this treatment, the nerves above and below the affected nerves are targeted, in addition to the affected nerves. This ensures that no pain is caused even by the less damaged nerves in the future.

Lumbar epidural steroid injection: When the aforementioned treatments fail, Lumbar Epidural Steroid Injection, LESI in short, helps in pain relief by using steroids. The skin is numbed with an anesthetic and the steroids are injected. The targets are the dura and sac that contain the nerve roots. The injections are effective in offering results for a few months. Over a period of one year, three LESI injections can be given. The pain relief is excellent and you can do exercises and stretches after getting one injection. This is an excellent treatment for chronic back pain and sciatica.

Sacroiliac joint block: These are a type of injections that used for diagnosing as well as treating low back pain pertaining to sacroiliac joint dysfunction. It is the joint that is located right next to the spine which is connected from the bottom of the spine to the hip. Here in a needle is inserted in the sacroiliac joint to inject a numbing agent and an anti-inflammatory medicatiton. This injection is repeated thrice a year. Also, for best results the injection must be followed by a physical therapy. 

In case you have a concern or query you can always consult an expert & get answers to your questions!

Neck pains can be due to muscle spasms, bone related like facet joint pains, disc related pains or nerve pain called neuralgia

A pain management specialist examines the patient thoroughly and puts on a combination of medicines like nsaid, neuropathic drugs and some exercises.

If severe pain is felt, injections are given at appropriate places.

Occipital nerve block for neuralgia
Facet block for facet pain
Epidural for disc prolapse
Trigger point injection for muscle pains

Patients usually get significant pain relief and are back to work.

A pinched nerve is a sensation that causes a lot of pain due to pressure on the nerve or some form of nerve damage that may have been caused due to an accident, sports injury, or even as a side effect of other chronic conditions like diabetes. In this condition, one experiences a sharp and shooting pain as soon as there is some movement of the area or pressure on the same.

A pinched nerve usually signifies damage rendered to a peripheral nerve which is usually to be found outside the spinal cord and the brain. Disc herniation and arthritis are also some conditions that may cause a pinched nerve in the affected area. This happens due to the pressure on the nerve which may lead to irritation in the protective layer of the same. This condition can make life quite painful. So here are a number of ways in which you can manage the pinched nerve.

• Location and Cause: In order to treat the condition in a satisfactory manner without causing further pain, the doctor will diagnose the location and the cause of the pain. This will have a large bearing on the treatment method to be followed. If there is an injury at play, it is imperative to give ample rest to the area while the treatment is conducted.
• Physiotherapy: One of the most preferred forms of long-term treatment for a pinched nerve includes physiotherapy, which will help in relaxing and exercising the muscles and joints of the area so that stiffness and pain do not set in. The right kind of physiotherapy will also include exercises that will help in building the core strength of the muscles and joints in the area so that one does not suffer from weakness and pain in the long run.
• Splinting and Bracing: For conditions that have affected the feet or the wrists, like Carpels Tunnel, for example, it is imperative to wear a splint or a brace, especially at night. This will ensure that the patient does not move the area unnecessarily, as this could lead to even more pain for the patient. One may also have to learn how to switch the natural body positions and change them accordingly so that the affected areas can be given enough of rest. These will usually be recommended by the doctor and the physiotherapist.
• Medication: Anti-inflammatory drugs may be taken in case of extreme pain. These should be taken after consultation with a doctor so that you only have the prescribed dose of a medicine that would suit you. Corticosteroids and painkillers are usually prescribed in such cases. Some of these medicines are also available in gel form for topical application, while others are for oral ingestion.

If above conservative treatment fails then we have to go for interventional pain management. Interventions can range from simple trigger point injection, inter lesional injections to more advanced rhizotomies, radio frequency ablation, neurolysis, etc.

SPINAL ARACHNOIDITIS

Arachnoiditis of the spinal cord is a non specific inflammatory disease of the arachonoid membrane which is characterized pathologically by thickening of the arachnoid membrane with adhesion or adherence to the dura matter and manifested clinically through roots or radiclar signs and symptoms.  

CLINICAL FEATURES

Arachnoiditis is usually seen in 40 to 60 years of age but rarely below 20years.

Onset: it can be acute or sometimes it may take months.Pain: pain is usually localized type with a burning character. Later the painstarts radiating down the lower limb due to nerve root irritation.

Paresthesia: this also takes place due to irritation of the sensory nerve  roots.

Sensory loss: this occurs when the sensory nerve roots get completely blocked.

Muscle weakness with atrophy: although the anatomy of the motor nerve roots make them less prone to get compressed, it can happen in the later stage which will then give rise to weakness and wasting of the corresponding muscles. 

MANAGEMENT 

The medical management usually consists of corticosteroids in acute stage of inflammation. NSAID for pain relief and inflammation.

Surgical management consists of Rhizotomy in cases of unbearable pain.Surgical decompression for removal of cyst. 

PHYSIOTHERAPY MANAGEMENT comprises of 

Moist heat mainly for reducing the muscle spasm. 

SSF also relieves pain by reducing spasm  and by increasing the blood supply to the area. In case of radiating pain due to involvement of nerve roots the patient may be treated with TENS. Even in     cases of paresthesia TENS is usually used. 

Laser has been found to reduce the inflammation and also break the adhesion in the deep seated structures  which helps in setting free the irritation on the nerve roots thereby     relieving the discomforts of the patient. 

Active exercises like static exercises for the abdominus, back extensor, gluteus and quadriceps helps in reducing   pain in the initial stages and also maintains the tone in the muscles. 

Dynamic exercises may be started once the  pain level comes within the patient’s tolerance level. These exercises may be continued by the patient throughout the life for preventing any chances     of recurrence. 

SLR: Active and passive SLR is given to  lengthen the neural structures and relieve the tension in them. This is a type of neural mobilization that helps in relieving the signs of   radiculopathy. 

Gait training in cases of muscular weakness.