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Non-Surgical Treatment For Trigeminal Neuralgia

Written and reviewed by
Dr. Sidharth Verma 92% (37 ratings)
MBBS, MD - Anaesthesiology, DNB Anaesthesiology, PDCC - Pain Management
Pain Management Specialist, Mumbai  •  12 years experience
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Hi,

I am Dr. Sidharth Verma, Pain Management Specialist. Today I will tell you about the non-surgical treatment options trigeminal neuralgia without open surgery. There are many patients who are suffering from this disease which is known as the suicide disease or trigeminal neuralgia. So, this disease occurs because there is a pain in the trigeminal nerve which comes out of the brain and supplies most area of your face. Usually, it is unilateral which occurs on one side and the patient is having sharp shooting kind of pain and this pain may come at any time of the day. It may be very severe. If you touch the area of the face or if you eat something or if you brush your teeth. It is very severe. This may be triggered by these actions. Many patients come with this symptom and then they are adviced with the surgery and I am happy to tell that now with the latest technology, we have a treatment option available for this problem wherein you need not go with this surgery and you can have the good relief from the symptoms. What are these treatment options? Let's have a look.

So, the number 1 thing is done nowadays is radiofrequency ablation. It is a very high-frequency current to the Gasserian ganglion of the trigeminal nerve. If we go with a needle and give this radiofrequency ablation then the pain is taken care of and this result in relief of the symptom. Now, how is it done? It is done by a pain specialist or pain physician. They will first diagnose the condition properly then do an MRI to find out some other cause of the pain. It is always done under local anesthesia. However, the anesthesia may be required before the content is taken in hand. It is x-ray guided. It can also be done in a cath lab where we will have a higher resolution and we can control the results in a better way. So, with the help of the needle, the patient is made to lie down with his back to the table and then we use x-ray. This we use for an opening in the brain from where this nerve comes out. With the help of a fine needle after numbing the skin so that the patient does not feel any pain. Once the needle enters in foramen ovale, it is slightly advanced and now stimulation is checked.

With the help of a radiofrequency generator, the patient is made to have an understand a concordance stimulation. The stimulation is given and the patient is asked whether it is the same pain which he used to feel every day and then the patient replies. If the patient says, yes, means the needle tip has reached. Then the radiofrequency current is applied. And once it is applied, the patient's pain almost immediately goes. And post-procedure the patient may have immediate pain relief and the needle is withdrawn and then we shift him to recovery. This procedure has many advantages. It is done under local anesthesia, daycare procedure. The patient can go home the same day or the next day. It is a very cost-effective treatment. It hs very low incidences of complications. The success rate is very high. It also gives a decent amount o pain relief which lasts up to 5 years or more in many cases. Another technique which is also very popular is the pulsed radiofrequency. The technique is the same as radiofrequency ablation. The only difference is instead of the thermal ablation, this technique uses the pulse radiofrequency current.

This way the patient pain reduces. Now the evidence is also fast catching up. Another technique which is used and not open surgery is the balloon compression. In this case, the needle is advanced but in this case, we put one catheter. After putting it inside, it is made to inflate which can be seen in x-ray and it is kept for 90 seconds. It compresses the ganglion. This results in blocking of these fibers and the patient will have the relief from symptoms and pain. This is very effective in cases, where all the 3 divisions are involved. If we talk about the results, results are excellent and the patient gets the long-lasting results from their symptoms. So, if you have facial pain which is not going even the tooth pain and you have the electric current like sensation, tried everything, gone to multiple doctor, you want to avoid surgery, then definitely, you should visit our clinic. A pain physician would be able to help you with a lot of treatment option and which do not involve any open surgery.

Thank You!

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