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Q
Fighting Facial Pain?

I have just been diagnosed with trigeminal neuralgia. The doctor tells me the standard treatment is anti-epileptic medicine. The neuralgia is very painful, but I am very reluctant to take such medication. Is there another way to deal with it?

A
Answer (Published 3/6/2002)

Trigeminal neuralgia, also known as tic douloureux, is a disorder of the trigeminal nerve which transmits sensation from the face to the brain. As you may have discovered, this can be an excruciatingly painful condition. The pain is often triggered by touching a particular spot on your face, but can also be set it off by doing something as routine as brushing your teeth or chewing. Even a cold breeze or wind can bring on the pain, and sometimes it just happens out of the blue.

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Patients describe the pain as coming in lightning-like flashes that usually occur in the cheek next to the nose or in the jaw. It can strike rarely - only a few times a month or year - or repeatedly during the day, sometimes so often as to be incapacitating. The good news is that spontaneous remissions of this painful condition are common.

Unfortunately, we don't know the cause of most cases of trigeminal neuralgia. Sometimes, an out-of-place blood vessel compresses the nerve. If so, the blood vessel can be separated from the nerve surgically although results aren't permanent.

The drug your doctor prescribed probably is Tegretol (carbamazepine), an antiseizure drug which stabilizes nerve membranes. Typically, if this doesn't help, others, including several antidepressants which can prevent pain, may be recommended. My personal treatment preference is an unorthodox one, a nasal spray of the nonaddictive narcotic drug Nubain (nalbuphine hydrochloride) which is less toxic than the anti-epileptic prescribed for you. Because Nubain comes as an injectable drug, your physician will have to ask a pharmacist to make it up into a nasal spray for you, but it is a safe drug and does work well for some people with your condition. I also recommend trying acupuncture and hypnosis, both of which may prove helpful. Taking a calcium/magnesium supplement can help calm overactive nerves.

Andrew Weil, M.D.

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