How to treat trigeminal neuralgia, one of the worst pains you can feel in your face

NORTHWOOD (WPVI) -- Pain is among the hardest medical problems to deal with.

And facial pain is one of the trickiest.

A Philadelphia man details his long journey to relief.

"The pain initially was numbness on my tongue," explains Donald Carlton, of the city's Northwood section.

Before long, the pain moved to his face.

"The worst part about it is you never know when it's going to come. You never know when it's going to leave," Carlton recalls. "Sometimes I felt like I was being stabbed in the face with needles. Other times I would just get a cramp in my face."

Speaking in the office and in public, he'd warn listeners he might suffer a pain attack.

After no answers from doctors and dentists, Carlton found a neurologist who said it was trigeminal neuralgia.

"One of the worst pains possible in the human body," says neurosurgeon Dr. Willard Kasoff of Temple Health.

"In many cases of trigeminal neuralgia, we see a blood vessel next to the brain pressing on the trigeminal nerve," Dr. Kasoff says.

That nerve carries sensation to and from the front of the face.

About five people per 100,000 will develop it.

Women and older people have slightly higher rates, but it's fairly common in Multiple Sclerosis patients.

"For many patients, medication will be enough," Dr. Kasoff notes.

But after about six years, Carlton decided he needed surgery, so he saw Dr. Kasoff, who presented three surgical options.

The first was open surgery.

A second option was a less invasive one using a needle to reach the base of the skull.

The third, even less invasive, focuses radiation on the nerve.

"Unfortunately, the more invasive is also the most effective," Dr. Kasoff notes.

Carlton opted for open surgery - a 12-hour procedure.

"They actually put cushions between my trigeminal nerve and the blood vessel," he says.

When he awoke after the operation, "The pain was gone and I haven't had a recurrence since."

"I was back at work within 3 weeks and doing my 3 miles in 3 weeks," he says.

"Dr. Kasoff says if I get to a year with no more pain, I'm cured," says Carlton, looking forward to that first anniversary on October 23rd.

"About two-thirds of patients are cured with one surgical operation," the doctor says.

Dr. Kasoff says anyone with unexplained facial pain needs to consider trigeminal neuralgia, and seek a medical center specializing in facial pain, so that all options are available.