Options for breaking free of excruciating facial pain

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Tuesday, July 26, 2022
Options for breaking free of excruciating facial pain
Trigeminal neuralgia is a severe facial pain usually caused by a blood vessel pressing on a nerve at the base of the brain.

NORTH PHILADELPHIA (WPVI) -- Imagine having a nerve so sensitive that eating or drinking - or even a light breeze - can set off excruciating pain.

That's trigeminal neuralgia. It's a debilitating problem, however, there are options to turn it off.

"Like an electric shock, like a lightning bolt, like an ice pick stabbing in their face," says Dr. Willard Kasoff of Temple Health.

"The pain is so severe, that they'd rather die," adds Dr. Curtis Miyamoto, also of Temple Health.

That's how Dr. Kasoff, a neurosurgeon and Dr. Miyamoto, a radiation oncologist, say patients describe trigeminal neuralgia.

There are about 150,000 new cases every year, however, patients often say they've never heard of anyone else with it..

It's usually caused by a blood vessel pushing on a nerve at the base of the brain. The nerve carries sensations from the face.

It's almost always on one side of the face, and as Dr. Kasoff notes, "It's a condition that has ups and downs. It can be very severe for weeks or months and then go away, very mysteriously, for weeks or months. Sometimes even for years.

Ordinary actions like eating, drinking, shaving, brushing teeth, encountering a light breeze, even talking, can set off attacks.

Unfortunately, patients often struggle to get diagnosed.

"They may start out seeing a dentist, they may start out seeing an eye doctor, they may start out seeing someone to look for TMJ, or jaw problems," says Dr. Kasoff.

Doctors Kasoff and Miyamoto say patients should find a facial pain specialist, at a center using a team approach.

Seizure medications are usually the first treatment.

If those lose their effect, there's a very effective surgical fix.

"Find where that blood vessel is compressing the trigeminal nerve, and very delicately move that to the side, and put some padding in between the nerve and the blood vessel," says Dr. Kasoff.

For 30 years, Dr. Miyamoto has used pinpoint radiation, such as the Gamma Knife, to target the root of the trigeminal nerve.

"We can cut off that pain at that site," he says.

Patients can have discomfort from the Gamma Knife head frame during treatment. However, the radiation is painless with no outside wound or hair loss.

"I have literally seen patients who suffered 30 and 40 years with this and then come back with complete pain relief," says Dr. Miyamoto.

He adds: "They should not lose hope. They should not live in pain. They shouldn't just accept it and say, 'Well, this is my life now.' Because there is relief out there for a lot of patients."