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Guideline: Surgery may be considered for extreme face pain

August 21, 2008

ST. PAUL, Minn. - A new guideline developed by the American Academy of Neurology finds surgery may be considered for people who suffer from extreme, electric shock-like pain in their face and do not respond well to drugs. The guideline on treating trigeminal neuralgia is published in the August 20, 2008, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"There are very few drugs with strong evidence of effectiveness in treating trigeminal neuralgia," said guideline author Gary Gronseth, MD, with the University of Kansas in Kansas City and Fellow of the American Academy of Neurology. "If people fail to respond to these drugs, physicians should not be reluctant to consider referring the patient for surgery. Often surgery is considered a last resort and patients suffer while the well-intentioned physician tries other medications with limited effectiveness."

Trigeminal neuralgia is a chronic pain condition that causes extreme, stabbing pain throughout the face. The pain normally doesn't last more than a few seconds or a minute per episode, but the episodes can last for days, weeks, or months and then disappear for months or years. The intense pain can be triggered by shaving, applying makeup, brushing teeth, eating, drinking, talking, or being exposed to the wind. It is more common in women than in men.

The guideline recommends the drug carbamazepine be offered as a first-line treatment for people with trigeminal neuralgia. The guideline also says oxcarbazepine should be considered.

"If patients don't respond well to carbamazepine or one or two other drugs, it is reasonable to consider surgery that targets the root of the trigeminal nerve," said Gronseth. "People with trigeminal neuralgia should be aware of the availability of surgical treatments and discuss these options with their physicians."

The guideline also recommends that physicians consider sending all patients with trigeminal neuralgia for MRI or trigeminal reflex testing since up to 15 percent of patients have an underlying structural cause of the disorder, such as a tumor.

American Academy of Neurology