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Trigeminal neuralgia

What is trigeminal neuralgia?

The trigeminal neuralgia is a painful craniofacial disorder that triggers a strong pain in a part of the face and that can cover the area of ​​the cheekbone, the mouth or even the eye. This pain is caused by irritation of the trigeminal nerve, which is the nerve that controls the sensitivity of this anatomical area.

What are the causes of Trigeminal Neuralgia?

There are neurological diseases that can cause this clinical condition (secondary trigeminal neuralgias) and in some cases, they must be treated with some urgency. Sometimes, there is no clear cause of the painful condition. However, this situation must also be evaluated by a specialist in the field who determines, according to clinical and radiological criteria, what is the most likely cause of the pain and thus guide the treatment.

Sometimes there is no clear cause of the pain; however, this situation should be evaluated by a specialist in the area to determine, according to clinical and radiological criteria, what is the most probable cause of the pain and, thus, guide the treatment.

Escáner neuralgia del trigémino

Treatment for Trigeminal Neuralgia

Broadly speaking, treatment with specific medication is usually effective and relieves pain in most of these situations. Only after trying multiple drugs, and especially in young people with a significant impact on quality of life, can effective surgical therapies be offered, always dependent on the type of pain. Such therapies should be evaluated by a specialist surgeon in headaches and neuralgias, since the application of some of them can cause irreversible symptoms, such as facial neuropathic pain, which is very difficult to resolve afterwards.

Neuralgic trigeminal pain versus neuropathic trigeminal pain

Trigeminal pain is a condition that affects the trigeminal nerve, which is responsible for sensation in the face. There are two main types of trigeminal pain: trigeminal neuralgia and painful trigeminal neuropathy.

Neuralgic trigeminal pain

Neuralgic trigeminal pain is a type of intense facial pain characterized by episodes of sudden, brief pain. The pain is often described as an electric shock or pinprick. Neuralgic trigeminal pain usually affects only one part of the face, but may affect both parts.

Neuropathic trigeminal pain

Neuropathic trigeminal pain is a type of continuous facial pain characterized by a burning, tingling or numbness sensation. Neuropathic trigeminal pain is usually more severe than neuralgic trigeminal pain and can be difficult to treat.

Differences between neuralgic and neuropathic trigeminal pain:

The main difference between neuralgic and neuropathic trigeminal pain is the duration of pain. Neuralgic trigeminal pain is brief, whereas neuropathic trigeminal pain is continuous.

Other differences include:

-Trigeminal neuralgia pain is often triggered by stimuli such as brushing teeth, eating, or talking. Neuropathic trigeminal pain is not usually triggered by stimuli.
-Trigeminal neuralgia pain usually affects only one side of the face. Neuropathic trigeminal pain can affect both sides of the face.
-Trigeminal neuralgia pain is usually easier to treat than neuropathic trigeminal pain.

imagen escáner neuralgia del trigémino

Surgery for Trigeminal Neuralgia

In the most severe cases of trigeminal neuralgia (TN) that present uncontrolled pain with medication (around 30% of patients), there are different effective and safe techniques for improving the condition. 

In a large proportion of these patients, the pain is caused by the rubbing of an artery against the trigeminal nerve. After evaluation by a neurosurgeon and, in those cases that meet suitable requirements, microvascular decompression surgery should be considered as the first option, which aims to separate the artery in question from the nerve and then interpose a material between them that prevents the pain from reappearing. This technique has great effectiveness in the short and long term, with complete disappearance of the pain in many cases. 

Assessing the extent of the pain and its characteristics is essential, especially before performing any surgical technique. 

In those cases where microvascular decompression surgery is not indicated, there are other less invasive techniques (percutaneous). This is done by placing a needle in the trigeminal nerve and controlled injury of the fibers that transmit the pain. In the indicated cases, the improvement is almost immediate and the results are also satisfactory in the long term.

NOMBRE DE LA FUENTE DEL ARTICULO

Introducción (origen del dolor, tipos de trastornos de columna, prevención, diagnóstico, tratamiento médico, fisioterapia, terapia física avanzada, técnicas mínimamente invasivas).

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Què és la Neuromodulació?

La neuromodulació és un camp de recerca clínico-quirúrgica que té com a objectiu restablir la funció normal de determinats circuits patològics (majoritàriament circuits del moviment o circuits relacionats amb el dolor). Aquest objectiu es pot aconseguir mitjançant l’ús de teràpies poc invasives que actuen directament sobre el nucli o nervi afectat i que en un percentatge no menyspreable dels casos poden ser molt efectives. Algunes d’aquestes teràpies inclouen fàrmacs neuromoduladors, tècniques de radiofreqüència o l’implant d’elèctrodes d’estimulació cerebral, medul·lar o radicular.

La valoració per un equip multidisciplinar és important per poder escalonar els tractaments, des dels menys invasius (fàrmacs) fins als més invasius (cirurgies), passant per teràpies intermèdies.

És important reconèixer que no tots els tipus de dolors són tributaris de teràpies de neuromodulació, i la correcta selecció del pacient és la millor garantia per obtenir un resultat clínic satisfactori.

What is Neuromodulation?

Neuromodulation is a clinical-surgical research field whose objective is to restore the normal function of pathological circuits (mostly movement circuits or pain-related circuits). This objective can be achieved using minimally invasive therapies applied to the affected nucleus or nerve, which in a non-negligible percentage of cases will be very effective. Some of these therapies include neuromodulatory medication, radiofrequency techniques or the implantation of electrodes for stimulation of the brain, spinal cord, or nerve roots.

The assessment by a multidisciplinary team is important so that the treatment can be “staggered” from the least invasive (medication) to the most invasive (surgery), passing through intermediate therapies. 

It is important to know that not all kind of pains are tributaries of neuromodulation therapies, being the correct selection the best guarantee to obtain a satisfactory result.

¿Qué es la Neuromodulación?

La neuromodulación es un campo de investigación clínico-quirúrgica cuyo objetivo es restablecer la función normal de determinados circuitos patológicos (mayoritariamente circuitos del movimiento o circuitos relacionados con el dolor). Este objetivo puede ser logrado mediante el uso de terapias poco invasivas que actúan directamente sobre el núcleo o nervio afectado y que en un porcentaje no despreciable de los casos pueden ser muy efectivas. Algunas de estas terapias incluyen fármacos neuromoduladores, técnicas de radiofrecuencia o el implante de electrodos de estimulación cerebral, medular o radicular.

La valoración por un equipo multidisciplinar es importante para poder escalonar los tratamientos, desde los menos invasivos (fármacos) hasta los más invasivos (cirugías), pasando por terapias intermedias.

Es importante conocer que no todos los tipos de dolores son tributarios de terapias de neuromodulación, siendo la correcta selección del paciente la mejor garantía para obtener un resultado clínico satisfactorio.