An agonizing sizzle of pain snakes through one side of your face. You can't explain it, but it seems to happen anytime you attempt to wash your face, shave, brush your teeth, or chew; even the brush of a cool breeze against your face may set off an excrutiating, electric shock-like burst of temporarily incapacitating pain.

Those who suffer from what one local doctor says are signs of a lingering nerve disorder will try anything to get rid of it, even asking a dentist to remove teeth they are convinced are the source of this facial pain.

'One of the worst pains'

"It's said to be one of the worst pains you can have. Some people think it's a dental problem, but it is found to be lingering trigeminal neuralgia. Anything can trigger the pain, and they often can't wait," said Dr. Carol Benoit of Neurology Associates of South Carolina in Orangeburg.

"The first line of defense is for the patient to be educated. It's probably the most important thing they can do," Benoit said.

Trigeminal neuralgia is a disorder of the trigeminal nerve, the fifth and largest of the cranial nerves. The trigeminal nerve is divided into three branches: the mandibular nerve which controls sensation in the lower jaw bones which assist in chewing; the maxillary nerve which controls sensation in the upper jaws, where most of the teeth are in higher vertebrates; and the ophthalmic nerve which provides sensation to the eyes, particularly the cornea.

"You would not want to lose sensation there because you could scratch the cornea, it could scar, and you could go blind from that. Sensation is very important here and everywhere in the body," Benoit said.

Trigeminal neuralgia, however, is a disorder marked by a "wearing out" of the nerves and usually occurring in the lower maxillary and mandibular branches, she said.

"That's all I know. We usually don't know why. It's usually found in people age 60 and older. They come to me and say that they have this terrible pain that usually goes into their nose, upper lip, jaw, teeth, and cheek. It's typically triggered by touch. Sometimes men will have one particular area that triggers it, so they'll shave everything else and have hair growing on the painful spot because it is so unpleasant. Since eating is a bilateral affair, sometimes people won't eat until they start losing weight. I'm very careful examining them because I know I'll probably trigger it," Benoit said.

Pain can vary in severity, with some patients having mild pain that is not always triggered with usual daily activities. While some people may have it for a month, after which it "pretty much stays gone," Benoit says others endure pain for years.

"It can be seen in multiple sclerosis, but that's uncommon. I think I've seen that once in over nine years of practice. I would be suspicious when a younger person came with it," Benoit said, stressing that the unnecessary extraction of teeth is one of the biggest tragedies of the disorder.

"The pain still continues and people have lost their teeth. I hate to see that happen. I think if a person went to a dentist and said, 'I have this pain that's growing everytime I wash my face or brush my teeth, and it's like electric shock,' the dentist would probably recognize it for what it was," she said.

She also instructs people to consult their physician with their complications.

"Your family practitioner ought to know and send you to a neurologist rather than a dentist, or you can directly request an appointment with a neurologist," Benoit said.

'Not a life-threatening condition'

The trigeminal nerve is responsible for chewing, producing saliva and tears, and for sending facial sensations to the brain. In trigeminal neuralgia, when the nerves "short circuit" usually on one side of the face, the pain is often unbearable, Benoit said.

"This is not a life-threatening condition ... except for people who wished they had died. If left untreated, it can get a lot worse. It damages the nerve overtime, and you'll have a constant dull ache. Once we get people on medication, they're a lot better," she said.

Various treatments have been tried, Benoit said. "Drug treatment can reduce the sensitivity of the nerve. The current drug of choice among neurologists is Neurontin, but drowsiness is among its side effects," Benoit said.

The anti-epilepsy medicine Tegretol is also used. While some "never really get the pain controlled," she encourages those who may become completely pain-free to get off their medication "after a month or so."

Neurosurgical treatment may free the trigeminal nerve from whatever is compressing it. Benoit said research indicates that a blood vessel filled with cholesterol plaque may be lying against the base of the nerve root, with the surgical procedure involving doctors "going in and putting little slugs of cotton underneath the vessel."

"Success has not been stellar. I think most of the time it doesn't help. Most people do fine with medication. But if surgery ... is required, then that's done by a neurosurgeon," she said.

Another treatment used is radial frequency ablation, a procedure through which doctors induce radio-frequency waves, gamma rays, or glycerol injections to deaden the nerve -- and the pain.

"They basically cook part of the nerve with a high frequency radio wave. The goal is to kill the pain fibers and not the ones that carry other sensation like touch. This is variably successful, and there's definitely a risk of being left with half your face numb. Since they can't go in at the microscopic level and just take out the pain nerve, sometimes the pain does come back," Benoit said.

"Also, acupuncture is an incredibly respected modality that's been around for 3,000 years," she said.

Checking patients for diabetes and vitamin B deficiencies, however, are part of her own holistic approach to treating patients.

"My approach is to make sure that there's not something else going on that makes the nerves all over the body not function right and less apt to tolerate some kind of abnormality going on in the brain stem. I'm certain that when I do find something like that, I can help the person to respond better to the medication, or maybe even recover by correcting what's wrong," she said.

T&D Staff Writer Dionne Gleaton can be reached by e-mail at dgleaton@timesanddemocrat.com or by calling 533-5534.

You must be logged in to comment.