Dear Dr. Roach: I am a 76-year-old male. A few months ago, I suddenly had the worst pain in my life, centred in the right side of my tongue, of all places. It felt like a live electrical wire was touching my tongue. It was excruciating.
I had been to a dentist the week before, but only to have the covering replaced on an implant crown. There was no injection or anesthesia needed. Could I have opened my mouth a little too wide and injured a nerve?
After three urgent care visits, I was placed on gabapentin and viscous lidocaine. I finally got to see an ENT doctor, who immediately diagnosed my condition as trigeminal neuralgia. Gradually, the condition went away.
But, I’m wondering, what causes trigeminal neuralgia in the first place, and will it return?
W.W.
“Trigeminal” means “born in threes” (such as triplets) and refers to the fact that the trigeminal nerve, also called the fifth cranial nerve, has three roughly equal divisions: V1 (the ophthalmic nerve), V2 (the maxillary nerve) and V3 (the mandibular nerve). Trigeminal neuralgia (TN) is a syndrome of nerve pain coming from one or more branches of the trigeminal nerve.
The electrical shock sensation you have is common in TN, and in nerve disorders in general (many people worry about circulation with this symptom, but it is nearly always due to nerve pain).
In TN, the pain often goes and comes, sometimes a few times, sometimes more than 50 times a day. However, some people have continuous pain. Pain in the V2 and V3 distribution are often misdiagnosed as dental problems, and I have seen people come in with dental extractions that failed to help the symptom.
The underlying cause of TN, when it can be found, is most commonly compression of the nerve, usually in the brainstem where the nerve root starts. A blood vessel compressing the nerve root is thought to account for 80% to 90% of cases.
Gabapentin, an anti-seizure medicine often used for nerve pain, is one treatment, as is another antiseizure medicine, carbamazepine. Pain management specialists might be very helpful. Surgery is sometimes used in patients with TN who cannot be helped adequately by pain medications, and although it is often initially successful, pain might recur years after surgery. Surgery might also have complications.
I recommend a support group for trigeminal neuralgia, such as facepain.org and livingwithfacialpain.org.
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