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Surgery an option for severe face pain: experts

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Reuters Health

Monday, September 1, 2008

NEW YORK (Reuters Health) - Surgery should be considered in people who suffer from extreme, stabbing pain in the face that does not subside with medication, doctors are advised in a newly-released practice guideline on treating the condition known as trigeminal neuralgia.

"There are very few drugs with strong evidence of effectiveness in treating trigeminal neuralgia," Dr. Gary Gronseth of the University of Kansas in Kansas City and member of the American Academy of Neurology (AAN) said in an AAN-issued statement.

"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," Gronseth added.

While the excruciating, electric shock-like pain of trigeminal neuralgia typically doesn't last for more than a few seconds or a minute per episode, the episodes can last for days, weeks, or months and then disappear for months or years, according to the AAN. The pain can be triggered by shaving, putting makeup on, brushing teeth, eating, drinking, talking, or being exposed to the wind. It is more common in women than in men.

There are two types of trigeminal neuralgia: symptomatic and classic. Symptomatic, the less common of the two, is diagnosed when there is a problem affecting the trigeminal nerve, such as a tumor or plaque from multiple sclerosis. With classic trigeminal neuralgia, the more common of the two, the cause of the severe face pain is unknown and there are no other neurologic problems.

The new guideline, which is based on a systematic review of the literature on trigeminal neuralgia by a panel of experts, recommends that doctors try the drug carbamazepine 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 doctors consider sending all patients with trigeminal neuralgia for magnetic resonance imaging (MRI) or trigeminal reflex testing since up to 15 percent of patients have an underlying structural cause of the disorder, such as a tumor.

SOURCE: Neurology, August 20, 2008.

Reuters Health

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