Prognosis
During the course of the disease spontaneous healing is possible, at least temporarily the disease can be controlled with medication. If the drug therapy fails, surgical procedures are available, which in most cases show a good success. Trigeminal neuralgia is not a curable disease in the classical sense.
The aim is to provide the patient with as long a pain-free or pain-free period as possible. Since nerves are very sensitive parts of the body, a complete freedom from pain is unfortunately not very often to be expected after a longer irritation, no matter whether it is caused by a herpes zoster or a constriction by a vessel. About one third of the patients with trigeminal neuralgia have a phase with pain attacks only once in their life.
Often, however, the course of the disease is progressive, i.e. the disease increases in intensity and should be treated with close medical supervision. With a well adjusted therapy, a relative pain reduction or even freedom from pain can be achieved in the majority of patients. Often there are periods without symptoms and pain, which are called spontaneous remissions. In about half of all patients, these last for half a year, in every fifth patient they even last for a year.
What are the underlying causes of trigeminal neuralgia?
The most common form of trigeminal neuralgia is idiopathic, i.e. it occurs without a recognizable cause. In rarer cases, local constriction of the nerve, for example due to arteriosclerotic changes in the vessels, leads to trigeminal neuralgia. Likewise, inflammatory processes, dental diseases, injuries to the nerve caused by surgery ́s in the visual field or a skull base fracture near the origin of the trigeminal nerve can lead to irritation of the nerve.
Stress or psysical strain can also be considered as triggers for nerve pain. In addition to the classic causes (formerly known as “idiopathic”, i.e. without a clear cause), there are symptomatic causes for trigeminal neuralgia, which are usually based on an inflammatory process. These include, for example, the systemic disease multiple sclerosis, which is responsible for trigeminal neuralgia in 3% of cases.
In this disease, the so-called marrow or myelin sheaths, which surround the nerve cords as a protective sheath, are destroyed. This process, also known as demyelination, is caused by inflammation and can also affect the trigeminal nerve. The myelin sheaths are attacked by the body’s defense cells and eventually lead to the typical inflammatory stabbing pain along the nerve.
Another possible cause of the inflammation of the trigeminal nerve is the so-called post-zoster neuralgia. This is pain in the area of the nerve and its supply area caused by a previous infection with the varicella virus. The pain manifests itself mainly when touched and is often described as stabbing or drilling.
The 3rd branch of the trigeminal nerve, the so-called mandibular nerve, supplies among other things the teeth. Its end branches even partially end in small fibers in the teeth themselves.Therefore, various diseases of the teeth, such as an abscess or extensive purulent inflammation, can cause pain in the mandibular nerve. Accordingly, the treatment of the cause, i.e. the dental disease, is in the foreground here.
In various operations in the area of the face and jaw, attention must be paid to the spatial proximity of the trigeminal nerve to the area where the operation is performed. The trigeminal nerve has several branches which sensitively innervate the entire face, i.e. are responsible for the sensation of touch and pain. If one of these branches is irritated or injured during an operation, this can lead to severe pain up to trigeminal neuralgia in the affected area.
When operating on the jaw, special attention must be paid to the maxillary and mandibular branches. When operating on the paranasal sinuses, the maxillary and frontal branches should be spared. Occasionally, the end branches of the mandibularisast can be injured during dental surgery, for example during the removal of wisdom teeth.
This happens, for example, when a nerve branch sits around a tooth, which is an anatomical exception. Therefore, one should be informed about the possible risks for the development of a trigeminal neuralgia before a corresponding operation. Nerves are among the most sensitive and susceptible tissues of the human body.
Therefore, they can be irritated and cause pain even under pronounced physical and psychological stress, as is the case with the trigeminal nerve. The diagnosis can be confirmed by various neurological tests. During treatment, relaxation techniques, acupuncture and targeted stress reduction should be considered alongside drug therapy.
Trigeminal neuralgia can be a possible manifestation of psychologically stressful problems. Many studies show that there is a great connection between the psyche of a person and his body. This is why psychological stress, especially pronounced stress, can manifest itself in the form of different types of pain in different parts of the body, including trigeminal neuralgia.
