“Anesthesia dolorosa” is Latin for “painful numbness.” When we perform a radio frequency lesion, we deliberately make the painful part of the face numb. It’s exactly the same feeling as a novocaine injection. The vast majority of patients find the numbness to be vastly preferable to the pain of trigeminal neuralgia. Usually they rapidly adjust to the numb feeling. A small number of patients, however, find the numbness to be very painful. They describe the feeling as “woody, thick, burning, crawling.” In fact, this is what novocaine feels like. Once the nerve is numb there is no reliable surgical treatment for anesthesia dolorosa. In about half the cases, the numbness gradually fades, the anesthesia dolorosa goes away, but the trigeminal neuralgia recurs.
If you have had novocaine for dental procedures and remember that feeling as particularly uncomfortable, you may not want to have a radio frequency lesion for trigeminal neuralgia. Painful numbness can also follow microvascular decompression or radiosurgery, although less frequently.
I have found the patients with anesthesia dolorosa often feel better after taking an older antidepressant medication called Elavil. This medication works directly on the pain and also on the depression which frequently accompanies chronic pain.