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“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.
Almost all patients with trigeminal neuralgia are first treated with medication. The medication of choice is carbamazepine (Tegretol). Very commonly, patients are started on a dose that is too high and that can produce significant side effects, like drowsiness, mental slowness, and imbalance. The key is to start at a low dose. I usually recommend 100mg twice a day. That dose will usually lead to rapid relief (within 24 hours) of trigeminal neuralgia, with minimal or no side effects. Over time, many patients have to gradually increase the dose to provide pain relief. As long as this is done slowly, side effects will be rare. Tegretol blood levels are NOT a useful guide when using the drug for facial pain. Routine blood tests are NOT necessary unless you start to feel unwell. In such cases, your doctor will check your blood chemistry, blood counts, and liver function as they can, rarely, be affected by this drug. Tegretol has been used for decades in large numbers of patients with epilepsy, as well as facial pain. It is safer than surgery. Surgery is reserved for those cases where medication fails to control pain or causes intolerable side effects.
Click here to check out my video on Trigeminal Neuralgia to see how to cure facial pain.
Some think that neurosurgery is just a job. Others see neurosurgery as a high tension, high skill frontier, an Everest of medicine, requiring Cushingesque, priestly, or simply obsessive levels of work and dedication.