There are so many types of facial pain, such as suicide disease (trigeminal neuralgia), post-herpetic neuralgia (shingles), temporomandibular joint pain, trigeminal neuropathy, and cluster headaches. Facial pain is a common everyday experience of nearly one-quarter of Americans.
What is Trigeminal Neuralgia?
Trigeminal Neuralgia is often medically referred to as tic douloureux and is generally referred to as Suicide disease.
It’s an unusual condition relative to other causes of facial pain, and because of this characteristic excruciating pain, people prefer to think and even acknowledge suicide tendencies.
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The disease is a very painful illness that affects the trigeminal nerve, which is the nerve that passes the sense of pain and touches from the face and the eye to the brain. One to three branches of the trigeminal nerves are affected by suicide disease.
Suicide disease is a form of neuropathic pain.
Types Of Suicide Disease
There are two main types of suicide disease: Typical trigeminal neuralgia and Atypical trigeminal neuralgia.
Typical trigeminal neuralgia
Former (typical trigeminal neuralgia) is a type that results in episodes of sudden, shock-like, intense pain on one part of the face that may last for a few seconds.
A group of these episodes may occur over few hours in this form of suicide disorder.
Atypical trigeminal neuralgia
The atypic type, on the other hand, results in a persistent burning pain that is less intense.
Both types of suicide disease may occur in the same individual. Painful symptoms may be either lateral or bilateral. And the episodes can be caused by a slight touch of the face.
Suicide disease is one of the most debilitating disorders known to humans and medicine, but it remains surprisingly enigmatic to many physicians and practitioners.
Brief History Of Trigeminal neuralgia
Suicide disease (Trigeminal neuralgia) was first identified by physician John Fothergill and was first surgically treated by John Murray Carnochan; both gentlemen were graduates of the University of Edinburgh Medical School.
The term “suicide disease” was first coined in Harvey Cushing’s studies involving 123 cases of Trigeminal Neuralgia in 1896 and 1912. The disorder recorded an annual incidence of 4.3 per 100,000 people, with a small predominance in the female generation.
The peak occurrence is 60-70 years of age and classical trigeminal neuralgia is rare prior to age 40.
Causes Of Suicide Disease
Suicide syndrome is a disorder of nerve pain and has other names, such as Prospalgia, Fothergill’s disease, and Tic douloureux.
The disorder is said to have an unknown origin, although some physicians suspected that the etiology of the suicide disease involved the loss of the trigeminal nerve myelin or any of its branches (ophthalmic, maxillary, and mandibular nerves).
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The Trigeminal nerve is a mixed cranial nerve that relates the sensory data of pressure, temperature, and pain from the face above the jawline.
This nerve is also responsible for the motor activity of the muscles involved in chewing but not for facial speech (the muscles of mastication).
The loss of myelin is believed to be due to compression of the blood vessels as the nerve comes from the brain stem, most commonly the upper cerebellar artery, compressing against the microvasculature of the trigeminal nerve close to its connection with the pons.
Such compression can result in damage to the myelin sheath that protects the nerve (demyelination) and causes erratic and hyperactive nerve dysfunction.
This malfunction is the cause of pain attacks at the slightest stimulation of the region served by the nerve and also the cause of hindrance of the nerve ability to shut off the signals of pain after the stimulation has ended.
Demyelination is hardly due to an aneurysm (a blood vessel outpouring), stroke, multiple sclerosis, or trauma. Less widely known causes of suicide syndrome include tumor or arteriovenous malformation.
Suicide disorder is seen in 3-4 percent of patients with multiple sclerosis who are theorized to be due to spinal trigeminal complex injury. Trigeminal pain has a common appearance in people with and without multiple sclerosis.
Symptoms of Suicide Disease
One of the main signs of suicide disorder is extreme pain on one or both sides of the face, which usually lasts for a few seconds.
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The pain is so great, generally around the eye, lips, cheeks, and lower part of the face, that it can lead to suicidal impulses in patients.
Pain can be caused by:
- Shaving, washing, or wind
- Touching, talking, or rubbing the face
- Brushing of teeth or hair
- Chewing, drinking, or eating
- Involuntary facial expressions, such as yawning and smiling.
Diagnosis of Suicide Disease
The diagnosis of suicide syndrome is based on the patient’s medical history, the examination of the symptoms presented by the patient and the explanation of the pain.
Magnetic resonance imaging (MRI) is also very helpful in diagnostic confirmation and differential diagnosis. In most cases, blood vessels can be seen rubbing against the trigeminal nerve.
Differential Diagnosis For Trigeminal Neuralgia
Some other conditions that are used as a differential diagnosis after careful examination can show local findings that suggest otitis, sinusitis, or dental disorders.
Some conditions present a history of persistent pain lasting more than two minutes.
Some of these conditions include:
- Giant cell arteritis: Persistent pain and bilateral jaw claudication
- Glossopharyngeal neuralgia: Pain in tongue, mouth, or throat, brought on by swallowing, talking, or chewing.
- Dental pain (caries, cracked tooth, pulpitis): Localized pain related to biting or hot or cold foods, visible abnormalities on oral examination.
- Cluster headache: Longer-lasting pain (orbital or supraorbital); may cause the patient to wake from sleep, autonomic symptoms.
- Intracranial tumors: May have other neurologic symptoms.
- Migraine: Longer-lasting Pain closely associated with photophobia.
- Otitis media: localized ear pain, visible abnormalities on examination, and tympanogram.
- Multiple Sclerosis: Eye symptoms and other neurologic symptoms.
- Trigeminal neuropathy: Persistent pain associated with sensory loss.
- Temporomandibular joint syndrome: Persistent pain, localized tenderness, and jaw abnormalities.
- Postherpetic neuralgia
- Paroxysmal hemicranias
- SUNCT (Shorter lasting, Unilateral, Neuralgiform, Conjunctival injection, and Tearing).
Treatment Of Suicide Disease
Suicide disease is treatable and various definitions of therapeutic procedures, whether medical or surgical, have been recorded.
If half of the pain decreases compared to baseline readings with pharmacological treatment, it is considered to be a success. However, measurements are different from surgical research.
Complete pain relief is one of the main objectives of the treatment of Suicide disease. Anticonvulsant like carbamazepine is the first line of medication; the second line of drugs contains lamotrigine, baclofen, oxcarbazepine, phenytoin, pregabalin, and gabapentin.
Antidepressants such as amitriptyline have shown good efficacy in the treatment of trigeminal neuralgia, particularly when combined with an anticonvulsant drug such as pregabalin.
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Duloxetine, with some evidence, has been shown to be an effective medication for neuropathic pain, particularly in patients with major depressive disorders, as it is an antidepressant. However, it can by no way be considered the first line of drug treatment and can only be used on the recommendation of a doctor.
Surgically, microvascular decompression offers pain-free treatment in about 70 percent of cases of drug-resistant trigeminal neuralgia.
In nearly all cases, pain relief is observed following surgery, but there is also a chance of the pain returning, adverse effects such as facial numbness, and permanent nerve damage.
Surgical procedures for suicide syndrome are categorized into non-destructive and destructive procedures.
Non-destructive Surgical Procedures
Microvascular decompression: This includes making a small incision behind the ear and extracting some of the bones from that spot. A cut through the meninges is made to expose the nerve, and any vascular compression on the nerve is carefully moved, and a sponge-like pad is put between the vascular compression and the nerve.
The pad prevents undesired pulsation and helps the myelin sheath to recover.
Destructive Surgical Procedures
All surgery in this category can induce facial numbness, post-relief, as well as pain relief. They may include:
- Balloon compression: inflation of a balloon at the nerve point causing damage and stopping pain signals.
- Glycerol injection: deposition of a corrosive liquid called glycerol at the nerve point that causes damage to the nerve to hinder pain signals.
- Radiofrequency thermo-coagulation rhizotomy: application of a heated needle to damage the nerve at this point.
- Stereotactic radiosurgery: a form of radiation therapy that focuses high-power energy on a small area of the body.
- Percutaneous techniques: a procedure in which the nerve responsible for the pain is destroyed by needle puncture.
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Complication Of Suicide Disease
Some complications that can occur in the course of suicide disorder (trigeminal neuralgia) treatment or management are as follows:
- Lack of relief and recurrence of neuralgia are the primary risks with suicide disease treatment.
- Abnormal facial sensation (facial dysesthesia)
- Facial numbness
- New facial pain
- Corneal anesthesia
- Weakness in jaw muscles (masseter weakness)
Microvascular decompression has additional risks that include:
- Anesthetic side effects such as headache, confusion, and Nausea.
- Surgical risk such as Hemorrhage, blood clots, injury to the brain stem, injury to the cerebellum, infection, and cerebrospinal fluid leakage.
Some Prominent Cases Of Suicide Disease
Some of the prominent cases of suicide that have provided substantial evidence and acted as a guide include:
- Salman Khan, an Indian Bollywood film star, was diagnosed with suicide disease in 2011. He underwent surgery in the United States. He shared that at one point he felt suicidal, even though he channeled his energies and worked harder. He said, “This is one disease that essentially has the highest suicide rate… There’s so much pain going on… I’ve suffered that…”
- Minister William Gladstone, the four-time British Prime Minister, is thought to have had the suicide disorder.
- Author Melissa Seymour was diagnosed with suicide disease in 2009 and underwent microvascular decompression surgery in a well-documented case covered by newspapers and magazines to help create an awareness of the disease.
- Christy Toye, an All-Ireland-winning Gaelic footballer, was diagnosed with suicide in 2013. The soccer player spent all five months in his bedroom at home and returned to the season in 2014 and lined up for another All-Ireland final with his side.
- In 2004, an African singer and songwriter, famous in the 1990s, Anneli van Rooyen was diagnosed with atypical trigeminal neuralgia. During surgery in 2007, surgery aimed at alleviating her condition went wrong, and the superstar suffered permanent nerve damage, which led to her complete retirement.
- British author, human rights activist, magistrate, founder, and president of Freedom Charity, Aneeta Prem, began to experience bilateral Trigeminal neuralgia in 2010, with extreme pain and subsequent sleep deprivation. Her condition remained undiagnosed until seven years later, and MVD surgery to alleviate pain on the right-hand side was performed at UCHL in December 2019.
- Drummer of the Rock band Blink, Travis Barker also suffered from Suicide disorder.
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Social and psychological help has been shown to play a key role in the treatment of chronic disorders and pain problems, such as suicide disease.
Chronic pain can frustrate both the sufferer and those around them. As a result, there are many support groups that can help a person deal with the disorder.
- Trigeminal Neuralgia: https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/symptoms-causes/syc-20353344
- Trigeminal Neuralgia: https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Trigeminal-Neuralgia
- Trigeminal neuralgia: https://www.nhs.uk/conditions/trigeminal-neuralgia/
- Trigeminal Neuralgia: https://www.healthline.com/health/trigeminal-neuralgia