Trigeminal Neuralgia - This is a disorder of the trigeminal or 5th cranial nerve and is one of the most painful afflictions. It's other name is Tic Douloureux which literally translates as "unbearably painful twitch." The characteristic symptom is a sharp, intense, electric shock-like pain which lasts for seconds. The pain is triggered by touching a specific area of the skin by washing, shaving, kissing, applying make-up, brushing the teeth - even cold air. The area most commonly affected is the mid-face, upper teeth and palate - where the branches of the nerve are distributed. This condition usually has no apparent cause. A less common form of this disorder is Atypical Trigeminal Neuralgia which may cause a less intense but more constant pain with intermittent shock-like stabs. Treatment for both is usually by anti-convulsant drugs as well as some anti-depressant drugs that have significant pain relieving effects. If oral medications fail, narcotic pumps can be surgically implanted to enhance pain management. Neurosurgical procedures are also available to relieve pressure on the nerve or to reduce sensitivity. Some patients report reduction of pain with alternative therapies such as acupuncture and chiropractic adjustments.

Atypical Facial Pain - Atypical Facial Pain occurs in the same areas as TN but the discomfort is different. Attacks last longer and the pain can be aching, dull or crushing. While surgery can be highly effective for TN, it is not appropriate for atypical facial pain. This disorder can be caused by infections of the sinuses or teeth as well as dental or other physical trauma.

RSD (Reflex Sympathetic Dystrophy) - This is a chronic condition characterized by severe burning pain, changes in bone and skin, swelling, excessive sweating and extreme sensitivity to touch. While it may occur without injury, it often appears at the site of an injury - particularly one of high-velocity impact. A visible sign of RSD is warm, shiny red skin that later becomes cool and bluish. The pain that patients report seems out of proportion to the injury and gets worse, not better, over time. RSD is diagnosed primarily through symptoms but sometimes X-rays and thermography (to detect changes in body temperature) are used. There are a variety of methods available to treat RSD. Injection of a local anesthetic and TENS therapy are usually the first steps used to relieve the chronic pain. In some cases, chemical or surgical sympathectomy - a procedure which interrupts the affected part of the nervous system - is performed. RSD of the neck/face region may also be treated by a special nerve injection performed by an anesthesiologist. In general, good progress can be made if treatment is begun early - usually within the first 3 months.

Phantom Tooth Pain - It's very uncommon, but patients who have a tooth extracted can have pain at the site of the extraction for months afterwards. This "toothache without a tooth" can also spread beyond the extraction site to other areas of the mouth. It is thought that changes may occur in a patient's pain threshold as a result of changes in surrounding nerves following an extraction. Patients who suspect they may have phantom tooth pain should consult a specialist in orofacial pain such as Dr. Greenberg. Often, when pain spreads, dentists who do not consider the possibility of phantom tooth pain may suggest more procedures including root canal and extracting other teeth, which may not be necessary. Additional procedures should not be done until the diagnosis of phantom tooth pain is ruled out.

For more information on Trigeminal Neuralgia and other types of facial pain, visit the Trigeminal Neuralgia Association website at www.tna-support.org