What Is the Trigeminal Nerve?
The Trigeminal Nerves are a group of nerves that originate on the brain stem. The brainstem is the uppermost part of the spinal cord as it exits the skull, and has a set of 12 nerves that comprise the cranial nerves. These nerves supply various functions of the head and face.
The Trigeminal nerve is the fifth cranial nerve and it splits into three branches:
These three branches of the trigeminal nerve are the ophthalmic, maxillary, and mandibular, respectively, and they provide sensation to the skin and motor functions to the muscles in each of these zones.
What is Trigeminal Neuralgia?
Trigeminal Neuralgia (TN) is denoted by the suffix “-algia,” meaning pain. Trigeminal Neuralgia refers to sudden, severe pain presenting on the face in one or all of the three branches. It is most commonly felt in the lower part of the face.
The onset of TN is varied and unknown. It usually begins as mild numbness and tingling and progresses to electrical bursts of pain. The associated pain episodes can last for several seconds to a couple minutes, with respites between episodes. The pain episodes can be triggered by very mild stimuli like hair brushing the cheek, brushing teeth, or chewing. Many people afflicted with TN ultimately have pain that eventually becomes constant.
TN is infamously severe, in fact “The intensity of the pain is exceptional: Some people report it to be more severe than experiencing a heart attack, passing a kidney stone or even giving birth(1).”
How is Trigeminal Neuralgia Diagnosed and Treated?
TN is diagnosed by your healthcare provider through a history and physical examination. The collection of information regarding onset and symptoms is the gold standard for how a physician would identify TN. There is no specific text that can identify TN. However, a physician may order a specific type of MRI that would be able to visualize if there is compression of a blood vessel at the trigeminal nerve root.
When a patient seeks relief from TN, the most common course of treatment is medication. Traditional over-the-counter medications have limited impact on TN pain, so medications for nerve relief, like gabapentin, are utilized.
Sometimes the medications don’t work long term. Sometimes a patient’s pain is recalcitrant to improvement from these medications, or the side-effects are intolerable, so they seek more interventional measures. This includes nerve blocks or even surgery.
A nerve block would include a corticosteroid injection around the trigeminal nerve to decrease the pain. A possible surgery would be a rhizotomy. A rhizotomy is where an electrical or chemical agent is used to ablate or deaden the nerve. The issue with these options is they seek to weaken or destroy the nerve that supply vital functions to the skin and muscles of the face.
Another surgery option for TN is Microvascular decompression (MVD) surgery. MVD is regarded as the most long-lasting treatment for trigeminal neuralgia caused by blood vessel compression, and it helps about 80% of people with this diagnosis confirmed by Magnetic Resonance Angiogram (MRA) (2). The goal of this surgery is to place a teflon cushion between the blood vessel and nerve where there is excessive compression causing pain.
Another avenue for managing TN is through alternative medicine, like acupuncture or dry needling for trigger points, or regenerative medicine.
Although the impact of Platelet Rich Plasma (PRP) hasn’t been explored by studies, a few case studies are out there. The main logic behind PRP for TN would be this type of procedure offers a solution that spares the nerve. PRP bathes the nerve root in growth factors that could decrease the pain caused by that nerve. This technique has been used in carpal tunnel and is illustrated in this article, which also provides a case study for a successful treatment of TN with PRP.
Additionally, PRP is routinely used in the management of nerve pain, as in the case of lumbar spine radiculopathy. For example, there are “12 studies using platelet products (including PRP and platelet lysate) have been published on lumbar epidural use to treat radiculopathy (4).” The treatment of treating any overactive painful nerve condition is an analogue to the case of TN, suggesting it could yield similar benefits.
The Takeaway?
TN is an extremely painful and frustrating condition. The treatment options range from medication to interventional to alternative methods. If TN is diagnosed as having a root in neurovascular compression, an evidence-based option for relief is the invasive MVD surgery. However, this option is not promising if the MRA doesn’t find neurovascular compression at the root – and if it does, this is an invasive major surgery.
In the realm of regenerative medicine, where Platelet Rich Plasma (PRP) is routinely used to treat nerve pain conditions, and this is a viable option to explore for TN. If you or someone you love is suffering from trigeminal neuralgia and you are exploring the best ways to manage and treat this condition, our physicians at Regenexx at New Regeneration Orthopedics of Florida in Tampa, Orlando, St. Petersburg, and Sarasota would be a great place to start.
References:
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/trigeminal-neuralgia
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002644/
- https://regenexx.com/blog/new-treatment-for-trigeminal-neuralgia/
- https://regenexx.com/blog/can-prp-injected-around-nerves-cause-serious-scar-tissue/
