[Trigeminal neuralgia-how patients experience their condition disease.]

Effective treatment of patients with trigeminal neuralgia is often a long and complicated procedure. The symptoms of trigeminal neuralgia are clearly defined in most cases. Sudden and brief episodes of severe and stabbing pain (tic douloureux) occur, with pain usually starting from a trigger point. Recent reports suggest 80-90% suppression of pain with various treatment regimens, which seems to indicate that the diagnosis and successful treatment of the disorder are no longer a major problem. In fact, however, the intense suffering of patients and isolated reports in the literature suggest that there are still considerable diagnostic difficulties. Patients are referred from one specialist to another, in most cases without the necessary interdisciplinary cooperation, and countless interventions and attempts at therapy not only remain unsuccessful, but may cause serious adverse effects.

The records of 120 trigeminal neuralgia patients in two different areas of Germany were analysed retrospectively. In addition, the course of the disorder from the initial symptoms up to the institution of effective therapy was documented by means of information obtained from the general practitioner or other physicians. The patients themselves were also interviewed about their history.

After a so-called pain career of 51/2 years, each patient had taken an average of 4,000 pills or capsules, 2,500-3,000 of which were carbamazine, lost 1-2 healthy teeth in attempts to treat the painful condition, undergone three or four maxillofacial or ENT operations, or been subjected to exeresis. The result is prolongation and exacerbation of suffering and an apparently hopeless situation. The financial burden on the patients and the health insurance companies is enormous.

Apparently there is a considerable need for more information about the clinical symptoms, cause, diagnosis and therapy of trigeminal neuralgia, especially as the symptoms are often no longer typical because they have become chronic or are the result of previous treatment. This is needed by all specialists involved, including dentists and general practitioners. In patients in whom clinical criteria suggest the diagnosis of trigeminal neuralgia, drug treatment should be initiated immediately in consultation with the neurologist or neurosurgeon. For cases in which drug treatment fails or resistance to the drug develops surgical treatments are available, such as non-destructive microvascular decompression or thermocoagulation of the gasserian ganglion.