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Trigeminal neuropathic pain
1Division of Neurosurgery, Oregon Health Sciences University, Portland.
Acta Neurochirurgica. Supplementum
|January 1, 1993
Summary
Typical trigeminal neuralgia involves episodic facial pain, while trigeminal neuropathic pain presents as constant, unremitting pain. Distal nerve injuries are linked to neuropathic pain, unlike typical neuralgia originating from the nerve root entry zone.
Area of Science:
- Neurology
- Neurosurgery
- Pain Medicine
Background:
- Typical trigeminal neuralgia (TN) presents as episodic, unilateral, lancinating facial pain.
- Trigeminal neuropathic pain (TNP) is characterized by constant, unremitting unilateral facial pain.
- Atypical TN is an overlap syndrome with features of both typical TN and TNP.
Purpose of the Study:
- To differentiate between typical TN, atypical TN, and TNP based on clinical presentation and underlying pathology.
- To explore the hypothesis that distal trigeminal nerve injuries cause TNP, similar to other peripheral nerve lesions.
Main Methods:
- Review of clinical syndromes associated with distal trigeminal pathology in 122 patients.
- Comparison of proposed mechanisms for typical TN (proximal REZ pathology) and TNP (distal nerve injury).
Main Results:
- Distal trigeminal pathology correlated with the clinical syndrome of TNP.
- Peripheral trigeminal nerve lesions are hypothesized to cause sensory loss, deafferentiation, and non-tic-like pains.
- Typical TN may be an exception to the general rule that nerve injuries cause constant pain and allodynia.
Conclusions:
- TNP is a syndrome resulting from painful injury to the distal trigeminal nerve.
- The proposed mechanism for TNP involves asynchronous axonal activity dispersion from peripheral pathology.
- Typical TN likely results from proximal pathology at the trigeminal nerve root entry zone (REZ).