Trigeminal neuralgia

 This is posted with the Consent of this gentleman suffering from Trigeminal neuralgia.

The trigeminal nerve is one of the 12 cranial nerves ( fifth ) that innervates the face and head namely upper and lower Jaw, orbit and eyeball, and cheek.

Both sensations and muscle movements.

There is a condition of this trigeminal nerve by inflammation causing severe chronic pain called Neuralgia.

This inflammation could be by many causes like compression of the nerve by a blood vessel impinging on it a tumor or cyst decreased blood supply to the nerve sheath, or trauma like in post-dental procedures.

This type of chronic pain ( lasting more than 6 months is chronic pain ) is called neuropathic pain.

It's excruciating generally on one side @ to nerve distribution and exhausting.

It sometimes is associated with reflex muscle movements or tics hence called tic dulorex.

The pain can come in waves for a few days triggered by a touch or food movements or even a cold wind and lasts for some time and with relief or no pain at times.

If an obvious compression is made out surgical methods could be used to relieve or radiofrequency ablation of interventional pain management by destroying part of nerve.

Medical treatment with mainly anti-epileptic ( used in seizures ) help.

There are other analgesics and in severe cases, even low doses of narcotics are given for relief.

Mr. M ......came to me in Indira Gandhi Cooperative Hospital referred by a neurosurgical colleague about a year back.

Luckily my combination of medications including a not-much-used topical ( patch ) semi-opioid has helped him so much.

He is one satisfied patient I have who calls me just to tell me he is pain-free and happy going about his work.

At his age quality of life and freedom from pain are our two aims

To an extent, I have succeeded in achieving that for him.

I am posting this just to just remove the impression that Palliative medicine is just tender loving care for dying patients as many believe,

that's called Terminal care which too is part of Palliative medicine.

Chronic pain management using the right combination of medicines including narcotics like Morphine and fentanyl judiciously for several chronic conditions is very much a part of Palliative medicine.

Communication and inclusion of family in the treatment process and feedback from patients are very important and my availability round clock by mobile by me gives them trust and confidence.

Even in cancer patients, many have severe pain during diagnosis and treatment and they could get completely cured of it if in favourable stages and pain management supports them during treatment but can be stopped once the cause gets cured.

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26Simi PM, Thomas Antony and 24 others