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Relieving facial pain

Imagine feeling pain whenever you smile, speak or eat, and you can appreciate what thousands of women with chronic facial pain disorder go through every day. This unusual condition, which is slightly more common in women than men, can have two different causes. The first, trigeminal neuralgia (TN), sends sudden bursts of pain into the forehead and cheeks and around the mouth. It’s a chronic ailment, named after the trigeminal cranial nerve that carries sensations from the face to the brain.

The second ailment, temporomandibular joint disorder (TMD), causes pain in front of the ears where the jaw attaches to the skull. Normally, a fleshy disc helps this “hinge” move freely, but in TMD the disc breaks down or becomes inflamed.

TN: Pinched facial nerve

Almost nine in every 10 cases of TN result when an artery pinches the trigeminal nerve. Other causes include tumors, multiple sclerosis or viral nerve damage from shingles.

Symptoms range from mild twinges to electric, shocklike bursts. An attack may last a few seconds or several minutes. Most TN strikes only the right side of the face and never both sides at once.

The most vulnerable zones are the lips or gums. Triggers include:

  • touching the face
  • chewing, smiling or talking
  • being exposed to cold or windy weather
  • drinking hot or cold beverages
  • showering
  • teethbrushing
  • applying makeup

Doctors look at the patient’s symptoms and pain history to diagnose TN. A magnetic resonance image may be taken to rule out tumors, multiple sclerosis or an aneurysm.

To treat TN, doctors first prescribe medications—in TN’s early stages, they’re effective up to 80 percent of the time. But 30 percent of patients become resistant to the drugs, causing them to require other therapies such as:

  • Blocks. Alcohol injections at the pain sites can block attacks for months. Injections can be repeated as needed.
  • Balloon compression. A balloon-tipped catheter inside the skull presses and damages the trigeminal nerve to deaden pain.
  • Thermal rhizotomy. A tiny heated electrode damages the trigeminal nerve inside the skull to short-circuit pain impulses.
  • Surgery. Surgeons can reposition or sever the nerve where it joins the brain or use a noninvasive gamma knife to snip the nerve with radiation.

TMD: Pain in the jaw

TMD is a jaw disorder with a variety of causes: arthritis, stress, teeth-grinding, faulty dentures, overuse or “mandibular trauma”—doctor-speak for a blow to the jaw.

The condition is marked by tenderness along the jaw, headaches, aching near the ears and popping sounds while chewing. Pain can range from mild to extreme.

Doctors and dentists diagnose TMD by analyzing a patient’s bite and dental records and by listening to the jaw as it moves. An MRI or X-rays can reveal if the jaw has any unusual features.

Treatment for mild cases might involve simply resting the jaw, taking pain relievers and eating soft food. For more advanced cases, however, healthcare providers might use:

  • Shots. Corticosteroid injections into the jaw hinge can quickly relieve severe pain and swelling.
  • Dental work. Dentists can reshape and repair bite problems by adding and removing tooth surfaces or installing a bite plate that realigns the jaws.
  • Mouth guards. An orthodontic mouth guard worn during sleep usually stops teeth-grinding.
  • Surgery. As a last resort, doctors can operate to repair the jaw hinge.
  • Self-management. Relaxation techniques such as deep breathing, meditation and yoga help relieve taut jaw muscles caused by stress. Doctors also suggest avoiding gum, caramels, peanut butter and tough-to-chew foods that can strain the jaw.