Atypical Facial pain and/or Trigeminal Neuralgia
Have you been suffering from facial pain that is unbearable by now? You could be suffering from the complex and debilitating disorder of trigeminal neuralgia. This disorder is characterized by episodes of intense facial pain that last from a few seconds to several minutes or hours. The description of the pain is a trigger area on the face so sensitive to touch, that even airflow can trigger an episode. However, in many patients the pain is generated spontaneously without any apparent stimulation. At FLPM we understand this syndrome affects your lifestyle drastically, as it can be triggered by the most common activities like eating, talking, shaving and brushing teeth.
Trigeminal Nerve Blocks and/or Radiofrequency Ablation
These blocks can be done at the level of the periphery, or at the ganglions under fluoroscopic guidance. By doing a series of blocks, both for diagnostic as treatment purposes, eventually they can be denervated by radiofrequency ablation, creating a longer lasting relief of that aching, lancinating facial pain you have suffered for so long.
Peripheral Nerve Stimulator (PNS)
A peripheral nerve stimulator is a device used to exert pulsed electrical signals to the nerves to control chronic pain. An implantable system delivers electrical pulses via a lead to nerves. Pain signals are inhibited before they reach the brain and replaced with a paresthesia that covers the specific areas where the pain was felt.
PNS procedure involves a trial period of 4-5 days, placement of electrodes in the subcutaneous tissue, above the nerve in question. These are done in the office as an outpatient procedure. After this, the patient will have a generator to control the stimulation, giving this procedure the uniqueness that no other medical intervention has. Giving you the control, to “test drive” the device before having it done, making you “your own doctor” in deciding if the product is going or not to work. If the results are satisfactory in the trial period, the leads are removed in the office and the implantation is done as an outpatient procedure in the operating room. Usually is a one-hour procedure. Dr. Sergio Lenchig has recently published his technique for a minimal incision insertion of the stimulator, and due to the lower risk of facial nerve injury, and more minimally invasive technique, he is currently training other pain physicians that are interested in performing his technique.
Please feel free to review his publication
Pain Physician Journal
September-October 2012 – Vol 15 Issue 5
A Minimally Invasive Surgical Technique for the Treatment of Posttraumatic Trigeminal Neuropathic Pain with Peripheral Nerve Stimulation.
Sergio Lenchig, MD, Jackson Cohen, MD, and Dennis Patin, MD
Temporomandibular Joint Disorder (TMJ)
Are you feeling pain, clicking, or locking sensation when chewing or opening your mouth? Does this pain causes headaches on this same side? You could be suffering of TMJ disorder. The temporomandibular joint is susceptible to many of the conditions that affect other joints in the body, but most commonly is the degenerative arthritis, from repetitive use. This is one of the most used joints in our body. The most common cause is teeth grinding while sleep.
Temporomadibular Joint Injection
These joints are very accessible and easy to block. Most of the times the block is more for diagnostic purposes, giving you relief that if temporary, it can be denervated with Radiofrequency Ablation creating a longer lasting relief of that aching back pain you have suffered for so long. Most of the times with the simple insertion of mild steroid to reduce the inflammation the problem resolves. Further interventions like Plasma Rich Platelets (PRP) injections can be done for more complex cases.
Do you feel that throbbing pain that usually is preceded by visual blurriness followed by annoyance by light, movement, or sounds? Do you have nausea, and vomit sometimes when it occurs? You could be suffering from migraines. Even though the classification of migraines is not as simple to be documented here. The treatment is usually the same.
Preventive migraine medications are considered effective usually reducing the number of attacks and severity by 50%. Recommended initial treatment for those with mild to moderate symptoms are simple analgesics such as non-steroidal anti-inflammatories like ibuprofen, or diclofenac. With a combination of acetaminophen, aspirin, and caffeine.
The FDA says Botox injections have been shown to be effective in the prevention of migraines. With very few side effects, the usual trigger points of migraines can be injected with botulinium toxin type A (Botox), and the evidence has showed to reduce the incidence of chronic migraine headaches.