Dr. Raymond Sekula and Dr. Chris Winfree Partner with the Facial Pain Association (FPA) for October's Face Pain Awareness Month
Resources for Patients Across the Face Pain Spectrum
October is Facial Pain Awareness Month and our experts Dr. Raymond Sekula and Dr. Christopher Winfree have partnered with our colleagues at the Facial Pain Association (FPA) to share the latest resources for patients and their families dealing with face pain.
Dr. Sekula and Dr. Winfree co-authored, "Reflections on the Facial Pain Patient: Journey and Treatment Options," as featured in the FPA's Quarterly Journal. Please find an excerpt of their article below.
Together Dr. Sekula and Dr. Winfree have co-authored, "Reflections on the Facial Pain Patient: Journey and Treatment Options" as featured in the FPA's Quarterly Journal. Please find an excerpt of their article below. Full report linked here
When Lightning Strikes
Most patients remember the day their pain began - it's that bad. Many patients report, "It's the worst pain you've ever imagined." That's sobering and drives our intentions to help as many patients with facial pain as possible. In the Center for Brainstem and Cranial Nerve Disorders at Columbia University, we have joined experts in neurosurgery, neurology, radiology, anesthesia, oromaxillofacial surgery, and pain management, along with a variety of other distinguished researchers to develop a true center of excellence for facial pain sufferers.
Our research begins with our patients. We actively follow over 1,500 patients undergoing one or more surgical treatments for trigeminal neuralgia. We also have an active preclinical (i.e., research conducted typically on laboratory animals) research program funded through the National Institutes of Health. Currently, we are investigating areas ranging from dysfunction of specific ion channels to abnormal electrical currents within cells of small animals and humans with trigeminal neuralgia. This work is fundamentally directed toward discovering new drugs for various facial pain syndromes.
In the clinic, we are working to better understand which patients with trigeminal neuralgia (TN) can benefit from surgical intervention. We know that patients with classical trigeminal neuralgia (CTN) fare better with most of the available surgical treatments than those with other types of TN. Information gleaned from a detailed history (i.e., a short conversation between patient and physician) allows the physician to diagnose classical trigeminal neuralgia (CTN). Patients with cTN describe sharp, intermittent facial pain usually lasting seconds or less and never longer than a minute. This pain does not encompass the posterior third of the scalp or the ear. Triggers include innocuous stimuli such as light touch, wind, or chewing. Attacks may occur numerous times daily with periods (i.e., days to months) of remission. Sensory deficit (i.e., orofacial numbness) is not a related symptom.
When It Is Not Classical Trigeminal Neuralgia
Although many effective pharmacologic, interventional, and surgical strategies are available to treat classic trigeminal neuralgia, many patients have facial pain that does not so readily respond to these treatments. Many types of facial pain syndromes are quite different from classical trigeminal neuralgia. Because these pain syndromes are different than trigeminal neuralgia, they have different treatments than trigeminal neuralgia.
Some patients have constant facial pain. These patients can have pain that is always present, perhaps burning or numbing in nature. Sometimes patients with classical trigeminal neuralgia develop a continuous burning pain after destructive procedures used to treat the lancinating pain. In many cases, the lancinating pain disappears but is unfortunately replaced by a different, constant pain syndrome. This type of pain is called trigeminal deafferentation pain. Some patients describe this pain as worse than the original trigeminal neuralgia lancinating pain since the pain is relentless and never goes away.
Some patients have facial pain that persists after a zoster outbreak in the face. This pain is often associated with severe itching, numbness, and burning. Although the pain usually fluctuates in severity, it is almost always present to some degree. This type of pain is known as trigeminal postherpetic neuralgia.
Some patients develop severe neuropathic facial pain following injuries to the trigeminal nerve or one of its branches. These nerve injuries can occur with trauma to the face, surgery to the face, or dental procedures. The patients often describe numbness in part of the face following the procedure or injury. Patients often report burning pain that develops in the numb area several weeks after the injury. This pain syndrome is called trigeminal neuropathic pain.
Patients with these constant facial pain syndromes may benefit from some combination of anticonvulsants, antidepressants, baclofen, medical marijuana, and topical medications. Sometimes nerve blocks and Botox injections can be helpful. Patients who do not obtain sufficient pain relief with the strategies often are referred to a neurosurgeon for more definitive management of their pain syndrome.
It is essential to remember that the constant neuropathic facial pain associated with these syndromes typically does not respond well to the traditional surgical treatment for classical trigeminal neuralgia. Microvascular decompression is usually ineffective and destructive procedures may make the pain worse. You and your physician must be aware of the different treatments available to treat these constant pain syndromes and avoid unhelpful surgical treatments that may worsen the pain.