Trigeminal Neuralgia (tic douloureux)

Explanation of Disease condition of the fifth cranial nerve that is characterized by paroxysms of pain in the area innervated by any of the three branches ,but most commonly the third and the second branches of the trigeminal artery.the pain ends as abruptly as it starts and is described as a unilateral shooting or stabbing sensation. Associated involuntary contraction of the facial muscles can cause sudden closing of the eyes or twitching of the mouth,hence the name tic douloureux (painful twitch).

Normal Function of OrganTrigeminal neuralgia: carries sensation from your face to your brain

PathophysiologyVascular compression and pressure.

Demylination of the trigeminal root.

Paroxysms can occurwith stimulation of the terminals of the affected nerve branches such as washing the face,shaving,brushing the teeth,eating and drinking.A draft of cold air or direct pressure against the nerve trunk may also cause pain.Certain areas are called trigger points because the slightest touch shows paroxysm or episode.To avoid stimulating these areas patients with trigeminal neuralgia, try not to touch or wash the faces,shave,chew or do anything that may cause an attack.

Cause/ risk factors

Health Promotion and Disease prevention

Clinical ManifestationsIntermittent episodes of intense pain with sudden onset,The pain is rarely relieved by analgesicspain generally starts peripherally and advances centrallysome patient have a trigger zone and others are triggered by light touchTactile stimulation such as touch and facial hygiene and even talking will trigger an attack

Diagnostic tests or LabsHistory collection and physical examination

Angiography ,CT Scan and MRI will identify a causative lesion.

The actual diagnosis is made by history collection

Nursing DiagnosisAcute painactivity intoleranceADL deficit, self carehopelessness

Goals of Treatment Reduce pain

Medical/ surgical TreatmentSurgical treatment; microvascualr decompression (remove blood vessel from post. Trig. Root) or rhizotomy (surgical severing of nerve root)

Nursing InterventionsPreventing pain-Recognize the factors that alleviate the pain such as food that is too hot or too cold and jarring of the patient s bed on the chair. Even washing the face, combing the hair and brushing the teeth can produce acute pain. the nurse should assist the patient by providing education regarding how to decrease the pain.

Provide cotton pads and room temperature water to wash the face.

Instruct the patient to use mouth wash to cleanse the mouth after taking food if tooth brush causes pain., instruct the patient to do personal hygiene when there is no pain.

The patient is instructed to eat the food at room temperature and to chew the food in the unaffected site, and to ingest soft foods.

Provide psychological support

Medication Treatment

Antiseizure medications such as Carbamazepine (Tegretol),relieves pain by reducing the transmission of impulses at certain nerve terminals.

NC: taken along with meals; Serum levels should be monitored continuously

Side effects: n/v, dizziness,drowsiness and aplastic anemia.

The patient should be monitored continuously for bone marrow depression during long term therapy.

Gabapentin(Neurontin)and Baclofen(Lioresal)is used for pain control (antispasmodics)

Phenytoin can also be used.

Complications

Dietary TherapyChew on unaffected side

Patient EducationAvoid triggers for pain: firm toothbrush, very hot or cold foods or liquids, mechanical pressure on cheeks