DESPITE rapid advances in the scientific diagnosis and treatment of many diseases, the evaluation and measurement of pain remain perplexing problems. Patients often have great difficulty in fully describing the pain they have, and healers are stymied by their inability to assess it.

Yet, the analysis of the quality and quantity of the pain experienced are central not only to diagnosis, but also to treatment. The condition which is usually referred to as neuralgia is diagnosed primarily by its characteristic pain.

The typical patient is a female above the age of 35. Frequently the pain involves the right side of the face and is usually elicited by a “trigger zone.” Rarely both the sides of the face are involved at the same time. The “trigger zone” precipitates an attack when touched and is commonly found on the pigmented part of the lips, sides of the nose, cheeks or around the eyes. In some cases, there is no need to touch the skin to start the pain. Being exposed to a strong breeze, eating or even smiling may be sufficient.

Neuralgia pain is relatively moderate in the initial stages. But as the disease progresses over the months or years, the attacks become more intense and frequent. The pain is usually sharp and severe, lasting a few seconds to various minutes. It may be so intense that the patient always lives in fear of an attack. It disappears just as suddenly as it appears and may be felt in any area of the face depending on which branch of the trigeminal (facial) nerve is affected.

Many diseases can imitate neuralgia which means that the dentist must exclude them in his differential diagnosis. One of the most common is Horton’s syndrome which is characterised by a severe ache on one side of the head lasting for hours. On some occasions, sinusitis is confused with neuralgia. Other diseases include Costen syndrome, cancer of the oropharyngeal region and herpes zoster.

No single factor has been identified as being the cause of neuralgia. One must appreciate that the oral and masticatory region is supplied with at least seven major nerve trunks, three of which originate from the spinal cord in the neck. Because of the central excitation, the location of many pain complaints does not identify its true source. The patient may be entirely mistaken as to where his suffering originates.

In any event, it seems as if arteriosclerotic changes in the blood vessels supplying certain branches of the facial nerve may be a principal cause of neuralgia.
Ruling out the dental pain should always be the first step when dealing with what may be believed to be neuralgia. The disease is confirmed when the characteristic pain pattern is established. The final step is the actual treatment.

Many methods are currently in use to treat neuralgia, though some are more popular than others. There are three small areas in the face where the dentist can make an incision to bisect the offending nerve. If not, he could inject alcohol at any of these points and the patient would be relieved of their misery for up to six months. Alternatively, the patient may inhale trichloroethylene which selectively numbs the facial nerve.

Two methods of treatment however remain the most predominantly used. One is the act of cutting the sensitive root of the trigeminal nerve which would then result in a permanent cure. The other way to treat the disease is with medication. One carbamazepine (Tegretol) tablet of 200 mgs strength taken daily for one week is of immense help.
It should be emphasised that a careful analysis must be done before arriving at a diagnosis, since, any hasty or dogmatic treatment administered without proper investigation may end up with serious consequences for the patient.