Insights from the Facial Pain Association Conference: A Treatment Pathway for **Classical Trigeminal Neuralgia 1**

Written By Dana Overland


Source Video: FPA Conference - Watch on YouTube

Note: This blog is my personal interpretation and summarization of the video above. Always do your own research before making medical decisions.

Introduction

This blog summarizes the key points from a video hosted by the Facial Pain Association, which covers classical trigeminal neuralgia (TN) with insight from Dr. Joanna Zakrzewska (facial pain consultant) and Dr. Raymond Sekula (neurosurgeon). It explores symptoms, diagnosis, medical and surgical treatments, and the broader support structure necessary for managing TN.

What is Classical Trigeminal Neuralgia?

Classical TN is defined by severe, electric-shock-like pain in the areas served by the trigeminal nerve. This pain is typically provoked by everyday activities like eating, talking, or touching the face. Attacks can be brief or occur in series and are often rated as 10/10 in intensity. Patients may also experience complete remission between episodes. MRI often reveals neurovascular compression (a blood vessel pressing on the nerve), but this finding alone does not confirm TN.

Diagnosis and Differentiation

Diagnosis requires thorough history-taking and specialized MRI imaging (heavily T2-weighted sequences with a 3 Tesla magnet). It's important to distinguish TN from tumors, MS, and other causes of facial pain. Accurate phenotyping ensures patients receive the appropriate treatment.

Medical Therapies

First-line Drugs:

  • Carbamazepine and Oxcarbazepine are primary treatments.

  • Side effects include tiredness, brain fog, dizziness, and memory issues.

  • Opioids are not effective for TN and are not recommended.

Optimization:

  • Medication should be adjusted to find the "therapeutic window."

  • Patients are encouraged to use pain diaries and monitor side effects.

  • Women may have lower tolerability to some drugs.

Surgical Interventions

Microvascular Decompression (MVD):

  • Preferred if MRI shows significant nerve compression.

  • Involves repositioning the blood vessel to relieve pressure.

  • Best for patients with classical symptoms and prior drug response.

  • Higher success rate; low risk of mortality or sensory loss.

Ablative Procedures:

  • Destroy nerve fibers to relieve pain (e.g., Gamma Knife).

  • Less invasive but may result in facial numbness.

  • Effects can be delayed (up to 6 months).

Predictors of Surgical Success

  • Classical symptoms.

  • Positive response to carbamazepine/oxcarbazepine.

  • Significant neurovascular compression seen on imaging.

A scoring system combining these factors helps determine candidacy for MVD.

The Role of Comprehensive Support

TN affects quality of life far beyond pain. Support systems include:

  • Psychological Therapy: Helps manage fear and depression.

  • Physical Therapy: Addresses musculoskeletal compensation issues.

  • Peer Support: Groups like the FPA provide community.

  • Education: Becoming an "expert patient" empowers management.

Patients are encouraged to create flexible management plans (Plan A, B, C) and participate in shared decision-making using tools like the Ottawa personal decision guide.

The Future: Patient Registries and Research

Efforts are underway to build a comprehensive TN patient registry. This will allow:

  • Long-term tracking of outcomes.

  • Improved classification of facial pain types.

  • Better prediction models for treatment success.

  • More accurate and personalized care.

Evolving Perspectives

The classification of TN is shifting. Terms like "TN2" or "atypical" are falling out of favor due to lack of precision. Some classical TN patients also experience low-level, chronic aching pain due to altered behavior (e.g., avoiding chewing on one side).

Conditions like SUNCT/SUNA are also being re-evaluated. Multidisciplinary collaboration, particularly in Europe, is pushing for more surgical options in less classical cases.

Final Thoughts

Managing Classical TN requires more than medication or surgery—it demands a multidisciplinary approach rooted in empathy, precision, and continued research. Patients benefit most when treated as partners in care, empowered with knowledge and supported by a strong network.


Written by Dana Overland, Founder of Dove Recovery Art
For advocacy, healing, and awareness in chronic pain communities.

Dana Overland

Dana Overland, Artist & Founder of Dove Recovery Art

I paint emotions. Not places, not things — but all the messy, beautiful, gut-wrenching, glittering feelings we carry. My art was born from survival: after years battling chronic pain, deep grief, and trauma, I found healing in watercolor and mixed media. Every piece I create is a surrender, a whispered prayer, and a story hidden in color and texture.

Through Dove Recovery Art, I turn pain into something soft and luminous — because even pain glitters when you hold it right. My work explores trauma, recovery, and the quiet power of starting over. Proceeds from my art help others on the same path: funding recovery efforts, community support, and creative healing spaces.

I believe art isn’t just something to look at; it’s something to feel, to carry, to heal with. Welcome to my world — where broken things become beautiful.

https://www.doverecoveryart.com
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