Third Monday in October
For World Pain Relief Day
(Global Day Against Pain)”
Pain is not hypocritical
It’s a disease
Pain specialist of the First Affiliated Hospital of Zhejiang University School of Medicine
Dismantle “the first pain in the world” for us
“Pear” is immediate and painless
“I’m going to be discharged from the hospital today. To be honest, I still miss you.” On the eve of the National Day, 60-year-old Aunt Wang (pseudonym) held Feng Zhiying, director of the pain department of the First Hospital of Zhejiang University. The doctor’s hand refused to let go for a long time.
She had recurrent episodes of pain on the right side of her face, on and off for nearly 11 years. “Life is worse than death. The right tooth was pulled out, and the pain couldn’t be relieved. After the surgery in the other hospital, the pain stopped for two years, and the pain came back again and got worse.” Aunt Wang said that she even thought about it a hundred times, and this entanglement How can people’s pain finally be cured?
Auntie, 60, had her teeth pulled
Still sore after surgery
Aunt Wang is from Anhui and has two daughters and one son. Her husband died early. She carried the burden of the family alone, swallowed the hardships of life, gritted her teeth, and pulled her three older children by herself. Her hard-working, hard-working, warm-hearted and indomitable personality made her a “Iron Lady” by the neighbors.
But in the past year, the “Iron Lady” seems to be unable to carry it any longer. When severe facial pain hits from time to time, let her don’t dare to chew and can only drink rice soup, “a frown and a smile” and even breathing will make her scream in pain. Even in such pain, Aunt Wang didn’t dare to cry, because as long as she made a slight expression, the unexpected and unpredictable pain would split the right half of her face like lightning , she could only hold back the tears in her eyes.
At the expert clinic of Director Feng Zhiying, Aunt Wang came to see the doctor accompanied by her eldest daughter Lingling (pseudonym). She covered her face with one hand, her expression extremely painful. Lingling introduced that about 11 years ago, her mother’s right half cheek would have a sharp pain from time to time. Because the frequency was not high, Aunt Wang had never been too concerned about it, and it was over. Four or five years ago, “My mother got up to brush her teeth, and her gums felt very painful. She thought it was a problem with rotten teeth. Going to the township health center to pull out all the right teeth, but the right side of the face was intermittent. The pain is not relieved.”
The snake wine, acupuncture, and cupping that my son bought at a high price were not effective. Because the pain was unbearable, Aunt Wang took painkillers in large doses, which even caused stomach bleeding. Watching her mother suffer, her children took Aunt Wang to a large local hospital for an examination and was diagnosed with “trigeminal neuralgia”. In 2020, received a craniotomy for trigeminal nerve microvascular decompression surgery in a local hospital, and the pain disappeared for a period of time. But recently, this kind of life-threatening
The “pear” is a pain in the ass
Have one craniotomy two years ago, do I need another craniotomy? The family was both anxious and distressed about Aunt Wang’s condition. Recommended by local hospital experts, they came to the expert clinic of Director Feng Zhiying for treatment.
Director Feng Zhiying was diagnosed with right trigeminal neuralgia (branch II and III) through careful inquiries about Aunt Wang’s condition and comprehensive examination. Considering that Aunt Wang had already undergone an open operation, after detailed communication with the patient and her family, it was finally decided to use percutaneous trigeminal nerve meniscus microballoon compression for her treatment.
The industry compares percutaneous trigeminal meniscus microballoon compression to “planting a ‘fragrant pear'”. In fact, this super mini “fragrant pear” is a balloon filled with about 0.3ml~0.7ml of water (mung bean to soybean size). By taking a puncture point the size of a grain of rice at the corner of Aunt Wang’s mouth, under X-ray fluoroscopy, the trocar was accurately inserted into the foramen ovale, and after the balloon catheter was protruded from the cannula head, the balloon was expanded to ” “Pear”-like, thereby compressing the trigeminal ganglion and achieving the purpose of analgesia. The entire operation takes about 30 minutes. After the operation, there was only one pinhole left on Aunt Wang’s face, and there was almost no bleeding. After the recovery from anesthesia, Aunt Wang’s pain symptoms disappeared, and the 11-year “curse of pain” was finally lifted! In the follow-up, Aunt Wang can eliminate the pain as long as she insists on regular review.
Director Feng introduced that the trigeminal nerve is the largest pair of mixed nerves in the cranial nerves, and it manages both sensory fibers and masticatory muscle movement (mouth opening + chewing). Like a big river, it gathers information from many small rivers, including pain signals from the head and face.
“The diagnosis is mainly based on the patient’s clinical manifestations, and secondary causes are excluded by instrumental examination.” Director Feng further explained that trigeminal neuralgia is known as “the first pain in the world” , When the attack occurs, the pain is severe and unbearable, such as knife cutting, acupuncture, tearing, burning or electric shock, and even the pain is unbearable. There are “trigger points” also known as “trigger points”trigger points” on the upper lip, nose, gums, corners of the mouth, tongue, eyebrows, etc. Lightly touching or stimulating the trigger points can cause Pain attacks, sometimes accompanied by facial twitching, even facial atrophy, and small eyelid fissures, seriously affect the patient’s work and life. The incidence rate in domestic statistics is 52.2/100,000. Females are slightly more than males, and they mostly occur in middle-aged and elderly people. The attacks of maxillary and mandibular ramus are the main ones, and they often occur unilaterally.
How is trigeminal neuralgia different from a normal toothache?
Experts introduced that toothache belongs to local pain, and the pain time is relatively long, and the pain feeling is relatively stiff. Trigeminal neuralgia involves a relatively large range. The duration of pain is several seconds to several minutes. The pain sensation is a tingling sensation, and the location of the pain is not limited to the upper and lower jaw area. Usually the pain is not obvious. If the pain occurs after washing your face, brushing your teeth, and talking, you need to consider trigeminal neuralgia. But the best way is to go to a large regular hospital to ask an expert for a professional diagnosis, and don’t “be yourself a doctor”.
What to do if you have trigeminal neuralgia
Special reminder from Zhejiang one expert
Director Feng emphasized: Once you discover trigeminal neuralgia, you must seek medical attention and get timely treatment! Because with the prolongation of the course of the disease, the intermittent period of the attack will gradually shorten, and the pain will continue to intensify, which will bring serious damage to the physical and mental health. In severe cases, it may lead to depression and suicide tendency.
“Microballoon compression is more suitable for those who are older or cannot tolerate surgery for other reasons; those who are less effective after microvascular decompression or treatment , Patients with ineffective pain recurrence after operation, patients with trigeminal neuralgia who refuse craniotomy, lesions of the first/second branch of the trigeminal nerve or more than 2 branchesdisease, etc. Director Feng emphasized that the First Hospital of Zhejiang University tailors an individualized treatment plan according to the location, symptoms and different conditions of each patient. The team treats more than 100 patients with trigeminal neuralgia every year and has rich experience. In the First Hospital of Zhejiang University , in addition to microballoon compression, the treatment methods for trigeminal neuralgia include:
Anti-epileptic drugs for pain relief, such as carbamazepine and phenytoin.
2Percutaneous trigeminal nerve block or pulsed radiofrequency
The purpose is to apply drugs or physical energy to the trigeminal ganglion or branches after the puncture is in place, so as to nourish the nerve, reduce inflammation and relieve pain.
Percutaneous radiofrequency thermocoagulation of the trigeminal nerve
A minimally invasive technique that uses high-frequency current to generate heat to ablate and damage nerves on one side of the painful face, thereby blocking pain transmission.
4Microvascular decompression in neurosurgery
Under a microscope, look for the responsible blood vessel compressing the trigeminal nerve root and isolate it, releasing the compression to relieve pain. The facial nerve will not be damaged during the operation, and the integrity and physiological function of the trigeminal nerve will be completely preserved after the operation.
Such as Gamma Knife, Trigeminal Neurochemical Destruction, etc.
How can trigeminal neuralgia be prevented?
Keep your head and face warm: Avoid partial freezing and dampness, and do not wash your face with too cold or too hot water.
Keep your mood stable: Try to avoid mood swings, avoid excitement, stay up late and get enough sleep.
Try to avoid hitting “trigger points”: Eat, rinse, talk, brush your teeth, and wash your face gently.
Have a regular diet: Choose soft, easy-to-chew foods. Reduce the stimulation of cold, hot and hard food chewing, must not eat fried, spicy and other irritating food.
Expert Outpatient Arrangement of the First Hospital of Zhejiang University