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find more aggressive medical or surgical treatments as the disease invariably progresses

Trigeminal neuralgia (TN) is among the most painful afflictions known. It is characterized by sudden attacks of pain that are typically brief, lasting only seconds to two minutes. These attacks are severe and described as intense, stabbing or electrical shock-like. TN pain occurs on only one side, involving the upper, middle and/or lower portions of the face. Each attack may come on spontaneously (without warning) or be triggered by specific light stimulation (gentle touch or movement), usually in the affected areas of the face. Common triggers include touch, talking, eating, drinking, chewing, tooth brushing, hair combing, water from a shower and kissing. Pinching or pressing these same trigger points will not usually cause TN pain.

During an attack of TN, the sufferer will almost always remain still and refrain from speech or movement of the face, so as not to trigger further attacks of pain. The face may contort into a painful wince. Early descriptions of TN confused these sudden attacks with seizures, leading to the term tic doloureux or neuralgia epileptiforme. TN attacks rarely occur when the sufferer is asleep, but may be worsened or alleviated by leaning or lying in a specific position. During an attack, TN pain never crosses over to the other side of the face. In rare cases of bilateral TN, (in which pain occurs on both sides) the left and right-sided pains are separate and distinct.

The disease course of TN is characterized by periods of flare-up (i.e. exacerbations), when painful attacks come on often and may be very difficult to control with medications. Then there are periods of remission, when no pain occurs. However, even during periods of remission, TN sufferers live in fear of their next flare-up. Over time the periods of exacerbation become more frequent and more severe, while the remissions become shorter. Therefore, the need for more aggressive medical or surgical treatments increases as the disease invariably progresses.

1. The need for more aggressive medical treatments