Trigeminal Neuralgia (Tic Douloureux)

  1. General information
    1. Disorder of cranial nerve V causing disabling and recurring attacks of severe pain along the sensory distribution of one or more branches of the trigeminal nerve
    2. Incidence increased in elderly women
    3. Cause unknown
  2. Medical management
    1. Anticonvulsant drugs: carbamazepine (Tegretol), phenytoin (Dilantin)
    2. Nerve block: injection of alcohol or phenol into one or more branches of the trigeminal nerve; temporary effect, lasts 6-18 months
    3. Surgery
      1. Peripheral: avulsion of peripheral branches of trigeminal nerve
      2. Intracranial
        1. retrogasserian rhizotomy: total severance of the sensory root of the trigeminal nerve intracranially; results in permanent anesthesia, numbness, heaviness, and stiffness in affected part; loss of corneal reflex
        2. microsurgery: uses more precise cutting and may preserve facial sensation and corneal reflex
        3. percutaneous radio-frequency trigeminal gangliolysis: current surgical procedure of choice; thermally destroys the trigeminal nerve in the area of the ganglion; provides permanent pain relief with preservation of sense of touch, proprioception, and corneal reflex; done under local anesthesia
        4. microvascular decompression of trigeminal nerve: decompresses the trigeminal nerve; craniotomy necessary; provides permanent pain relief while preserving facial sensation
  3. Assessment findings
    1. Sudden paroxysms of extremely severe shooting pain in one side of the face
    2. Attacks may be triggered by a cold breeze, foods/fluids of extreme temperature, toothbrushing, chewing, talking, or touching the face
    3. During attack: twitching, grimacing, and frequent blinking/tearing of the eye
    4. Poor eating and hygiene habits
    5. Withdrawal from interactions with others
    6. Diagnostic tests: x-rays of the skull, teeth, and sinuses may identify dental or sinus infection as an aggravating factor.
  4. Nursing interventions
    1. Assess characteristics of the pain including triggering factors, trigger points, and pain management techniques.
    2. Administer medications as ordered; monitor response.
    3. Maintain room at an even, moderate temperature, free from drafts.
    4. Provide small, frequent feedings of lukewarm, semiliquid, or soft foods that are easily chewed.
    5. Provide the client with a soft washcloth and lukewarm water and perform hygiene during periods when pain is decreased.
    6. Prepare the client for surgery if indicated.
    7. Provide client teaching and discharge planning concerning
      1. Need to avoid outdoor activities during cold, windy, or rainy weather
      2. Importance of good nutrition and hygiene
      3. Use of medications, side effects, and signs of toxicity
      4. Specific instructions following surgery for residual effects of anesthesia and loss of corneal reflex
        1. protective eye care
        2. chew on unaffected side only
        3. avoid hot fluids/foods
        4. mouth care after meals to remove particles
        5. good oral hygiene; visit dentist every 6 months
        6. protect the face during extremes of temperature.


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