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TREATMENTS FOR A 'PAINFUL TIC'

Q: There is some relief in knowing that the cause of this terrible pain and tic has a name "tic douloureux (painful tic)," but now my search goes on to find out more about it and any treatments that might help in overcoming the anguish.

A: Most patients with this condition would agree that "painful tic" is an appropriate name for what is known medically as trigeminal neuralgia, or tic douloureux. Patients complain of sudden and excruciating pain on one side of the face that feels sharp and stabbing, sometimes like an electric shock.

The pain occurs in spasms, subsides rapidly and can be triggered by such activities as talking, eating, feeling the wind blow against the side of the face, seeing flashing lights or even hearing sudden noises.

Although sometimes difficult to identify because of the many conditions that may provoke the symptoms, a careful diagnostic workup usually results in establishing the precise diagnosis. A number of treatments exist, although some pose certain risks.

Trigeminal neuralgia is often caused by pressure from a blood vessel pulsating against the trigeminal nerve. Other causes are blamed on tumors, multiple sclerosis, aneurysms and angiomas.

If diagnostic tests rule out causes like tumors that require specific treatment, your doctor will probably try drug therapy first. Phenytoin or carbamazepine are two of the most popular choices, since both are generally effective with long-lasting results, although both can cause side effects.

If your pain is especially severe, your doctor can also inject a local anesthesia or prescribe a narcotic pain reliever.

If drug therapy is unsuccessful in alleviating your pain, other treatments can be used, but these can be risky.

Injections of alcohol, glycerol, phenol and hot water into part of the trigeminal nerve can be used to block the action of the nerve, thereby stopping pain, but this procedure can also cause loss of feeling in the face.

Surgically cutting or separating the trigeminal nerve branch (the Jennetta procedure) relieves pain longer than injections, but again, this is another treatment that can cause numbness.

The most common procedure today is posterior fossa microvascular decompression. This operation involves separating the blood vessel that is pressing against the trigeminal nerve by placing a small plastic implant, or similar device, between the vessel and the nerve to keep them apart.

About 80 percent of patients find pain relief with this operation for up to five years. Although this procedure does not cause a loss of sensation in the trigeminal nerve, it can cause problems like hearing impairment and hemorrhage.

Another popular procedure is percutaneous trigeminal radio frequency coagulation. A general anesthetic is injected through an insulated needle, then a radio frequency current is used to coagulate the branches of the trigeminal nerve. The proper choice of treatment depends upon your special case and is one that will provide the greatest chance of relief, with the least risks.

Q: Confusion reigns in our family with both my husband and I suffering from arthritis. Yet it seems we have different kinds, I have rheumatoid and he suffers from osteoarthritis. Would you please explain the differences in these two diseases that cause us both to have painful joints?

A: While both conditions affect the joints in the body, they really have two quite different mechanisms. Rheumatoid arthritis is a chronic inflammatory disease, which has a course with acute periods alternating with periods of remission. It can range from a barely noticeable disease to one that is crippling and mutilating.

Rheumatoid arthritis was once thought to be the result of a virus, but this has been rejected. And although no specific cause is known it is probable that the immune system is involved in the process. It is treated with anti-pain medicines, anti-inflammatory agents as well as medicines that repress the working of the immune system.

Osteoarthritis is a joint disease characterized by degeneration and loss of cartilage. It is the most common type, seen increasingly as age advances and affects more than 10 percent of the population over the age of 60.

Inflammation rarely is seen in this type, and pain is increased when the joint is in motion. Pain is relieved by rest. Though both aspirin and non steroidal anti-inflammatory drugs are useful treatments, so are other treatments using heat, cold and physiotherapy.

Dr. Allan Bruckheim welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Bruckheim in care of Tribune Media Services, 435 N. Michigan Avenue, Suite 1400, Chicago, IL 60611.

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