Trigeminal Neuralgia (Tic Douloureux)

  • Also known as prosopalgia.
  • Is a neuropathic disorder characterized by intense pain in the eye, nose, ear, lips, jaw, scalp, forehead, cheeks, and alongside of the face. Some patients experience pain in the left index finger.

Etiology and Pathophysiology

  • Disorder of the fifth cranial (trigeminal) nerve characterized by excruciating knifelike pain along the branches of the nerve.
  • Etiology is unknown.
  • Incidence higher in women of middle age and older.

Signs and Symptoms

  • Burning or knifelike pain lasting 1 to 15 minutes, usually over the lip, chin, and in teeth.
  • Pain precipitated by stimulation of trigger zones during activities such as brushing hair and eating when sitting in a cold draft.
  • Sudden closure of an eye.
  • Twitching of the mouth.

Assessment

  1. Description of pain.
  2. Specific factors that trigger attacks.
  3. How condition affects behavior such as avoiding eating, shaving, washing the face, or brushing the teeth because of fear of precipitating the attack.

Nursing Diagnoses

  • Fear
  • Risk for injury
  • Pain
  • Altered nutrition, less than body requirements

Therapeutic Interventions

  1. Administer analgesics and antiepileptic drugs as ordered.
  2. Injection of alcohol into the ganglion to relieve pain for several months or years until the nerve generates.
  3. Surgical intervention requiring intracranial approach.
    • Severing the sensory root of the nerve, which will cause loss of all sensation in the area supplied by the nerve.
    • Microscopic relocation of arterial loop that may cause vascular compression of the trigeminal nerve.
    • Percutaneous radio frequency trigeminal gangliolysis.

Nursing Interventions

  1. Instruct the client to avoid factors that can trigger the attack and result in exhaustion and fatigue.
  2. Avoid foods that are too cold or too hot.
  3. Chew foods in the affected side.
  4. Use cotton pads gently, wash face and for oral hygiene.
  5. Provide teaching to clients who have sensory loss as a result of a treatment.
  6. Inspection of the eye for foreign bodies, which the client will not be able to feel, should be done several times a day.
  7. Warm normal saline irrigation of the affected eye two to three times a day is helpful in preventing corneal infection.
  8. Dental check ups every 6 months is encouraged, since dental caries will not produce pain.
  9. Explain to the client and his family the disease and its treatments.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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