"The Scream" by Edvard Munch

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Last Updated 09/15/06















Surgical Treatments for Facial Neuralgias



    In nerve blocks, a local anesthetic is injected near the nerve, either at the root or at a peripheral site. A single nerve block will usually only give short-term relief lasting for as long as the anesthetic is effective. Sometimes, nerve blocks can help stop a sudden, severe TN attack. In addition, there is some evidence that when injections are repeated several times over weeks or months, the pain may be relieved for much longer times.

    There are several possible types of nerve blocks. In a trigger point injection, the anesthetic is injected very near a trigger point, that is a point which when touched causes a pain spasm. Such points around the face are typical in TN. The injection may also include cortisone.

    In a stellate ganglion block, the anesthetic is injected near the ganglion (root) of the nerve. The injection site is on the neck. This type of nerve block results in the blockade of the sympathetic nerves of the face and does not directly anesthetize the trigeminal nerve. Thus, it appears to be most successful in treating various types of atypical facial pain.

    Nerve blocks do not generally give permanent relief. Even in the best of cases, painlessness rarely lasts more than a year or two. However, since nerve blocks do not scar or otherwise damage the nerve, they can be repeated as necessary.

    The TNA book, "Striking Back" reports on a study in the 1980's where 16 out of 20 TN patients got pain relief for more than two years after a series of lidocaine and streptomycin sulfate injections.  It also reports that a Nebraska dentist, Dr. Gerald D. Murphy, who specializes in orofacial pain has been successful in reducing pain with Marcaine injections in pain trigger points.  Others have failed to replicate these studies in a small double-blind study with no success and noted that some patients suffered side-effects such as facial swelling.

==> UW: Nerve blocks. Discusses nerve blocks for cancer pain, but the information is applicable for nerve blocks in general. Also discusses neurolytic blocks.

==> Local and Regional Anesthesia. General information about local anesthetics.

Positive Experiences

( 07/06/00) I am a Trigeminal sufferer and have been for twenty three years now. Atypical TN and Atypical Facial Pain. Beleive me I've been through the misery.  Two years ago I was at my wits' end. Pain, pain, pain would not go away. I volunteer in the medical library at my hospital and one fortunate day I discovered The Neural Blockade Textbook In Clinical Anesthesia and Management of Pain, Published by J.P. Lippincott, second edition, Edited by Dr's Michael J. Cousins and Phillip O. Bridenbaugh. Specifically, Chapter 15, Somatic Blockade of Head and Neck, by Terence M. Murphy. I photocopied Chapter 15 and took it to Dr. Reddy, Chief of Anesthesiology, Pain Clinic, Dayton, Ohio V.A.. We have been on a roll ever since. I have had many blocks done since-- Supratrochlear, Supraorbital, Infratrochlear, Nasal Blocks, many blocks, and they have all worked. One injection each in any specific area and the pain was terminated and has never returned. What a Godsend! I still have pain, but nothing what I had!

The doctor really has to know, and be an expert in the landscape and nerves of the face. And Murphy states that in his introduction to Chapter 15. I was very fortunate to have a doctor who really knows how to do these blocks. One of the anesthesiologists at my hospital told me he would not be able to do them properly because he does not know the face nerves well enough to perform them properly, they have to be performed by someone with proper knowledge. . A patient has to have those pictures from Chapter 15 of The Neural Blockade Textbook to present to a doctor, and be able to ask "can you do these". That's exactly what I did, and it worked. Without them, I would have been dead two years now. I was on my way out. I wasn't going to live another crummy twenty years with that god awful misery. I am not KIDDING! Send me an email if you want to phone and talk.  Clarence ; Email: past.performer@GATEWAY.NET

Mixed experiences

"Helped relieve atypical component of TN pain (constant, dull aching pain). However, failed with sharp TN pains, in fact seemed to make them worse" -   "Winston". 


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