Why Opioids for Trigeminal Neuralgia Aren’t the Answer

As a trigeminal neuralgia patient, you know firsthand what it is like to live with chronic pain. Though the condition has been difficult to diagnose and treat in the past, opioids for trigeminal neuralgia is not the answer. The great news is there are now treatment options available that can help ease your symptoms, and for many patients, may prevent them altogether.

Unfortunately, some patients with trigeminal neuralgia are prescribed opioids, or “painkillers,” by doctors who mean well and want to help get people out of pain. While these medications may be mildly effective in alleviating pain for other conditions, they are ineffective for trigeminal neuralgia patients. Opioids for trigeminal neuralgia are not the answer, and other treatment options, such as Gamma Knife radiosurgery, are far more effective.

About Trigeminal Neuralgia

Before considering the use of opioids for trigeminal neuralgia versus other treatment options, it may be helpful to understand a little more about the condition itself. Trigeminal neuralgia is a chronic pain condition, characterized by intermittent, incredibly painful episodes in response to normal stimuli, such as talking or eating, with a baseline level of constant pain.

The pain you experience is because something is abnormally stimulating the trigeminal nerve, the cranial nerve responsible for transmitting sensation from the face to the brain – including pain. Though it most commonly affects women over 50, anyone can develop trigeminal neuralgia.

Doctors and researchers have learned that the cause of trigeminal neuralgia is usually because something is pressing on the trigeminal nerve itself, causing it to fire inappropriately and sending signals of pain to the brain. In most cases, it is a blood vessel near the brain that is presenting an issue, though there are cases where it could be another cause, such as a tumor.

Opioids for Trigeminal Neuralgia

Opioids are commonly prescribed to help ease pain, which is why they would seem like a good choice for your trigeminal neuralgia. However, you might be surprised to learn that opioids, such as oxycodone and hydrocodone, are not effective in the treatment of neuropathic pain, which is what you are experiencing. Your brain is receiving pain signals because the nerve itself is essentially hyperstimulated. This is in contrast to something like a broken bone, where tissue damage is causing the pain signal.

You have likely seen opioids in the news lately. They can be very addicting for some people, and there is a movement towards only prescribing opioids for patients who require an additional level of pain relief. However, though the pain you are experiencing is very intense, opioids are ineffective for trigeminal neuralgia treatment and would not be appropriate for your condition, regardless of current prescribing trends.

Other Treatment Options

Generally speaking, the first line of treatment for trigeminal neuralgia is medications, but not opioids. Instead, your doctor has likely prescribed anticonvulsants, which alleviate symptoms in many patients. However, these medications do not work for everybody, and they do not always continue to be effective over time. The next step is to consider treating the source of the disturbance at the trigeminal nerve, commonly a blood vessel.

An excellent, noninvasive treatment option is Gamma Knife stereotactic radiosurgery. Though it sounds like a surgical procedure, it is actually an advanced form of radiation therapy that allows your neurosurgeon to target a highly focused area. There are no scalpels or incisions, and the entire procedure takes place in an outpatient setting, requiring no overnight hospital stay.

Another potential treatment option is microvascular decompression surgery. This involves a surgical procedure where your neurosurgeon adds a buffer between the impinging blood vessel and the trigeminal nerve. However, Gamma Knife radiosurgery is able to accomplish the same goal with a noninvasive approach in many trigeminal neuralgia patients.

Gamma Knife for Trigeminal Neuralgia

If the idea of a noninvasive, nonsurgical treatment for your trigeminal neuralgia intrigues you, then you may wish to learn a little more about Gamma Knife radiosurgery as a treatment option. The procedure itself takes place at a hospital or treatment center, and you are discharged following your treatment. The actual length of your session can range from 15 minutes to an hour, depending on the area being treated. Many patients only require a single session, though this too will be dictated by your individual circumstances.

Recovery is much shorter and milder than surgery, and most patients are able to resume all normal activities within a day or two. Common side effects include headache, fatigue and nausea, although all are far less severe than traditional radiation therapy and can be alleviated with medications. A huge benefit of Gamma Knife radiosurgery is it does not carry any of the risks associated with surgery in general, such as infection and bleeding.

The Answer is Not Opioids

There are different treatment options available to you for managing or even resolving your trigeminal neuralgia pain. However, these options usually do not include opioids.

Be sure to bring up any questions or concerns you may have, whether lingering or new based on the information here, at your next appointment. Your doctor will be happy to discuss them with you to ensure you are comfortable with your trigeminal neuralgia treatment options. Continue learning throughout this process, keeping yourself informed about your condition and setting your mind at ease as you progress along your treatment path.

Anthony D’Ambrosio, M.D., M.B.A., F.A.A.N.S
Anthony D’Ambrosio, M.D., M.B.A., F.A.A.N.S
Dr. Anthony D’Ambrosio is a board-certified neurosurgeon that specializes in Neurosurgery, Stereotactic Radiosurgery, Gamma Knife Radiosurgery (GKRS) and more. He is the Director of Neurosurgery and Co-Director of the Gamma Knife Program at The Valley Hospital. Dr. D’Ambrosio is an expert in treating patients with trigeminal neuralgia, benign or malignant brain tumors, as well as many other neurological conditions.

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