The pain of fifth nerve is the most severe types of pain, and injures the women slightly more than the men.
The pain of fifth nerve is a sensory disorder injures the fifth nerve in the head and causes repeating severe pains on temple, gum, lips or chin on one side of the face.
The fifth nerve is a sensory nerve of the face and chewing muscles, and it transfers the sensation from specific parts of the face and the mouth by 3 sections:-
1- The eye:-
It transfers the sensation from the top of the face and forehead to the end of the eye.
2- The temple:-
It transfers the sensation from the middle of the face from the tip of the eye to the side of the mouth.
3- Lower jaw:-
It transfers the sensation from the lower part of the face.
The small part of the nerve is responsible for the motor functions of the chewing muscles through the third section (lower jaw).
The symptoms of the fifth nerve:-
The patient complains from repeated bouts of acute pains such as electric shock with severe burning for seconds on one side of the face. (Third section often, the second rarely and the first very rarely).
The pains start on one side of the face from ears to the temple and the side of the mouth with repeated painful bouts for many hours.
The researches proved that the pain can injure the two sides of the face In case of sclerosis and these bouts are repeated for many weeks or months after that a phase of improvement and laziness happens for many months or years.
The pain happens periodically, the motivation of starting the pain is by touching specific areas from the skin of the face, mucous membrane or dental breaks which feeds on the fifth nerve such as: washing the face, shaving, chewing, washing teeth, swallowing, talking…….
The pain is in the place of the fifth nerve, especially the second and the third section (The temple, Lower jaw) but it injures the first section rarely (The eye).
We find difficulties to examine the patient because he feels fear of causing pain and in serve cases; we find the patient looks like meagre because of his fear from chewing with bad care of oral and dental hygiene and no shaving in men.
When we examine the patient in primary or classical cases, there is no disorder or weakness in the sensory or motor part of the fifth nerve.
In the secondary cases, there are other diseases affected on neural ganglion which causes some symptoms such as: lack or lost the sensation in the fifth nerve area and weakness or atrophy of chewing muscles.
The reasons of the fifth nerve pain:-
There is no one reason for the pain but there are several reasons that overlap with each other.
– One of the most famous theories that a blood vessel which presses on the fifth nerve which extends the length of electric flashes in the nerve and leads to re-irritation of the nerve causing pain.
– The reason may be the infection of the nerve with viruses, especially; simple herpes virus and a small proportion of cases are secondary because of other diseases such as: the inflammation of the nervous system and brain and cerebellum cancer.
– The infection of diabetes also helps to get the inflammation of the fifth nerve.
Examination and radiology:-
In the primary or traditional cases of the fifth nerve, all examinations are normal whether drawing the nerve and muscles, CT scan or MRI.
In these cases, it is better to do CT scan with multi sections for the arteries of the brain to exclude a blood vessel pressing on the nerve.
In secondary cases, the radiations detect that there is a cancer in the bottom of the skull, brain or inflammation of the nervous system.
In these cases, there are changes drawing the nerve and muscles.
The treatment is different if the pain is primary or secondary as the treatment in secondary cases is treating the original disease such as: eradication of the cancer causing the nerve, but in primary cases the treatment is medical, interventional or surgical.
1- Pharmaceutical treatment:-
– It is mainly to treat the primary cases, the medicines are various from simple analgesics to anticonvulsant in severe cases.
The most using of anticonvulsant is (Carbamazepine) and has good results in about 75% of patients, the therapeutic dose does range from 600 to 1200 mg per day but the therapeutic dose should be increased gradually by 50 mg/day and then increased it slowly to avoid the appearance of side effects such as: dizziness and imbalance especially with elderly.
– The patient should perform a periodic blood count to watch the count of white blood cells when using the (Carbamazepine).
– The patient may need to use the sedatives and antidepressants.
– Some patients feel better when using eye drop with anesthetic effect because its effect on optic nerve calms the pain of the fifth nerve but they should take care of these dangerous practices which harm their eyes.
2- Interventional treatment by thermal frequency:-
This treatment happen by a doctor specialized at pains treatment without a surgery but the doctor inserts a special needle in the skin of the face by local anesthesia and this needle reach the roots of the nerve.
We can do more to treat the nerves such as: Injection of a chemical substance, entering a balloon, refrigeration, Radiofrequency Thermo coagulation or Pulsed Radio-frequency but all these ways have positive and negative effects.
The modern treatment is Radio-frequency Thermo coagulation or Pulsed Radiofrequency and the researches proved the effectiveness of these treatments as they reduce the pain bouts and sometimes disappear for ever, often the patient does not need to pharmaceutical treatment.
The successful percentage of removing chronic pain is 50% or more and the patient returns to practice his life normally by 100% and without pain.
The doctor inserts a special needle in the skin of the face by local anesthesia from the side of the mouth under arc radiation or CT rays but recently we use electromagnetic input support.
The patient may need to sedatives and general analgesic without general anesthesia because the patient’s awareness and cooperation during the overlap is very important to the doctor to be sure that the needle reach the roots of the nerve before launching treatment charges by sensory and muscular.
After removing the needle, ice packs are put on the face and the then the patient returns to his home to practice his daily life.
Some negative effects may happen such as: tingling or losing some sensation in the face and a strange sensation but he can’t describe it (dysethesia), but these effects are not dangerous.
3- Surgical treatment:-
When there is a blood vessel or cancer pressing on the fifth nerve, the treatment is removing this pressure by surgery in the skull at the brain to separate the blood vessel from the nucleus of the fifth nerve.