Classification Systems for Trigeminal Neuralgia and Quantification of Facial Pain

Classification Systems for Trigeminal Neuralgia and Quantification of Facial Pain

Michael G. Brandel (University of California – San Diego, USA), Kevin Porras (University of California – San Diego, USA), Jeffrey A. Steinberg (University of California – San Diego, USA), Robert C. Rennert (University of California – San Diego, USA), Arvin R. Wali (University of California – San Diego, USA), David R. Santiago-Dieppa (University of California – San Diego, USA), Vincent J. Cheung (University of California – San Diego, USA), Brian R. Hirshman (University of California – San Diego, USA), Jeffrey Scott Pannell (University of California – San Diego, USA), John F. Alksne (University of California – San Diego, USA) and Alexander A. Khalessi (University of California – San Diego, USA)
Copyright: © 2018 |Pages: 13
DOI: 10.4018/978-1-5225-5349-6.ch002

Abstract

Trigeminal neuralgia is a rare syndrome classically described as brief paroxysms of severe, lancinating facial pain along a unilateral trigeminal nerve distribution. Numerous clinical presentations of trigeminal neuralgia exist, with various distinct etiologies. Several classification schemes have been designed for clinical and research purposes. However, varying terminology and inconsistent utilization of these systems can lead to diagnostic confusion and ungeneralizable research findings. Similarly, multiple pain scales have been used for trigeminal neuralgia with differing degrees of granularity, validity, and reliability. This chapter provides an overview of the commonly used classification systems and pain scales in the context of their evolution and utilization. Furthermore, the authors provide recommendations for application of these systems to clinical and research practice.
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Classification Systems For Trigeminal Neuralgia

The original clinical classification scheme for trigeminal neuralgia was the delineation of Typical (Classic) TN or Atypical TN (Giovanelli, Marini, & Marossero, 1963; Hughes, 1950). Typical TN is the TN presentation best-recognized by physicians, involving brief paroxysms of severe, shock-like pain along one or more unilateral divisions of the trigeminal nerve. The pain may be triggered by light touching of the face, or by other activities such as speaking, chewing, or swallowing (other classic ones are brushing teeth or even wind blowing against face). Furthermore, neurological deficits are almost always absent, and pain-free intervals between attacks are common. In contrast, Atypical TN is used as an umbrella term to classify TN that does not fit the presentation of Typical TN. The timing may be prolonged or constant rather than paroxysmal, and the characteristics of the pain may be aching, dull, sharp, throbbing, or burning in contrast to the classic lancinating pain. The presence of neurological deficits or bilateral pain, particularly in the absence of an identifiable anatomic etiology such as compression of the trigeminal nerve root, suggests a diagnosis of Atypical TN and further workup should be considered.

Etiologic classifications of trigeminal neuralgia have additionally been created. Essential, Classical, Primary, and Idiopathic TN are terms that have been used interchangeably to describe TN due to vascular compression or an unidentifiable cause (Apfelbaum, 1977; Guidetti, 1950; Kaess, 1951; Strandjord, 1973). In contrast, Secondary and Symptomatic TN have been used synonymously to label trigeminal neuralgia caused by tumors, multiple sclerosis, or other discernable anomalies (Elster, 1951; Obrador & Boixados, 1955).

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