Social Security Disability Lawyers: Riverside, San Bernardino and Orange County
Trigeminal neuralgia (“TN”), sometimes called” tic douloureux,” can be an extremely debilitating condition because of the severe facial nerve pain that it causes. It is a relatively rare disorder (i.e., 12 new cases in 100,000 people per year), and it occurs mostly in middle aged women. However, TN can occur in men and in children or young adults.
The National Institutes of Health (NIH) describes trigeminal neuralgia as a chronic pain condition that affects the trigeminal or 5th cranial nerve, one of the most widely distributed nerves in the head. TN is a form of neuropathic pain (pain associated with nerve injury or nerve lesion.) The typical or "classic" form of the disorder (called "Type 1" or TN1) causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to a few minutes. These attacks can occur in quick succession, in volleys lasting up to two hours. The “atypical” form of the disorder (called "Type 2" or TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than Type 1. Both forms of pain may occur in the same person, sometimes at the same time. The intensity of pain can be physically and mentally incapacitating. [Ref: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet]
Cause of TN
Sometimes the cause of trigeminal neuralgia can be diagnosed, and sometimes it arises for no known reason. When the cause of TN can be identified, it is usually compression of the trigeminal nerve by a tumor or blood vessel that presses on the nerve, or some type of demyelinating disorder (e.g., multiple sclerosis) that damages the protective sheath (myelin) around the nerve.
Other causes include direct trauma to the nerve, surgery with damage to the nerve, and a stroke that affects branches of the trigeminal nerve.
What is the Trigeminal Nerve?
As the name suggests, the trigeminal nerve has three branches. It is the 5thcranial nerve, meaning that it originates in the brain, and as it comes out of the brain, it divides into three main branches to the face. The ophthalmic (upper) branch innervates the eyes, forehead, front of the head and the scalp. The maxillary (middle) branch innervates the cheeks, around the nose, top lip, upper jaw, and teeth and gums. The mandibular (lower) branch innervates the bottom lip, lower jaw, and teeth and gums.
The pain from TN can come from any of the three branches. The middle (maxillary) and lower (mandibular) branches are the most frequently involved.
The Symptoms of TN Can Be Disabling
The pain associated with TN can be sudden, severe, and stabbing, or it can be a constant, aching, burning sensation. There may be periods of intense flashes of pain, which can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. Id.
TN has been described by some as “the most excruciating pain known to humanity.”
The Diagnosis of TN
It is usually a neurologist that diagnosis TN. The diagnosis is made by taking a medical history and performing a neurological examination. An MRI brain scan is usually performed, although the results may be normal.
Treatment of TN
There is no cure, but there are many medications that are used to successfully treat TN. They include anti-convulsant medications such as carbamazepine, oxcarbazepine, topiramate, gabapentin, pregabalin, clonazepam, phenytoin, lamotrigine, and valproic acid.
Sometimes anti-depressant medications, such as amitriptyline (Elavil), are used to help treat the pain. Analgesics are used, including opioids, but they tend not to always work well. Botox injections have been found to be effective in some patients. Muscle relaxants, such as baclofen, may also be used.
Surgery is used when medications fail to control pain, or if they gradually lose their effectiveness over time. The types of surgical procedures that are available include rhizotomy, balloon compression, glycerol injection, radiofrequency ablation (RFA), gamma knife surgery, microvascular decompression, and neurectomy. Id.
Disability Benefits for TN
The National Organization of Rare Disorders (“NORD”) has noted that “the pain associated with TN can be so severe that affected individuals avoid simple activities such as brushing one's teeth and/or avoid social situations for fear of an impending attack. The disorder can cause profound psychological effects such as depression and anxiety.” [Ref: https://rarediseases.org/rare-diseases/trigeminal-neuralgia/]
Because the pain from TN may flare suddenly and without warning, people who suffer from trigeminal neuralgia do not know and cannot predict when their pain will strike. The unpredictability of TN contributes to its debilitating nature.
Disability benefits for TN under the Social Security program (SSDI) and/or pursuant to an employer-sponsored group plan (ERISA) are awarded when the flare-ups of pain are severe, frequent, impair work, and cannot be adequately controlled with medications or surgery.
Because TN-pain is a subjective symptom, it is especially important (as it is for all subjective complaints) for a treating neurologist to carefully and consistently document a patient's pain symptoms and how they affect functional capacity. The documentation should include the intensity, persistence, frequency, and limiting effects of the pain.
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