Diagnosis

Pain is defined as an unpleasant sensation related to actual or potential tissue damage.  There is a lot of room for variation in that statement.  Unpleasant?  Actual or potential?  It is difficult to diagnose pain and certainly difficult to diagnose a specific type of pain.  It is a physical sensation combined with an emotional reaction.  Basically, pain is whatever the person who is experiencing it says it is.  Trigeminal neuralgic pain is no different.  It is diagnosed based on history and current description of the symptoms by the patient.

Trigeminal neural  is often diagnosed by ruling out other diseases.  For example, shingles, TMJ and multiple sclerosis are all able to cause facial pain but specific testing can be done to determine whether or not one of these three diseases is the cause.

Sometimes, a differential diagnosis is used.  This is done by aligning specific symptoms of the current disease and determining which category they fall into.  Below is a table showing differential diagnoses between trigeminal neuralgia and atypical facial pain.

Feature Trigeminal Neuralgia  Atypical Facial Pain Prevalence Rare  Common Main location Trigeminal area  Face, neck, ear Pain duration Seconds to 2 minutes  Hours to days Character Electric jerks, stabbing  Throbbing, dull Pain intensity Severe  Mild to moderate Provoking factors Light touch, washing, shaving, eating, talking  Stress, cold Associated symptoms        None  Sensory abnormalities

It is difficult to diagnose trigeminal neuralgia.  It is a relatively rare disorder with similar symptoms to several other disorders.  The most important thing in the process of diagnosing is to remember that this person in front of us is in great pain and offering some comfort and compassion while we determine how we can help.



References:

http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm#280103236

http://emedicine.medscape.com/article/1145144-differential