TN News: Nursing Care for Patients with TN

Possible Nursing Diagnoses for Patients with Trigeminal Neuralgia (TN):

1. Chronic/Acute pain related to disease process as evidenced by patient report, demeanor, increased blood pressure, pulse, and respiration, visible distress
2. Chronic anxiety related to chronic bouts of acute pain, as evidenced by patient report of anxiety, sleeplessness, etc.
3. Social isolation related to chronic acute bouts of pain, as evidenced by difficulty maintaining previous social relationships at school, work, in family, and friendships at former level of involvement.
4. Risk for suicide related to chronic acute bouts of pain, as evidenced by patient report of hopelessness and/or depression, suicidality; positive diagnostic assessment for depression and/or suicidality.
5. Risk for activity intolerance related to chronic pain, anxiety, fatigue, symptoms of medications used to manage disease process, as evidenced by reduced ability to perform ADLs (activities of daily living) such as shopping, driving, personal hygiene such as brushing teeth, etc.

Nursing Interventions for Acute/Chronic Pain:

1. Medication management such as administration of anti-seizure medications known to decrease symptoms of some neuralgias (eg. Gabapentin/Neurontin, etc).
2. Guided visualizations to distract patient from pain and aid in sense of calm, relaxation, safety.
3. Distraction through music therapy, art therapy, video games, movies, etc.
4. Cognitive-behavioral therapy geared towards improving coping skills of patient in dealing with bouts of chronic pain.
5. Patient and family education regarding pain management options including non-medication interventions such as visualizations, distraction, and alternative medicine.

TN News: Nursing Plans of Care for Patients with TN

1. Assess for pain and administer analgesics as prescribed
2. Provide non-medication interventions for pain such as guided visualization and distraction
3. Provide pre/post-operative care as applicable
4. Provide patient education to avoid possible aggravating factors such as use of an electric toothbrush or electric shaver, wind on face, hot or cold drinks, contact with air/water at extremes of temperature (hot or cold), etc
5. Interdisciplinary care to include not only neurovascular care but also social work, psychiatry, etc to support patient and family with the challenges of intractable pain and illness that may have no readily apparent cause
6. Referral to regular dental exams every 6 months because dental caries may be indistinguishable from bouts of pain related to TN (trigeminal neuralgia)

Sources:

Antipuesto, D. J., MN, RN. (Feb 2011). Trigeminal Neuralgia (Tic Douloureux). From Nursing Crib. Retrieved 5/23/2015 from http://nursingcrib.com/nursing-notes-reviewer/medical-surgical-nursing/trigeminal-neuralgia-tic-douloureux/

Sweet Haven Publishing Service. (2006). Lesson 38 Trigeminal Neuralgia. From Nursing Care for Neurological patients. Retrieved 5/23/2015, from http://www.waybuilder.net/sweethaven/MedTech/NurseCare/NeuroNurse01.asp?iNum=38

Trigeminal Neuralgia (Tic Douloureux). (n.d.). From Nursing Articles. Retrieved 5/23/2015 from http://studynursing.blogspot.com/2011/02/trigeminal-neuralgiatic-douloureux.html

TN News: Treatment

The primary option for treating TN (trigeminal neuralgia) is called a microvascular decompression. The surgeon approaches the brain from a small hole in the base of the skull, finds blood vessels pushing on the trigeminal nerve, and removes or re-routes the blood vessels. After this the surgeon places a teflon "cushion" between your nerve and the blood vessels. Yes, that's teflon like the non-stick coating on your pans!

Source: Understanding Trigeminal Neuralgia

Dr. Clyde provides a great explanation of microvascular decompression above. Side effects following the surgery may include facial numbness or lack of muscle tone/control in the affected region(s) of the face. The surgery is not always a success, but many people are able to find relief from their symptoms with this surgery. However it is important to note that this surgery only works if the nerve is being compressed by a blood vessel! If your pain is caused by another source, you may need to explore other treatment options.

Sources:
  Understanding Trigeminal Neuralgia (November 2, 2010). Retrieved May 10, 2015, from https://www.youtube.com/watch?v=wYpWgeC3K-s

TN News: The Symptoms

This video documentary of the experiences of Frances Shaver with TN (trigeminal neuralgia) provides an excellent firsthand description of how TN feels. People living with TN experience repeated bouts of excruciating facial pain that might be confused with dental pain or MS pain (multiple sclerosis). The best description of symptoms in this video takes place during approximately the first six minutes:

Source: The Suicide Disease

Sources:

 The Suicide Disease (December 19, 2013). (n.d.). Retrieved May 10, 2015, from https://www.youtube.com/watch?v=uzx_m-a2BJw