Relieving patients of chronic pain at KMC Hospital

Government Kilpauk Medical College Hospital offers a day care procedure for trigeminal neuralgia, providing relief for intense facial pain.

In trigeminal neuralgia, a chronic pain disorder, patients experience an intense, electric shock-like pain in the face. The pain could be excruciating, making simple activities like eating or brushing the teeth difficult for many. While medical management is one of the treatment options, doctors of the Department of Neurosurgery, Government Kilpauk Medical College (KMC) Hospital have been offering a day care procedure for patients who do not respond to medications.

Since 2021, doctors have been performing Percutaneous Retrogasserian Glycerol Rhizotomy in which anhydrous glycerol, which has a specific property to destroy only the pain fibres, is injected into the nerve, said M. Kodeeswaran, head of department, neurosurgery, KMC.

“The pain is caused due to irritation of the trigeminal nerve by a vascular loop. When blood supply pulsates, the nerve gets irritated at the exit point of the brainstem. The pain will be excruciating and intolerable for patients. In at least 30% of the patients, the pain is idiopathic. There are three treatment options: medical, percutaneous treatment using glycerol injection or radio frequency ablation, and surgery,” he said.

Surgery involves opening the skull and placing a patch around the nerve to reduce pulsation from hitting the nerve, he said, adding: “A patient on medication will be drowsy, less active and may have depression.” This is where the day care procedure comes in, he said. “Using a C-arm machine to locate the nerve, we inject anhydrous glycerol into the trigeminal ganglion to destroy the pain fibres. This comes with no major risks, and we can repeat the procedure if it fails,” he said.

Overall, Dr. Kodeeswaran, in his experience, has so far performed the procedure in over 300 patients. Since its launch at KMC, more than 150 patients have undergone the procedure, with at least five to six patients in a month. “We are getting patients from across the State as well as from neighbouring places such as Bengaluru. We have had patients who suffered from chronic pain for 20 to 25 years. This has the same result of surgery,” he said.

He said that they have founded World Trigeminal Neuralgia Foundation, a not-for-profit organisation, to train young doctors in the treatment modalities. “Patients will have depression and suicidal tendencies. They should be given proper counselling and treatment as early as possible,” he said.

In fact, doctors, including Dr. Kodeeswaran, in an article published in the World Neurosurgery, in the report Failed Face Syndrome : Understanding and Addressing the challenges of persistent facial pain after Trigeminal Neuralgia procedures, have proposed a new terminology called failed face syndrome. This refers to patients who have undergone treatment for trigeminal neuralgia and have had recurrence due to failure of treatment or have new form of facial pain. These patients have been classified into four groups based on factors such as pain score, financial burden, psychiatric illness and previous treatments. Based on this classification, treatment modalities have been determined.