Trigeminal neuralgia, pathophysiology. Considerations in its etiology

Authors

Keywords:

pain, neuralgia, trigeminal, V cranial nerve

Abstract

Introduction: trigeminal neuralgia has been referred since ancient times as one of the most intense facial pains; its etiology is controversial and its prevalence rises along with life expectancy.
Objective: to integrate criteria on the etiology of trigeminal neuralgia.
Methods: documentary review through an automated search in the databases PubMed/Medline, Cochrane Library, Scielo, Medigraphic and Science Direct, using the Google Scholar search engine, during the period from March 2021 to the same month of 2022. Thirty-one articles related to the proposed objective were selected; 23 (74.2%) are updated.
Results: the causal factors of trigeminal neuralgia (trauma, infectious diseases and compression by neighboring anatomical structures or tumors) promote an inflammatory process in the connective tissue that composes the nerve, the release of leukocyte products causes its destruction and the nervous tissue is exposed; action potentials are triggered that cause the painful symptoms typical of the disease.
Conclusions: the development of an inflammatory process in the connective tissue constituent of the trigeminal nerve causes a decrease in the excitability threshold of the affected fibers and provokes pain in response to different stimuli.

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Author Biographies

Ena Luisa Lahera Fernández, Universidad de Ciencias Médicas de Villa Clara

Doctora en Estomatología. Especialista de I Grado en Estomatología General Integral. Especialista de I Grado en Fisiología Normal y Patológica. Máster en Odontoestomatología Infanto-Juvenil. Profesora Asistente en la Universidad de Ciencias Médicas de Villa Clara.

Marisol González Falcón, Universidad de Ciencias Médicas de Villa Clara

Doctora en Estomatología. Especialista de I y II Grado en Fisiología Normal y Patológica. Profesora Auxiliar en la Facultad de Estomatología, Universidad de Ciencias Médicas de Villa Clara.

Odalis Beatriz Díaz López, Universidad de Ciencias Médicas de Villa Clara

Doctora en Estomatología. Especialista de I Grado en Estomatología General Integral. Profesora Auxiliar en la Facultad de Estomatología, Universidad de Ciencias Médicas de Villa Clara.

References

1.HIS Classification ICHD-3 [Internet]. London: International Headache Society; 2021 [citado 23/12/2021]. Pain attributed to a lesion or disease of the trigeminal nerve; [aprox. 2 pantallas]. Disponible en: https://www.ichd-3.org/13-painful-cranialneuropathies-and-other-facial-pains/13-1-trigeminal-neuralgia/

2.Cohen SP, Raja SN. El dolor. En: Cecil y Goldman Tratado de Medicina Interna. 24 ed. España: Elsevier; 2013. p. 135-136.

3.Leach JP, Davenport RJ. Neurology. Davidson’s Principles and Practice of Medicine. 23 ed. España: Elsevier; 2018.

4.Nugraha B, Gutenbrunner C, Barke A, Karst M, Schiller J, Schäfer P, et al. The IASP classification of chronic pain for ICD-11: functioning properties of chronic pain. Pain [Internet]. 2019 [citado 15/06/2022];160(1):88-94. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30586076/. https://doi.org/10.1097/j.pain.0000000000001433

5.Treede RD. The International Association for the Study of Pain definition of pain: as valid in 2018 as in 1979, but in need of regularly updated footnotes. Pain Rep [Internet]. 2018 [citado 15/06/2022];3(2):e643. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902252/. https://doi.org/10.1097/PR9.0000000000000643

6.Marín Medina DS, Gámez Cárdenas M. Neuralgia del trigémino: aspectos clínicos y terapéuticos. Acta Neurol Colomb [Internet]. 2019 [citado 15/06/2022];35(4):193-203. Disponible en: http://www.scielo.org.co/pdf/anco/v35n4/0120-8748-anco-35-04-193.pdf. https://doi.org/10.22379/24224022267

7.Headache classification committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia [Internet]. 2018 [citado 15/06/2022];38(1):1-211. Disponible en: https://journals.sagepub.com/doi/10.1177/0333102417738202. https://doi.org/10.1177/0333102417738202

8.Alcántara Montero A, González Curado A. Neuralgia del trigémino: nueva clasificación y tipificación diagnóstica para la práctica clínica y la investigación. Rev Soc Esp Dolor [Internet]. 2017 [citado 17/03/2022];24(2):105-107. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-80462017000200105. https://dx.doi.org/10.20986/resed.2016.3483/2016

9.Migueláñez Medrán BC, Goicoechea García C, López Sánchez A, Martínez García MA. Dolor orofacial en la clínica odontológica. Rev Soc Esp Dolor [Internet]. 2019 [citado 17/03/2022];26(4):233-242. Disponible en: https://scielo.isciii.es/pdf/dolor/v26n4/1134-8046-dolor-26-04-00233.pdf

10.Jones MR, Urits I, Ehrhardt KP, Cefalu JN, Kendrick JB, Park DJ, et al. A comprehensive review of trigeminal neuralgia. Curr Pain Headache Rep [Internet]. 2019 [citado 17/03/2022];23(10):74. Disponible en: https://link.springer.com/article/10.1007/s11916-019-0810-0. https://doi.org/10.1007/s11916-019-0810-0

11.Gambeta E, Chichorro JG, Zamponi GW. Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments. Mol Pain [Internet]. 2020 [citado 17/03/2022];16:1744806920901890. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985973/. https://doi.org/10.1177/1744806920901890

12.Molina Gil J, López López B, Zunzunegui Arroyo P, Criado Antón Á, González Fernández L, García-Cabo Fernández C. Neuralgia del trigémino como única manifestación neurológica de la COVID-19. Open Respir Arch [Internet]. 2021 [citado 17/03/2022];3(SC1):459-464. Disponible en: https://www.elsevier.es/en-revista-open-respiratory-archives-11-pdf-X2659663621007830

13.Öztürk Ş. COVID-19 and Neurology. Turk J of Neurol [Internet]. 2020 [citado 17/03/2022];26(2):109-111. Disponible en: https://tjn.org.tr/jvi.aspx?pdir=tjn&plng=eng&un=TJN-73384. https://dx.doi.org/10.4274/tnd.2020.73384

14.Llerena Freire LF, Acurio Chingo DJ, Zambrano Saldarriaga LC, Izurieta Mera LM, Gordon Escalante VC, Zurita Villacres AX, et al. Alternativas emergentes en la farmacoterapia de la neuralgia del trigémino. Arch Venez Farmacol Ter [Internet]. 2019 [citado 17/03/2022];38(2):34-42. Disponible en: https://www.redalyc.org/journal/559/55964524006/55964524006.pdf

15.Zakrzewska JM, Wu J, Mon-Williams M, Phillips N, Pavitt SH. Evaluating the impact of trigeminal neuralgia. Pain [Internet]. 2017 [citado 17/03/2022];158(6):1166-1174. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28114183/. https://doi.org/10.1097/j.pain.0000000000000853

16.Fármacos en dolor neuropático: puesta al día. INFAC [Internet]. 2018 [citado 17/03/2022];26(8):67-75. Disponible en: http://www.osakidetza.euskadi.eus/contenidos/informacion/cevime_infac_2018/es_def/INFAC_Vol_26_8_dolor%20neuropatico.pdf

17.Pawlina W, Ross MH. Ross. Tejido nervioso. Histología: Texto y Atlas: Correlación con biología celular y molecular. 7ma ed. España: Wolters Kluwer; 2015.

18.Firestein GS. Mecanismos de la inflamación y la reparación tisular. En: Goldman-Cecil. Tratado de Medicina Interna. 24 ed. España: Elsevier; 2013.

19.Kumar V, Abbas AK, Aster JC. Inflamación y reparación. Robbins and Cotran. Pathologic Basis of Disease. 9na ed. España: Elsevier; 2015.

20.Rincón Carvajal AM, Olaya Osorio CA, Martínez Rojas S, Bernal I. Recomendaciones basadas en la evidencia para el manejo del dolor neuropático (revisión de la literatura). Rev Soc Esp Dolor [Internet]. 2018 [citado 17/03/2022];25(6):349-358. Disponible en: https://scielo.isciii.es/pdf/dolor/v25n6/1134-8046-dolor-25-06-00349.pdf. https://dx.doi.org/10.20986/resed.2018.3673/2018

21.Flint Beal M, Hauser SL. Neuralgia del trigémino, parálisis de Bell y otros trastornos de pares craneales. En: Harrison’s Principles of Internal Medicine. 19 ed. Nueva York: McGraw-Hill Education; 2015. p. 2645-2646.

22.Ropper AH, Samuels MA, Klein JP, Prasad S. Principios de Neurología. 11 ed. Nueva York: McGraw-Hill Education; 2019.

23.Yaya Huaman R, Campos E, Rubio E. V par craneal. Nervio trigémino y Tratamiento quirúrgico de la neuralgia del trigémino. En: Codina Puiggros A. Tratado de Neurología. Barcelona; 2016. p. 754-759

24.Jannetta PJ. Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. J Neurosurg [Internet]. 1967 [citado 17/03/2022];26(1part2):159-162. Disponible en: https://thejns.org/view/journals/j-neurosurg/26/1part2/article-p159.xml. https://doi.org/10.3171/jns.1967.26.1part2.0159

25.Fromm GH, Terrence CF, Maroon JC. Trigeminal Neuralgia. Current concepts regarding etiology and pathogenesis. Arch Neurol [Internet]. 1984 [citado 17/03/2022];41(11):1204-1207. Disponible en: https://pubmed.ncbi.nlm.nih.gov/6487105/. https://doi.org/10.1001/archneur.1984.04050220102026

26.Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G. Trigeminal neuralgia - diagnosis and treatment. Cephalalgia [Internet]. 2017 [citado 17/03/2022];37(7):648-657. Disponible en: https://journals.sagepub.com/doi/10.1177/0333102416687280. https://doi.org/10.1177/0333102416687280

27.Cruccu G, Di Stefano G, Truini A. Trigeminal Neuralgia. N Engl J Med [Internet]. 2020 [citado 17/03/2022];383(8):754-762. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32813951/. https://doi.org/10.1056/nejmra1914484

28.Obata Y, Kawano Y, Tanaka Y, Maehara T. Prognostic Impact and Post-operative Evaluation of Volumetric measurement of the Cerebellopontine Cistern in Trigeminal Neuralgia Using 3 Tesla Magnetic Resonance Imaging. Neurol Med Chir (Tokyo) [Internet]. 2018 [citado 17/03/2022];58(2):71-78. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5830526/. https://doi.org/10.2176/nmc.oa.2017-0157

29.Digree Kathleen B. Cefaleas y otros tipos de dolor cefálico. En: Cecil y Goldman Tratado de Medicina. 24 ed. Madrid: Elsevier; 2013. p. 2255-2256.

30.Roig Fabré E. Neuralgia del Trigémino. Goyenechea Gutiérrez FF, Pereira Riverón R. Neurocirugía. Lesiones del sistema nervioso. Tomo 2. La Habana: Editorial Ciencias Médicas; 2014 [citado 17/03/2022]. Disponible en: http://bvs.sld.cu/libros/neurocirugia_lesiones_sistemanervioso2/neurocirugia_completo_tomo2.pdf

31.Santos Velázquez T. Neuralgia del trigémino idiopática. Rev Electrón Dr. Zoilo E. Marinello Vidaurreta [Internet]. 2019 [citado 17/03/2022];44(1):[aprox. 4 p.]. Disponible en: http://www.revzoilomarinello.sld.cu/index.php/zmv/article/view/1668/pdf_548

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Published

2023-03-29

How to Cite

1.
Lahera Fernández EL, González Falcón M, Díaz López OB. Trigeminal neuralgia, pathophysiology. Considerations in its etiology. Acta Méd Centro [Internet]. 2023 Mar. 29 [cited 2025 Jul. 12];17(2):363-7. Available from: https://revactamedicacentro.sld.cu/index.php/amc/article/view/1689

Issue

Vol. 17 No. 2 (2023): Abril-Junio

Section

Review Articles

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