For two years, Bruna Gasparin, 26, suffered from trigeminal neuralgia, considered one of the worst pains in the world. “It was a pain unlike any I’ve ever felt in my life”, says the nursing technician who had difficulties eating, drinking and even speaking.
In an MRI, the doctor discovered that Bruna had a 4 cm tumor in her brain and that it was compressing the trigeminal nerve, which would help to further explain the intensity of the pain. At the age of 23, the young woman underwent surgery to remove the tumor and the pain disappeared. Already recovered, Bruna became a nursing technician at the hospital where she operated and today she motivates other patients with her story.
“In 2017, I felt a very strong pain, as if it were a shock near the jaw on the left side and then in the chin. It lasted a few seconds, but it was unbearable. At first it was sporadic, I imagined it could be a muscle pain, a bad like it had hit the neck or even a more intense headache.
In late 2018, the pain began to come and go several times during the day. I went to the dentist thinking it could be the wisdom teeth, but when he moved, the shock didn’t come and we ruled out the possibility of something related to that.
The second professional I looked for was an otolaryngologist because I thought it could be a problem with the TMJ (temporomandibular joint). On clinical examination, the doctor moved behind the joint and I felt the shock near my jaw and chin. He asked for an TMJ resonance, but nothing came of it.
My biggest difficulty was being able to describe what this pain was like to know which specialist to look for. Over time, it only got worse and started to affect simple things in my daily life.
I felt the shock when chewing, drinking, talking, brushing my teeth, greeting people with a kiss on the cheek, for example. During the crises, I cried and screamed in pain.
I went to the emergency room several times, some doctors gave some hypotheses about what it could be, but they never came to a conclusion. They said it could be some chronic pain, or pain caused by trigeminal neuralgia, considered one of the worst pains in the world, even described as worse than the pain of normal childbirth.
I went to the neurologist, he said that it was not normal for a person my age — I was 23 years old — to have trigeminal neuralgia, because it is more common in the elderly. He suspected two possibilities: multiple sclerosis or a tumor near the trigeminal nerve. At his request, I had an MRI of the skull that showed a 4 cm tumor located at a point that was compressing the trigeminal nerve.
I took the exam result to another neuro who had already passed it a few times. He said that my case was surgical, according to him, only the removal of the tumor could reduce the pressure on the nerve, which would relieve or even stop the pain. He gave me an urgent referral for surgery to remove the tumor and gave me an anticonvulsant, indicated for trigeminal neuralgia.
To be honest, my pain was so bad that I had no reaction when I found out about the tumor. My desperation hit me when I passed the screening for surgery, and they said it could take up to three years to come out—I couldn’t bear to live another three years with that pain.
My mother went to the city hall of my city to ask for help, they saw her suffering, mobilized and managed to speed up the process. By then, she had stopped taking her technical nursing classes and spent most of the day lying in bed, drowsy from the strong medication.
On May 30, 2019, I had the surgery, the tumor was completely removed. After doing the biopsy, we found it to be benign, but removing it over the trigeminal nerve was critical for the shocks to stop.
In the hospital room, I was able to drink water, eat and talk to my mother without pain. The feeling was wonderful, of happiness and gratitude. In two months, my life returned to normal and I started to follow up once a year.
I finished the course and, in April 2020, I got my first job as a nursing technician at Hospital Universitário Cajuru, in Curitiba, where I had the surgery. I work in the renal transplant inpatient unit.
Overcoming my own struggle from the time I was sick helped me to reframe the way I treat my patients and see life. The treatment and reception I received from the team when I had the surgery and was hospitalized was very important at a time when I felt fragile and discouraged.
Today, as a healthcare professional, I am empathetic and put myself much more in the other’s shoes. I try to offer a more humanized care and when I see a sad or scared patient, I tell my story as motivation to convey hope.”
What is trigeminal neuralgia?
Trigeminal is the name given to the cranial nerve responsible for the sensitivity (tactile, thermal, painful sensation) of the face and the masticatory movements. Neuralgia is pain originating from a nerve, in this case, it is a paroxysmal pain, that is, it happens from one moment to the next, in one or more areas of innervation of the trigeminal nerve, caused by the acts of chewing, coughing and touching the face.
Simple acts like brushing your teeth, combing your hair, washing your face or even a light breeze blowing on your face can trigger terrible painful crises.
The cause of trigeminal neuralgia is not completely understood, but some conditions have been highlighted, such as intracranial compression of the trigeminal nerve by peripheral vessels, usually arteries. Other causes include viral infections, tumor lesions, multiple sclerosis, aneurysms, and alveolar involvement after tooth extractions.
The pain is similar to a shock or burning, of strong intensity, lasting from seconds to minutes and that disappears as soon as it started – in attacks, it can last for hours. It is limited to one or more branches of the trigeminal nerve and affects one side of the face.
Classically, it is not associated with abnormalities on neurological examination, but in some cases it is possible to observe sensory changes in the territory of the affected nerve. The pain can be so intense and the attacks so frequent that it can drive the patient to commit suicide.
As in Bruna’s case, an intracranial tumor located close to the trigeminal nerve can cause neuralgia by compression or displacement of the nerve, as well as tumors originating from the trigeminal nerve itself can cause neuralgia.
The diagnosis of trigeminal neuralgia is essentially clinical, with a detailed history of the onset of symptoms, the characteristics of the pain and its evolution, combined with a thorough physical and neurological examination. In suspected cases, it is necessary to carry out complementary tests with electrophysiological, neuroradiological and CSF examination.
Initially, treatment is done with specific medications for neuropathic pain, and this is usually sufficient in most cases. Surgery is indicated for patients whose medication has had no effect or where a definite cause of trigeminal neuralgia, such as a tumor or vascular compression, has been identified.
In situations where the cause is identified, surgery can provide healing and total relief of pain symptoms.
Source: Robinson Antonio Menegotto marquisneurosurgeon at the Cajuru University Hospital.