Trigeminal Neuralgia is a condition marked by very severe pain that significantly affects both the brain and the overall personality. This presentation discusses the effects of such long-term, or chronic, pain on the brain, the body, and a person’s life.

What is Chronic Pain Syndrome?

Long-term or chronic pain lasting for many months or years is often referred to as Chronic Pain Syndrome or disorder. This condition isn’t limited to one area and can manifest in various forms, including:

• Chronic back pain

• Rheumatoid arthritis

• Neuropathy (due to diabetes or other reasons)

• Other types of neuralgia

Chronic pain conditions like Trigeminal Neuralgia have, in lectures, been referred to as “suicidal” pain. This term highlights a crucial point: the pain can be so severe that it prompts genuine concerns about a person’s mental state, emphasizing the need to discuss its effects on the mind and body.

Understanding the Three Types of Pain

Any pain sensation is complex and goes beyond simple sensitivity. There are three types of pain involved in the complete experience:

1. Nerve Sensation: The direct awareness of the pain by the nerves (e.g., when a hot object touches the leg).

2. Nerve-to-Brainstem Sensation: The transmission of the pain signal from the peripheral nerves (like the trigeminal nerves in the face) to the brainstem.

3. Brain Processing: The final processing and interpretation of the pain signal within the brain itself.

The brain’s interpretation, or Mendu’s response, determines the body’s and mind’s reaction to the pain. This response includes more than just the physical feeling; it involves anger, self-satisfaction, and the decision for the next action, all of which are negative responses to the pain.

The Brain’s Structural Changes Due to Chronic Pain

Extensive research, particularly with the advent of advanced MRI volumetric research, has shed light on the profound structural changes that occur in the brain due to prolonged or chronic pain.

1. Decrease in Brain Size (Grey Matter Atrophy)

A key finding is a structural change in specific parts of the brain that process pain sensation. If the pain sensation is maintained for a prolonged period, the brain’s size gradually decreases.

• The grey matter—the more conscious part of the brain—shows a particular decrease in volume.

• This atrophy is significant in areas where pain sensation connects to the center of emotions and conscious awareness.

This decrease in brain volume weakens essential cognitive and emotional abilities:

• The ability to concentrate the mind.

• Memory for various subjects and their circuitry.

• Emotions generated by the pain.

• The ability to think.

These weakened abilities contribute to the noticeable change in personality observed in individuals facing prolonged chronic pain. The deeper the pain’s “bad cycle” continues untreated, the more profound these changes become.

2. Negative Neuroplasticity

The brain has an inherent ability to change and adapt—known as neuroplasticity—which is usually positive. However, in the context of chronic pain, this ability can lead to negative symptoms, a process called negative plasticity.

3. Sensory Cortex Expansion

Another major change in chronic pain is the increase in the volume and surface area of the part of the brain called the sensory cortex.

• Due to the prolonged and frequent pain, the number and size of the nerves (synapses) involved in sending pain signals to the brain increase.

• The result is that the brain becomes hypersensitive; the intensity of pain is magnified, even for other types of stimuli.

Chronic Pain Syndrome and the “Cage” Effect

Chronic pain essentially affects memory, thoughts, emotions, the ability to work, and personality, collectively leading to what is called Chronic Pain Syndrome.

Furthermore, common medications for chronic pain often do not reverse these structural changes in the brain. Patients live in a state of constant anxiety and fear—an “anxiety neurosis.” This fear is analogous to the story of the animal who, even with food in front of it, cannot touch it because it is perpetually paralyzed by the fear of its cage.

For a patient with Trigeminal Neuralgia, this translates to living in a “cage” of fear—the constant apprehension of when the extreme pain will return, even while on medication.

Final Wording

Trigeminal Neuralgia (TN) is a severe, chronic pain condition that is also a disease of the brain and personality.

1. TN Changes the Brain: Chronic pain causes structural damage (grey matter atrophy) in the brain areas governing emotions, memory, and concentration. This leads to personality changes and cognitive decline.

2. The “Cage” Effect: Patients live in a state of anxiety and fear—a “cage” of anticipating the next pain attack, which is not fully broken by medication.

3. Urgency of Early Treatment: The goal is to treat the pain early and decisively (with effective medical or surgical solutions like MVD). This is critical to prevent the pain from permanently rewiring the brain (negative plasticity) and devolving into a lifelong Chronic Pain Syndrome.