What is anesthesia dolorosa? 

Anesthesia dolorosa (AD) is a feeling of pain in an area that is completely numb to the touch. “Anesthesia dolorosa” literally means “painful numbness”. Numbness describes a loss of sensation or feeling in a part of your body, but it is often accompanied by or combined with other changes in sensation.  

AD causes pain in one or more areas of the face which are completely numb to touch. The pain is described at constant, burning, aching, squeezing, heaviness, tightness, pressure or likened to pins and needles.  The primary pain is usually continuous or near-continuous. You may also experience brief bursts of pain, but these are not typically the predominant pain type. Diagnosis is generally based on the description of symptoms. 

AD occurs when the trigeminal nerve is damaged so that the sense of touch is diminished or eliminated while a malfunctioning sensation of pain is left intact. AD is caused by nerve damage, either from an underlying condition, traumatic injury, or from past treatment of the trigeminal nerves. AD is referred to as a deafferentation pain syndrome, meaning that it results from complete or partial interruption of nerve impulses.  

Anesthesia dolorosa and trigeminal neuralgia 

AD pain is usually constant with a burning or jabbing quality, while trigeminal neuralgia (TN) is intermittent, with sharp, electric-like jabs. The distinction between the two can affect the course of treatment. Further destructive procedures for an AD patient may make the condition worse. 

What causes anesthesia dolorosa?  

AD can be a side effect of surgery involving any part of the trigeminal system. There are several theories about what causes AD. 

  • Theory 1: The touch-carrying nerve fibers are injured by surgery, while little or no damage occurs to pain-carrying fibers. 
  • Theory 2: Surgical injury may also prevent nerve fibers from overlapping as they normally should, resulting in distorted signals being sent to the brain. 
  • Theory 3: AD pain is much like phantom limb pain, but is occurring to an amputated trigeminal nerve branch instead of an arm or leg. After surgery, when these pain signals suddenly stop, the brain may deal with this loss of input by remembering and replaying old pain signals. 

Treatment for anesthesia dolorosa 

Medications 

  • Muscle relaxants (Baclofen, Zanaflex) 
  • Antidepressants like amitriptyline (Elavil), nortriptyline (Pamelor), clonidine (Catapres), paroxetine (Paxil) 
  • Anticonvulsants such as TN- carbamazepine (Tegretol, Carbatrol), oxcarbazepine (Trileptal), gabapentin (Neurontin), clonazepam (Klonopin), valproate (Depakote), topiramate (Topamax), phenytoin (Dilantin) 
  • Topical anesthetic (EMLA) 
  • Topical ointments (Zostrix, Capsaicin-P) 
  • Anesthetic Injections (lidocaine), opioids, such as a transmucosal fentanyl (Actiq) 
  • Oral Morphine drugs (oxycontin) 

Complementary health approaches  

  • Acupuncture  
  • Upper cervical chiropractic 
  • Nutrition therapy 
  • Hot and cold compresses 
  • Biofeedback 
  • Electrical stimulation (TENS, SCENAR) 
  • Medical treatment 
  • Anesthetic injections (nerve blocks) 
  • Motor cortex stimulation (an implanted electrode gives constant electrical stimulation) 
  • Drez procedure  

As medical science better understands the brain, surgeons also are looking into the newer field of stimulating or selectively disabling parts of the brain that process pain signals.

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