Facial pain is one of those experiences that defies simple definitions. When the trigeminal nerve is involved, it can appear like a sudden electrical discharge or take the form of constant pain — quiet yet relentless. It is suffering that doesn't always strike in waves but often persists without pause, present from morning to night like tension beneath the skin, like a heat that refuses to fade.
The paroxysmal form of pain and its constant form are two different experiences that, while affecting the same area of the face, may arise from distinct mechanisms. In paroxysmal neuralgia, the cause is often a neurovascular conflict — compression of a vessel against the trigeminal nerve root. In such cases, surgical decompression of the nerve can bring significant relief, and sometimes even complete resolution of attacks. Constant pain, on the other hand, is often associated with persistent hypersensitivity or damage to nerve fibers, and does not always have a single identifiable anatomical source.
One thing, however, remains the same: pain is not "made up." It is a signal. Information that something in the nervous system has stopped functioning properly. Sometimes the problem is visible on imaging; sometimes it isn't. And a result described as "normal" does not mean there is no suffering. It only means that the mechanism is more complex and requires a more careful examination.
Pain as a message to be read
In a conversation with Dr. Bartosz Kudliński, one thing stands out: a tremendous respect for pain as a phenomenon. He doesn't treat it as a symptom to be silenced, but as a message that must be deciphered. The physician should be a guide in this process. They should help the patient name the pain — identify its intensity, location, radiation, character, and its relationship to temperature, stress, or atmospheric pressure changes. A well-conducted clinical history is not a formality — it is often the key to understanding the mechanism of suffering.
The limits of modern medicine
Modern medicine has a limited arsenal. A few drug classes, approximately thirty active substances, interventional methods in select cases. It is not an infinite repertoire of possibilities. In chronic pain — and neuropathy with constant pain is a classic example — it is rarely possible to completely switch off suffering. The goal of therapy becomes reducing intensity, regaining some control, and improving quality of life.
Empathy as a condition of treatment
And this is precisely where empathy stops being an add-on and becomes a condition of treatment. It does not directly relieve pain. It does not block nerve impulse conduction. But it allows the physician to truly listen to what the patient is saying — and to what they're not saying directly. It facilitates recognizing the mechanism, selecting the right therapy, and finding possible solutions. For someone living with chronic pain, empathy means something very concrete: that on the other side of the desk sits someone who takes their suffering seriously. Who doesn't assume exaggeration, simulation, or "oversensitivity." Who sees a person, not just a symptom.
And yet, in the reality of an overburdened healthcare system, there is often no space for this. Appointments last a few minutes. Questions are abbreviated. Decisions are quick. For the pain patient, this can feel like their credibility is being questioned. Sometimes it feels outright humiliating. Pain that already isolates is additionally invalidated.
We cannot afford this. A person living with neuralgia or neuropathy is not fighting for comfort. They are fighting for the ability to speak, eat, work, and sleep. They are fighting for relationships and dignity. In a sense, they are fighting for their very life — because chronic, untreated pain steals its quality piece by piece.
The full picture
Facial pain — both paroxysmal and constant — has a neurological dimension, but also a psychological and social one. It can narrow the world down to a few safe activities. In neuropathy with constant pain, what is particularly difficult is that there are sometimes no clear breaks. The suffering continues. It therefore requires not only pharmacotherapy, but also coping strategies, support from loved ones, and sometimes psychological help.
There is no life completely free of pain. That sentence may sound harsh, but in the words of a physician who looks suffering in the eye every day, it is not an expression of resignation. It is an expression of realism and humility. And from that humility grows the most important thing — attentiveness.
For people living with trigeminal neuralgia, with neuropathy and constant pain, this conversation matters deeply. It doesn't promise miracles. But it restores something equally important: the sense that pain is real, that it has its mechanisms, and that it can be understood — together.
Natalia — since 2014 I've been living with trigeminal nerve pain. I write in plain language, based on reliable sources and personal experience. Read my story →
Frequently Asked Questions
What is trigeminal neuralgia?
Trigeminal neuralgia is a chronic facial pain condition. It manifests as sudden, severe, usually one-sided pain attacks — often described as an electric shock. A single attack typically lasts from a few seconds to about two minutes.
What is the difference between neuralgia and neuropathy?
In simple terms: neuralgia primarily involves paroxysmal pain along a nerve, usually without loss of sensation. Neuropathy involves nerve damage that more often causes constant pain along with numbness and sensory loss.
What is neurovascular conflict (vascular compression)?
This is the most common cause of classical trigeminal neuralgia — a blood vessel compresses the nerve root at the base of the brain, damaging its myelin sheath and triggering pain.
Can trigeminal neuralgia be cured?
In many people, pain can be effectively controlled with medications or procedures, and MVD provides the most durable results in eligible patients. The course varies — with periods of remission and relapse. Decisions are made together with your doctor.
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