What started off as numbness and a tingling on the right side of Wang Li’s face became a nightmare when she could no longer brush her teeth or even chew her food, a condition known as trigeminal neuralgia.
At the turn of her 50th birthday in 2013, Wang Li began experiencing slight numbness and a tingling sensation on the right side of her face, almost as if a small animal was crawling on her skin.
“At that time the symptoms were mild, just slightly uncomfortable, and did not interfere with my daily activities. To manage the discomfort I consulted a Traditional Chinese Medicine (TCM) physician, who diagnosed me with trigeminal neuralgia (TN), a type of severe facial pain. He also prescribed medication which eliminated the symptoms for two years,” shares Wang Li, who worked as a researcher in the laboratory.
About three years later, the pain worsened and became so unbearable that she was not able to go for brisk walks as the vibration from walking would intensify the pain.
“I even found it challenging to brush my teeth, as opening my mouth would generate sudden and intense pain,” she adds.
Desperate for relief
Wang Li then consulted a neurosurgeon, who prescribed her with two drugs, carbamazepine and oxcarbazepine, for trigeminal nerve pain. Unfortunately, she was among 30% of patients who do not respond to these medications.
“The medications also caused side effects, such as slowing down my physical responses and brain functions. I was taking much longer to formulate verbal responses, I was not mentally present at work, and felt like I was in a zombie-like state. This made it difficult for me to perform my work as a scientist, and I informed the doctor that I would stop taking these medications,” she says.
In 2017, Wang Li underwent radiofrequency ablation (RFA) with a well-known doctor in China. The treatment, which uses heat energy to destroy a small part of the trigeminal nerve responsible for the pain, proved successful in staving the pain, but the relief was short-lived.
The numbness and tingling sensations returned just one year later. She underwent regular acupuncture treatments and massages, which offered her temporary relief for about two years. By the end of 2019, her pain had intensified so much that she decided to undergo another RFA session with the same doctor.
Again, the pain returned, but this time, travel restrictions were in full force due to the COVID-19 pandemic, preventing Wang Li from returning to China for a third round of RFA. She resorted to TCM and acupuncture treatments to manage her pain.
“I was having trouble eating as opening my mouth or chewing food caused such severe and intense pain that radiated from the jaw up to my eyebrows. I had to blend and mash my food to almost liquid form so I could easily swallow it. Whenever I felt the sharp pain, I had to stop moving my mouth and wait for it to subside. It took me more than 10 minutes to brush my teeth every morning as I had to first condition my nerves using small movements with my mouth, before I could properly brush my teeth,” shares Wang Li.
“Then, I noticed the right side of my face was starting to swell, and as acupuncture was no longer able to manage my symptoms, I began looking for another solution.”
Consulting a pain expert
Through desperate online searches and recommendation from friends, Wang Li learned about Dr Bernard Lee Mun Kam, consultant pain specialist from the Singapore Paincare Center.
According to Dr Lee, trigeminal neuralgia is characterised by recurrent pain in the face where the trigeminal nerve is located. It is the most common type of severe facial pain, affecting four to 13 people per 100,000 annually.
“Interestingly, TN predominantly affects the right side of the face. Patients usually experience brief episodes of intense, stabbing, electric shock-like pain in the face. Some patients also experience continuous dull, aching or burning pain which incapacitates them such that they are unable to perform day to day tasks, and causes them to live in constant anxiety or fear of the next episode,” he shares.
“While this condition is notoriously difficult to treat, pain specialists are able to combine minimally invasive procedures such as specialised injections and oral medications to help patients like Wang Li,” he adds.
To date, the Singapore Paincare Center has treated more than 300 trigeminal neuralgia patients and sees 15 new patients every year.
A specialised approach
Wang Li scheduled her first appointment with Dr Lee in April 2021.
“When I first saw Wang Li, her face was so severely swollen that she could not speak and had to type out her responses to communicate. I had to first treat the inflammation using a steroid-based anti-inflammatory medication. After two weeks, the swelling had subsided and her face returned to its normal size, but it took another three months before the inflammation was properly managed. I then used the ‘trial and error’ approach with medications and landed on a set of four different medicines that have been effective in stabilizing and calming her facial nerves,” explains Dr Lee.
He prescribed a combination of anti-depressants, anti-anxiety medications and tranquilizers, intended to calm the nerves so that they are not over-activated and do not generate intense pain.
“In October 2021 I also administered platelet-rich plasma (PRP) therapy, which helps the muscles to repair, relax and regain muscle tone lost due to injury from prolonged periods of muscle spasm and toxin accumulation; and peripheral nerve block. After three weeks, her pain gradually reduced by 70-80%.”
Today, Wang Li is able to manage her pain effectively and resume daily activities with the help of Dr Lee.
“While the medications have helped me manage my pain and functioning on a daily basis, to maintain my long-term health, I have been working with Dr Lee since February 2023 to gradually wean off the medications, as its long-term use could contribute to increased cholesterol and triglycerides level, ” says Wang Li.
Photos of Wang Li courtesy of Wang Li.