People who suffer from Trigeminal neuralgia, which is a chronic pain condition, often have depression. I have written this blog to help understand how the pain-anxiety-depression cycle kicks in.
I remember a story told to us in childhood.
Akbar asked Birbal, what is the worst punishment for a human being? (Akbar was a powerful Mughal emperor in India and Birbal was his wisest court- minister).
Birbal said, “Sire, before I give you the answer to this question, may I ask you what do you think is the worst punishment ?”
“Why, Birbal, of course it is death penalty ! …I just want to know if you have any different thoughts.”
“Sire, the worst punishment is not death; it is a “continuous, chronic mental terror that death or pain is about to come. I do not wish this punishment upon my worst enemy too.”
“Surely Birbal, you are joking. How can anything be worse than death itself? You have to prove your claim” said the Emperor in his usual style.
And in his usual style, Birbal too arranged the experiment.
He ordered a ferocious and hungry tiger to be brought in a cage. He ordered that the tiger should be kept half fed.
Five feet from the cage, he tied a well-fed sheep to a tree.
A heap of grass was kept by the sheep’s side so she could feed to her heart’s content.
Birbal told Akbar, “Sire, we will visit this site daily.”
On the tenth day. The sheep had lost all the weight, had not eaten any grass and there was a terrified look on her face that had become almost permanent. The fear of the tiger had taken away her appetite.
This story is more than just amusement.
A chronic pain, chronic terror, continuous foreboding that the next attack of pain in imminent is typical of trigeminal neuralgia pain….even in patients who are on medicines for months and years together.
This continuous terror and severe anxiety is worse than pain itself.
It has been proven with the help of functional MRI that the surface area of sensory pain mapped on brain surface is found to have increased many-fold in patients with trigeminal neuralgia and other types of chronic pain.
So, the brain actually changes for worse in these patients….literally and structurally.
This results in even small painful stimuli causing severe pain as the sensory interpretation of the pain has multiplied many fold.
Thus chronic pain can cause severe depression, and induce suicidal tendencies.
And this is the reason that procedures like MicroVascular Decompression should be used to CURE the disease (Trigeminal Neuralgia), rather than any temporary methods or medicines.
Dr Jaydev Panchwagh is a renowned neurosurgeon with special interest in Trigeminal neuralgia treatment, and has performed over a thousand Microvascular Decompression surgeries.
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