Pain management
Facial pain is a symptom reported by many people living with facial palsy. As the causes of facial palsy vary, so do the symptoms, and each person’s experience and how they recover may be slightly different.
Pain caused by muscle tightness
One of the main causes of facial pain, regardless of the cause of your facial palsy, is poor muscle health. This occurs in people who experience a delayed or prolonged recovery (i.e. people who have not made a full recovery within the first 3 – 6 weeks).
Facial muscles become stiff and tight because the recovering facial nerve can overwork sending out too much energy to the muscles in the form of electrical signals. Electrical signals are the fuel for muscles which, when delivered in normal quantities, give our facial muscles tone and definition. However, when the muscles receive more electrical impulses than required to keep a healthy muscle tone, the affected muscles become thicker. This leads to stiffness and tightness of the muscles resulting in facial pain.
What can help?
Facial pain caused by stiff, tight muscles can be relieved by:
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- Relaxation
- Facial massage
- In more severe cases ofsynkinesis, treatment with Botulinum Toxin injected into the affected muscles may be required.
Facial pain due to muscle tightness can be exacerbated by the cold. It is recommended that you wear a scarf/ski-mask or similar when out and about in very cold weather. Applying heat to the face in the form of a warm pad or flannel may also help to reduce your pain.
Bell’s palsy
Ear pain is a commonly reported symptom in people diagnosed with Bell’s palsy because of sensory fibres (pain sensors), arising from the facial nerve, supply the ear. People with Bell’s palsy commonly report pain and tenderness in or around the ear especially in the early days of recovery. This can usually be managed with non-prescription painkillers but if pain persists you should seek advice from your GP.
Trigeminal Nerve, Trigeminal Neuralgia
The facial nerve only supplies pain sensors to the ear. The nerve which senses pain is called the trigeminal nerve and supplies sensation to the face, mouth, gums and teeth. The trigeminal nerve is divided into three branches which supply sensation to the forehead, the cheek, and the jaw. ‘Neuralgia’ means ‘nerve pain’. Trigeminal neuralgia refers to pain associated with the three divisions of the trigeminal nerve. It is a condition that can arise suddenly, and the cause is often unknown. It is normally a separate diagnosis which is unrelated to facial palsy but can also be part of a cluster of symptoms reported by people diagnosed with Ramsay Hunt Syndrome (RHS).
Ramsay Hunt Syndrome
The form of facial pain that occurs in Ramsay Hunt Syndrome (RHS) can cause a variety of pain symptoms. This is because the trigeminal has been affected. Symptoms may include:
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- Pain in and around the ear.
- A painful rash, on the affected side, which can develop on the eardrum, ear canal, earlobe, tongue or roof of the mouth.
- Pain can occur without the presence of a rash due to the involvement of the trigeminal nerve.
Pain is described as:
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- Stabbing or shooting but passes rapidly
- A burning pain which can be prolonged or constant
- An aching sensation which can be prolonged or constant
- Throbbing
- Pain is associated with a very light touch, but firm pressure is generally not painful
These painful symptoms are often poorly managed with non prescribed pain medication. If you have been diagnosed with RHS, ordinary pain killers may not be effective, and you should seek prompt advice on pain management from your GP. The effects of treatment are better when treatment is given early. There are several medications which can be prescribed specifically for nerve pain including some antidepressants which are only given in very small doses.
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