Steven Schreiner remembers the first time he felt the pain. He was walking down a stairway at his workplace about a year ago when he felt a strange stabbing sensation across his right cheek.

“I thought to myself, ‘What the heck was that?'” said Schreiner, a senior programmer-analyst at EMC Insurance Group Inc. “But I shrugged it off, since it only lasted a second or two.”

That brief flash was just the beginning, however, of what would turn into a living hell for Schreiner, now 49. The disorder he would later learn he had – trigeminal neuralgia – was causing his nervous system to misinterpret even the slightest stimulation to his face as a life-threatening injury.

At the time Schreiner’s agonizing odyssey was beginning, no doctor in Greater Des Moines had the expertise to surgically correct the disorder, which occurs when a blood vessel indents the trigeminal nerve in the face.

Trigeminal neuralgia wears away the “insulation” surrounding the nerve, similar to a damaged electrical wire. The damage occurs gradually over the years with the vibration of each heartbeat, just as drops of water can gradually erode a rock, said Dr. Robert Kerr, the neurosurgeon who successfully operated on Schreiner in September.

Kerr had joined the neurosurgery group at The Iowa Clinic P.C. only two weeks earlier, having just completed a two-year fellowship to study minimally invasive skull-based surgery at the Mayfield Clinic in Cincinnati. During that time, he worked with one of the few surgeons in the world who specializes in microvascular decompression, the surgical procedure used to correct trigeminal neuralgia.

“I believe things happen for a reason,” Kerr said of his move to Iowa. A native of Toronto, Ontario, the neuro-oncology surgeon found himself too specialized to practice in Canada, and sought work in the United States. Needing to practice in an underserved area of the country to earn a green card and ultimately U.S. citizenship, he chose Des Moines.

“As part of the investigation of looking for a place to call home, I really fell in love with the Midwest world,” he said. “The way people are very generous, honest and hard-working. That kind of ‘Nothing is impossible; we can do things together’ attitude is refreshing, and that’s the kind of community I wanted to be a part of.”

In mid-2009, while Kerr was still in Cincinnati, assisting in four or five surgeries a week on patients from around the country with this rare condition, Schreiner’s attacks were becoming more painful and frequent.

Thinking the pain was related to a tooth on which he had had root canal surgery, Schreiner visited his dentist, but hesitated to spend thousands of dollars to rebuild bridgework built around that tooth.

When the pain continued, Schreiner was referred to another dentist who recognized the symptoms of trigeminal neuralgia and referred him to his family physician. A prescribed anticonvulsant medication eliminated the pain for about a month, but wore off.

After that, even a mild breeze on his cheek or eating or drinking could trigger the next debilitating round of pain, which can feel like a hot poker or an electric shock.

“I would be talking to someone at work, and without warning the condition would erupt and I would be in excruciating pain and would have to excuse myself from the conversation,” Schreiner said.

Schreiner’s doctor referred him to a neurologist, who experimented unsuccessfully with different combinations of medications.

By this time, “I was really getting desperate,” Schreiner recalled, as the attacks were lasting up to 40 minutes at a time and returning nearly every hour, even waking him in the night. Reaching a point where he was unable to go to work, “all I could do was lie on the floor at home and try to get through the day. I had put my entire life on hold.”

After Schreiner saw another neurologist for a second opinion, that doctor referred him to a neurosurgeon at The Iowa Clinic, who then referred Schreiner to Kerr. Schreiner had been living with the condition, which was now a constant, intense burning sensation in his face, for about seven months.

“It was really remarkable; he was one of the worst cases I had seen,” Kerr recalled. “His whole eye on his right-hand side looked like it was infected and he was in so much agony sitting in my office.”

Within 10 minutes, Kerr “had me penciled in for the operation,” Schreiner said. “He said, ‘We’re going to get you some relief.’ I cried like a baby. I couldn’t believe that somebody finally understood.”

Kerr said because Schreiner was young and otherwise healthy, “he was a prime candidate to move beyond some of the things that treat just symptoms, and move right to surgery, which goes to the source of the problem. It’s very satisfying from the point of view of relieving real suffering, and it’s highly, highly effective.”

The surgery involves making a hole less than an inch in diameter in the skull behind the ear and the surgeon using a microscope to see the nerve so it can be moved away from the blood vessel. Patients can usually go home within 48 hours of the surgery. Schreiner said when he woke up from the surgery, “I probably had a big smile on my face,” because the pain was gone.

An alternative treatment option, particularly for older patients who may not be able to tolerate general anesthesia, is rhyzotomy, which uses radio frequency treatment to knock out certain nerves.

Another technique, an advanced radiation therapy known as stereotactic radiosurgery that uses the Cyberknife device, is also effective in some cases. However, Kerr said he views it as a secondary option to microvascular surgery.

Using the Cyberknife, “it can take up to three months for the deadening of the nerve to occur, but the radiation injury often causes the entire face to go numb,” he said. “So the pain is still there, but they’re left with a completely numb face, which to me is the worst of all possible outcomes.”

Kerr has since successfully performed six more surgeries on patients with trigeminal neuralgia, and he has three more scheduled.

“I’m starting to educate people that I’m here and that it’s available and that you don’t have to travel long distances to have this done,” he said.