I went in not knowing what to expect, he came in with a smile which I guessed was a good start. He sat down in his chair and drilled me off the bat with every and any questions he could of had about my past medical and current condition. Almost to the point that I was second guessing if I had TN and why I had come there in the first place. Was starting to feel overwhlemed at that point but I have just been over emotional these past few weeks. He was surprised that I was on so much Tegretol 500 mg twice a day, and said that for me I would not get anymore effect from it by upping the dose anymore and infact it could do harm. He took me off all my other meds and put me on a pain patch FentaNYL. (Please any good news on this patch will put me at ease) He is ordering a head scan to be done, I just have to call monday to make an appointment for it. He stated if nothing else showed on the scan...and TN was what it was if the Tegretol and Patch was not working a nerve block was the next path. Now I read from lots of people on this site and other sites about all the Meds that are out here to help this, combinations that can work....sounds like he is jumpin the gun? There are or are not alot of other med combinations that can help me. I really was not looking to do things from nerve block on up . xP.....I need to hear your input...please help me.
Also word on this Patch being good or bad....your say would be great!
I know some people, with other neuropathic conditions, for whom the fentanyl patch has worked very well. I, on the other hand, tried it, and it made me depressed, which was very unfortunate, because it has worked so well for others. So I discontinued taking it.
Good luck, and I hope that you have more of a normal reaction than I did. Every person reacts differently to meds.
The nerve block is often used to confim a diagnoses of TN. There a lot of combinations of medications that can help you, but what works for one will not work with another. Meds are something that you and your doctor will have to work on. As for the patch I do not do well with narcotics so I did not try it.
fentanyl is 100 times more potent than morphine. if you weren't out of pain, i'd be surprised. it works quickly, but unfortunately, doesn't last long.
this doctor is treating your pain aggressively. some people would pray for a doctor like this; others might be scared by him. everyone is different, and everyone's level of pain is unique. if you're not comfortable with this type of drug; ask for something non narcotic and tell him you want to keep the Fentanyl as a rescue drug. be prepared to be disappointed. fentanyl is the mother of all pain killers; it vetoes the pain receptors and floods the brain with a virtual sense of euphoria.
this doctor's pharmacology decisions impress me, but his surgical recommendations make me worry; a doctor who knows to ditch Tegretol at a high dose and give a strong narcotic should also know nerve blocks are useless for classic TN. there is also a weird subculture i have seen where people who have TN elect for regular nerve blocks (a standard shot with Lidocaine) and are made worse by them, myself included. it's unclear why this seems to happen, but i've spoken with several people where this event has occurred. it could be that the Lidocaine irritates the nerve, but this is not documented as medical certainty.
get the facts on which kind of "nerve block" this doctor wants you to have; is it a standard Lidocaine shot, or the kind where they go in and permanently injure the nerve to stop the pain signals? (this is called a rhizotomy, but doctors are often guilty of using terribly informal jargon to patients regarding treatment.)
make sure your MRI is a thin slice scan with an MRA, or the scan is useless.
i'm not a doctor, speak to your own about what i have said here.