A patient, and her 'TN' pain

General General TN & GPN (Old Site)
1

Not sure this is entirely within the rules of the forum, but I'm not advocating a specific treatment modality, and if it is outside the rules I'm sure it will be bounced/ deleted, maybe to the new back room at best.

A female patient mid thirties, a prison officer (not particularly relevant, kinda setting the scene), 5 years ago ish consulted myself for low back pain after an assault within her work place. After a handful of treatments she was happy enough with the outcome, as was I. She would recommend family and friends (again not entirely relevant, but who doesn't like to pat themselves on the back, especially when we don't advertise, it is all word of mouth- didn't even have a sign outside until the last eight years- finally got fed up with patients who couldn't find us then were late- not entirely their fault).

Anyhow, this lady ( probably not described as such in her work place by clients due to manacles and possibly mace), after two months of not being able to function or indeed sleep, she didn't look so good, returned to the clinic complaining of right sided jaw face and teeth pain, consulting us as a last resort, possibly. She had been referred to a neuro appointment on the NHS but they were a little slow in her words for someone at the end of their tether ( or words to that effect, basically she was just desperate, understandably, so she came to see myself, not exactly flattering.)

Preceding her complaint, she had collapsed on the floor after suffering a miscarriage, out of it for some half hour, followed by an ambulance and a trip to A&E.

Anyway to cut it short neuro exam fine, neck examination not fine and exacerbated symptoms. G.P.? TMJ as did I.

First treatment, by her judgement 50% better after two(ish don't have her notes to hand) fine, after three,fine (her neuro appt. came prior and diagnosed PROBABLE TN) Not seen her since, but have seen some of her family members.

This actually led me to more of an interest in TN and investigating its causes. Previously over twenty years having seen, most probably by default, many ( in the scheme of things not many facial pain but many bearing in mind our main type of patients- back and neck pain- relatively many)

I write this, hoping some might investigate that their neck might be a cause of their TN, you don't actually need neck pain for it to be a cause. I'm not advocating a treatment modality. This patient I mention, although I'm not about to ask would no doubt back me up in claim.

Anecdotal, sure, but for you to decide if it has merit.

2

I have no doubt you are right! Had cervical disk fusion C5-7 four years ago. Seemed fine after about a year. But migraines became more intense after this surgery. Now have problem at C4 and need another surgery -- fusion recommended but I went for a 2nd opinion with a neurosurgeon who suggested a different type of surgery inserting a plate in place of the disk rather than fuse the bones as an orthopedic surgeon would do. TN has hit within the last 4 years, although not diagnosed as such until fall 2015. Although my TN began as a toothache, it progressed to eye. Neck pain is present and i take Percocet to live with it instead of surgery, as my life just won't allow me to have surgery just now. Plus I dread the year-long recovery and don't feel I have time to be knocked down for awhile (if you've followed my story at all, you'd understand why). Hoping to get gamma knife surgery for the TN soon since the recovery time is minimal. At least hopefully I can knock out one demon and deal with the other later. There's always a delay -- I had an appt w/ neurosurgeon earlier this month but couldn't keep it due to a TN episode that put me in bed for a day. Takes 5 weeks to get another appt. Hoping & praying to make February appt so we can get this ball rolling and I can get relief for at least PART of my problems!

3

Yep I've followed your posts.

One concern, with regarding your TN and Gamma knife. You haven't stated you do but if you think your TN is neck related what do you hope to gain from Gaamma knife? If you have a destrustive procedure, yet the irritation is still present i.e. in the neck then it will not stop the symptoms, and you may get additional ones from the procedure.

A recent article from a chiropractor ( in fpa tn) mentions success with Anaesthesia D., To me it would seem you might be headed down this route in trying destructive procedures- think phantom limb pain.

You say you enjoy a smoke, tut tut, if nothing else, smoking constricts blood vessels, hence the body is less able to rid itself of inflammation which causes pain. If you do intend to smoke you need to drink copious amount of alcohol to combat the vasoconstriction of the smoking, alcohol being a vasodilator, and the two often go hand in hand.

On a serious note (though I partake in both), smoking is a bad idea even with regard to TN.

I do wonder about the wisdom of Gamma knife, in your case.

CindyLou said:

I have no doubt you are right! Had cervical disk fusion C5-7 four years ago. Seemed fine after about a year. But migraines became more intense after this surgery. Now have problem at C4 and need another surgery -- fusion recommended but I went for a 2nd opinion with a neurosurgeon who suggested a different type of surgery inserting a plate in place of the disk rather than fuse the bones as an orthopedic surgeon would do. TN has hit within the last 4 years, although not diagnosed as such until fall 2015. Although my TN began as a toothache, it progressed to eye. Neck pain is present and i take Percocet to live with it instead of surgery, as my life just won't allow me to have surgery just now. Plus I dread the year-long recovery and don't feel I have time to be knocked down for awhile (if you've followed my story at all, you'd understand why). Hoping to get gamma knife surgery for the TN soon since the recovery time is minimal. At least hopefully I can knock out one demon and deal with the other later. There's always a delay -- I had an appt w/ neurosurgeon earlier this month but couldn't keep it due to a TN episode that put me in bed for a day. Takes 5 weeks to get another appt. Hoping & praying to make February appt so we can get this ball rolling and I can get relief for at least PART of my problems!

4

Do you have a reference link to the chiropractor article you mentioned? tx.

aiculsamoth said:

Yep I've followed your posts.

One concern, with regarding your TN and Gamma knife. You haven't stated you do but if you think your TN is neck related what do you hope to gain from Gaamma knife? If you have a destrustive procedure, yet the irritation is still present i.e. in the neck then it will not stop the symptoms, and you may get additional ones from the procedure.

A recent article from a chiropractor ( in fpa tn) mentions success with Anaesthesia D., To me it would seem you might be headed down this route in trying destructive procedures- think phantom limb pain.

You say you enjoy a smoke, tut tut, if nothing else, smoking constricts blood vessels, hence the body is less able to rid itself of inflammation which causes pain. If you do intend to smoke you need to drink copious amount of alcohol to combat the vasoconstriction of the smoking, alcohol being a vasodilator, and the two often go hand in hand.

On a serious note (though I partake in both), smoking is a bad idea even with regard to TN.

I do wonder about the wisdom of Gamma knife, in your case.

CindyLou said:

I have no doubt you are right! Had cervical disk fusion C5-7 four years ago. Seemed fine after about a year. But migraines became more intense after this surgery. Now have problem at C4 and need another surgery -- fusion recommended but I went for a 2nd opinion with a neurosurgeon who suggested a different type of surgery inserting a plate in place of the disk rather than fuse the bones as an orthopedic surgeon would do. TN has hit within the last 4 years, although not diagnosed as such until fall 2015. Although my TN began as a toothache, it progressed to eye. Neck pain is present and i take Percocet to live with it instead of surgery, as my life just won't allow me to have surgery just now. Plus I dread the year-long recovery and don't feel I have time to be knocked down for awhile (if you've followed my story at all, you'd understand why). Hoping to get gamma knife surgery for the TN soon since the recovery time is minimal. At least hopefully I can knock out one demon and deal with the other later. There's always a delay -- I had an appt w/ neurosurgeon earlier this month but couldn't keep it due to a TN episode that put me in bed for a day. Takes 5 weeks to get another appt. Hoping & praying to make February appt so we can get this ball rolling and I can get relief for at least PART of my problems!

5

Thanks for that tidbit of info! I will await my next visit with my neurosurgeon. I haven't seen him since I joined this site -- Frankly, I've learned more here and from "Striking Back" than he has shared with me. So we shall see ...


aiculsamoth said:

Yep I've followed your posts.

One concern, with regarding your TN and Gamma knife. You haven't stated you do but if you think your TN is neck related what do you hope to gain from Gaamma knife? If you have a destrustive procedure, yet the irritation is still present i.e. in the neck then it will not stop the symptoms, and you may get additional ones from the procedure.

A recent article from a chiropractor ( in fpa tn) mentions success with Anaesthesia D., To me it would seem you might be headed down this route in trying destructive procedures- think phantom limb pain.

You say you enjoy a smoke, tut tut, if nothing else, smoking constricts blood vessels, hence the body is less able to rid itself of inflammation which causes pain. If you do intend to smoke you need to drink copious amount of alcohol to combat the vasoconstriction of the smoking, alcohol being a vasodilator, and the two often go hand in hand.

On a serious note (though I partake in both), smoking is a bad idea even with regard to TN.

I do wonder about the wisdom of Gamma knife, in your case.

CindyLou said:

I have no doubt you are right! Had cervical disk fusion C5-7 four years ago. Seemed fine after about a year. But migraines became more intense after this surgery. Now have problem at C4 and need another surgery -- fusion recommended but I went for a 2nd opinion with a neurosurgeon who suggested a different type of surgery inserting a plate in place of the disk rather than fuse the bones as an orthopedic surgeon would do. TN has hit within the last 4 years, although not diagnosed as such until fall 2015. Although my TN began as a toothache, it progressed to eye. Neck pain is present and i take Percocet to live with it instead of surgery, as my life just won't allow me to have surgery just now. Plus I dread the year-long recovery and don't feel I have time to be knocked down for awhile (if you've followed my story at all, you'd understand why). Hoping to get gamma knife surgery for the TN soon since the recovery time is minimal. At least hopefully I can knock out one demon and deal with the other later. There's always a delay -- I had an appt w/ neurosurgeon earlier this month but couldn't keep it due to a TN episode that put me in bed for a day. Takes 5 weeks to get another appt. Hoping & praying to make February appt so we can get this ball rolling and I can get relief for at least PART of my problems!

6

In answer to a question through email, regarding initial success with MVD although unfortunately short lived some might be interested in this response to MVD and why it works.


This is my belief, indeed beef.
1) We know folks have vascular compreesion at the REZ and indeed along the root from the Pons and have no TN.


2) At this point, it is a peripheral nerve, and yet TN due to compression doesn't appear to act like any other peripheral nerve compression within the body- no neurological deficit for example, is required or present for a diagnosis.


3) In the sixties early seventies there were two cranial surgeries taking place, one being MVD yet they had similar success rates, they can't both be correct.


4) Recently reminded by someone on the forum, though I think I may have written about it, the trigeminal nerve is more prevalent on the left yet TN is noted to act more on the right, this would argue against compression.


5) If vascular compression were the cause, it should affect the opthalamic branch more than any other yet it is the least affected.


6) If compression why don't we see an effect on the artery/vein accused, even stroke, equal and opposite forces etc.


7) Folks who have no vascular nerve compression, are successfully treated with nerve manipulation/ combing, a 'damaged' nerve reacts to more damage in a favourable way?? no I don't buy it.


8) The nerve root, needs a blood supply, hence why these vessels are in close presence to the trigeminal root anyway. The actual nerve root has an internal arteriole/ vein along its length. these aren't implicated by medics, why, considering their proximity?


9) Remission is supposedly due to remylination of the nerve root yet some 30% of the root fibres are unmyelinated. The majority of TN due to 'vascular' compressions is reported to occur in the first third of the root along the the REZ, this is covered by central myelin, which does not regenerate, hence Multiple Sclerosis plaques or scars.


10) Common medication for TN acts on the cervical/ neck trigeminal nucleus/ nerve bundle.


Why do folk originally gain relief? I would hypothesise, due to the equal success of the two surgical procedures above, the action of the common entity, general anaesthetic and it's action on cervical/ neck skeletal muscle as in relaxing/ resetting it. In my opinion whether TN due to trauma or connective tissue disease often has it's mechanism on the musculature structure- resume the same pattern which originally caused it or for that matter a different stress on these structures will lead to a potential recurrence.