I was wondering if anyone has had any experiences with nerve blocks who have ATN. I had one done Wednesday to the top branch of the trigeminal nerve, specifically the Supraorbital nerve.
So far yesterday and today have been the most pain free days I can remember, which kinda demonstrates to me just how much pain I was in day-to-day. I was wondering if other people have had nerve blocks who also have ATN (I know there have been discussions around TN and nerve blocks) and what peoples experiences have been. If they've helped, for how long, complications, etc.
I've had two types of nerve blocks. First type - steroid shot to the V2 area of the nerve ganglion (laying down with mouth partially open, needle inserted through jaw.) Extremely painful for a few moments when it hits the nerve center but worth it ... however it takes 3 weeks (exactly 21 days!) until you get any pain relief but once you do, it lasts up to 8 weeks. I've also had a steroid with a local injected directly to the infraorbital nerve where my pain is. I got immediate relief that lasted 3-4 weeks.
I had no complications, had them in the morning and went directly to work that day with no problems other than a sore jaw or some swelling under my eye for a day. The pain relief kept me off of opiates for 3 years (I am still on anti-seizure med)
The one negative is that as time went on (over 3 years) the blocks became less effective. I must have built up a tolerance to them. I've been off them for a few months and I hope I can start back on them soon.
I believe the type they gave me (into V1 Supraorbital) was the steroid + local one (they made reference to it later being a "Cipro Nerve Block") I left a VM for them clarifying "hopefully you don't mean cipro like the antibiotic, which I am allergic to..." heh, but thats another story :)
I guess I found out how long that kinda nerve block lasts (for me), about 5 days of complete relief, and then tapering off since then. And when it was finally gone, wham had one of the most painful days in years on the V1 branch. The nature of the pain was different, less burning / stinging pain, and more like someone kicked me in the right side of my forehead and eye, almost felt like physical trauma (except that it was continuous, of course).
The other location of my ATN pain is along the V2 branch and specifically the infraorbital area. I haven't tried a nerve block there yet (since that, while very painful, isn't as bad as V1 branch), but its good to know that those can be done and that some of them work longer, etc.
Good to know as well about the body getting more used to them, if they start lasting only a couple of days, might have to evaluate if a couple good days is worth a really, really bad day at the end.
Hi there - I had a supraorbital, infraorbital and a sphenopalatine block. Nothing worked for me. Glad to hear you got relief. I have also had occipital nerve blocks and well a whole gamut of stuff. Out of all the injections I had, the occipital nerve block was the most painful. I can takethe pain, unfortunately, nothing seems to help the constant ache/pressure/pulling I have in my eyes and nose. It is constant.
The next one they want to try is the sphenopalatine block, which they think might provide longer than 5 days worth of relief, will let you know if it works or not
Jeff, are they doing your SPG (sphenopalatine ganglion) block intra-nasal or via injection? Just curious because most people do them through the nose, but my doctor does them via injection, which scares me because the SPG is so deep in the head.
Regardless of the method, I'd love to hear how this works for you, as it's something that's an option for me.
Actually that is a good question. I am not entirely sure :) I've got the referral to my pain doctor to do it, but haven't scheduled it yet. The dr. who recommended it, from what she described made it sound like via injection, but I am not 100% sure.
jeffk, I had left SPG nerve blocks for my ATN under general anesthesia at Cedars Sinai Pain Center in L.A. earlier this year. The injections were a combo of lidocaine/marcaine/dextomorphane because I had previously had MVD surgery. They are very good and they do ten or more a day using a production line approach-waiting room, preparation room and recovery room. From entering the building to leaving was four hours because I take longer to wake than most (they just roll your guerney into the recovery room and wait for you to wake naturally and offer some juice). I talked to other patients in the waiting room to compare stories. Many of the patients use these injections as their main treatment. Effects of the nerve blocks vary for each individual with some getting only a one week relief so they come often and others getting three months relief. I got no relief but the injections confirmed my pain problem is upstream of the SPG and we proceeded to an RF SPG partial Rhizotomy (ablation of one of the five nerve fibers in the bundle) four months later after multiple nerve block injections had failed. Other patients made their decisions to simply come in for injections every few weeks or months. Dr. Christopher Zarembinski was added by me to this web site under recommended physicians. By the way, many patients were out of there after getting their injection in less than two hours including the waiting room time. The SPG block is done with a five inch needle through the cheek about an inch in front of the ear and that is why the general anesthesia. You can review the pictures or animation on the procedure at www.cedarssinai/paincenter . I walked out and went to lunch in the deli downstairs. Post op was a reminder to remove my band-aid after a couple of hours.
I recently had marcaine injections subcutaneously (under the skin) for V1 and V2 pain in Lancaster, CA by a neurosurgeon and doctors are beginning to use injections as diagnostic tools as well as treatments. But, you have to find them since they are usually only done by neurologists. I wish they were widely used before my first MVD. The subcutaneous injections lasted five minutes or less with a pinprick novocaine injection to numb the face with a small needle then a bigger needle for the higher viscosity marcain injection then I walked out. A dental visit for a tooth filling is worse. In fact, the SPG nerve block was also less painful than a dental visit for tooth filling.
I am heading to the Pain Center today in about 2 hours or so to get the SPG block. I am not sure which method they are going to use, but from what they've told me over the phone, the doc is only scheduling 20 min for it and since they haven't asked me to fast I am guessing the anesthetic might be a local of some sort. Maybe its the intranasal route? not sure, but will let you know how it turns out and what they ended up using/doing.
Yep, intra-nasal, basically they stuck a couple of really long q-tips into my nose (on both sides) and then drip numbing agent down them, takes about 20 min or so. Will see if it helps!
I have blocks every two to three weeks. The blocks are for the right side TN3 and TN2, on my left side, the TN2 and in the rear scull, I have occipital nerve blocks on both sides and trigger points. Over many years, I have found that every block is diffirent and every doctor is different. If you find a good doctor who you like, I would stay with the doctor. TommyR
jeffk, Sounds like you are on a good path for isolating the cause of your pain before discussing surgery. I hope you have success with the nerve block and don't need to discuss surgery. At this point, your doctor would likely still require pharmacologic trials before discussing surgery if the nerve blocks don't give you solid relief. You may want to consider recommending your doctor in the Recommended Physicians section. Hope to hear good news on your nerve block results and thanks for sharing your news. RonaldS
Unfortunately it seems this block didn't work, it may have dulled the pain slightly, but definitely no full (or significant) relief like the other block offered. Oh well, at least one of the two types worked :)
I had three nerve blocks done which were injected into the back of my head near the base of the occipital bone. Other specifics I cannot give you. It was a combination of lidocaine, a steroid, and another drug which I cannot recall. The first one worked for 3 months dulling my ATN. The second and third ones lasted 6 months and completely dulled my attacks, I just had some residual pain which was somewhat tolerable. Mine were done at Allegheny General Hospital in Pittsburgh.
Hi La LA - were you also diagnosed at the Allegheny Hospital? Did it take a long time to determine your diagnosis. I am curious as they seem to be one of the better cranial nerve centres. Thanks Alison
La La said:
Hi Jeff,
I had three nerve blocks done which were injected into the back of my head near the base of the occipital bone. Other specifics I cannot give you. It was a combination of lidocaine, a steroid, and another drug which I cannot recall. The first one worked for 3 months dulling my ATN. The second and third ones lasted 6 months and completely dulled my attacks, I just had some residual pain which was somewhat tolerable. Mine were done at Allegheny General Hospital in Pittsburgh.
I was fortunate enough to have my PCP at the time have a grandfather that had TN. He treated me for about 6 months and it wasn't working so I started researching who was the best in the field. I was just fortunate enough to live close to Allegheny General Hospital.
I had my MVD done 9-9-2010. I should have been transfered to a Neurologist but my Neurosurgeon still sees me and treats me in accordance with my pain management doctors which are also at Allegheny General (AGH) and they specialize in TN.
I am very blessed to be so close to Pittsburgh but it is still a drive. At least it's not like the lady who had surgery the same day as I did who flew here from Miami. I am only an hour and a half north of the city.
The staff at AGH have been so wonderful and supportive, I just wish the staff around my hometown were.