Atypical TN and Trigeminal Neuropathic Pain-Difference in treatment?

General General TN & GPN (Old Site)
1

Dear brothers and sisters,

I hope your experience maybe can help to define my diagnosis and find right treatment.

As I live in small Post Soviet country (Latvia,population-only 2 millions), neurologists here are not very familiar with Atypical TN (I start realize that after coming to LwTN!) also we don't have specialists, who specializes on facial pain.

My pain started 5 years ago and was located at the one side of face in cheek area (smarting, stabbing, pressure like, lvl 2-7/10, almost 24/7) As I was just recovered from sinusitis (got them often, had 2 small nose partition correction surgeries before 2 and 4 years), went to ENT, x-rays showed nothing, neurologist wrote Nimesulide, Diclac - nothing helped. Then I went to dentist who find pulpitis in my upper mollar (same side where pain was) and did that root canal. Also I used medication course consistining of Coxtral, Solpadeine, Mydocalm, antidepressants. I was pain free for 6 months!

And then...it started again :( in same location&character of pain. I tried Carbamazepine, Gabapentin, Lyrica - nothing helped. I was so depressed and couldn't stand out it anymore so I went to neurosurgeon, who was certain that reason is my mollar. X-rays showed there was a cyst!!! I had that mollar extracted, but unfortunately it was connected with maxillary sinus, which suppurated in 3 days after extraction. I had to undergo 2 sinus-oral surgeries under full anaesthesia to move that crap out. Also camed out that reason why there formed cyst was root canal sealant, which was in jawbone and nerves :s !!!

To my sorrow pain didn't disappear. Even worse - 6 months after surgery I start to feel pain in another side of face! Same character&location - cheek, upper jaw&teeth, nose, temple. Teeth&sinus healthy there.Pain is not equal at both sides at same time. Have tried Anafranil, Baclofen, Mydocalm, Cymbalta, Lyrica - none of them giving remarkable relief. I have been to lot of doctors and got lot of diagnosis: Somatoform disorder (hahaha),Fibromyalgia, Somatization, Atypical TN...

I red Face pain info here and I had thought that maybe I have Trigeminal Neuropathic Pain?

I want thank everyone in advance who will answer me, especially thanks to this miracle web patrons - Richard A.Lawhern and Stef!

God bless You!

2

Dear Stase,

The present pattern of pain you are describing may possibly be described as "iatrogenic facial neuropathic pain", rather than either type of Trigeminal Neuralgia. It may have started from nerve injury during the sinus operation, but was then later complicated by the cyst and by surgery for the cyst.

Though your recent pain resembles TN Type II (Atypical), the presence of the over-fill material from your root canal in the nerve and jaw bone suggests that the root canal treatment may be the primary cause of the most recent pain. It's unclear to me what mechanism could be involved in the pain that has since emerged on the other side of your face. But I've heard of this kind of thing happening from other patients, particularly following complex dental surgery.

It's a safe bet that you do not have somatoform "disorder" or any form of conversion disorder since neither is a valid medical entity. All medical entities are defined in a manner which requires a consistent set of presenting symptoms, a natural course (a series of developments and events which are found in most or all patients), and one or more reliable treatments known to be effective. None of those requirements is met for the problems that the American Psychiatric Association tried to describe on this axis of the Diagnostic and Statistical Manual (DSM-IV). "Somatization" is not a diagnosis; it's a descriptive label by reduction -- and not a particularly helpful one at that. It's just another way of saying that your pain is primarily mental rather than physical, and that as you seem to know is a damned lie and a delusion on the part of the doctor who used the term.

It's also a safe bet that you don't have fibromyalgia, unless you also have wide-spread pain throughout the body and joints.

For the type of pain you are describing, current practice concentrates on the use of tri-cyclic antidepressant drugs which have a cross-action against pain. These include Amitriptyline, Nortriptyline, and perhaps 10 others in the same class. Such drugs may be combined with anti-seizure agents like Tegretol, Trileptal or Neurontin, or with anti-spasmodic agents such as Baclofen or Flexeril. Also helpful for some people as elements of a multi-therapy might be a tranquilizer. If other measures do not help, then the use of opiod drugs (Percocet, Oxycontin, Demerol, others) is accepted here in the US and throughout much of western Europe.

I hope this information gives you a starting point for talking with your doctors. Feel free to ask them to visit this site and read our Face Pain Info tab, on all of our page menus.

Go in Peace and Power

R.A. "Red" Lawhern, Ph.D.

Resident Research Analyst, LwTN

3

Richard,

Thank you so much for your quick response. I think we all are your debtors here and should build monument for you one day!

I start realize how important is to understand own symptoms, I always relied on doctors (maybe because my family members didn’t had serius health problems, nobody teached me how important is to find right doctor :( ), I can’t tell in words how gratefull I am to you and this web and members who share an information, helping, supporting, giving advice!!!!

Now I feel more confident about myself, so I started research to find good specialist. When some doctor couldn’t find right treatment for my pain, they put everything to my psychological/mental problems, thatš discusting! Imagine, I even started consider maybe they are right, so confused I had been!!

Althought my pain is different from Atypical TN in your opinion, treatment are similar as I understand from Face Pain info. I don’t get meaning of “Iatrogenic” very well, as I red in Wikipedia it is medical negligence? You wrote that I might have “Iatrogenic facial neuropathic pain”, but why not Trigeminal (My pain is located on itš 2nd branch)?

After research I also think and don’t have fibromyalgia, because I feel constant pain in face, but nowhere else in body, only one side head/neck/shoulder pain often.

Respectfully,

Stase



Richard A. "Red" Lawhern said:

Dear Stase,

The present pattern of pain you are describing may possibly be described as "iatrogenic facial neuropathic pain", rather than either type of Trigeminal Neuralgia. It may have started from nerve injury during the sinus operation, but was then later complicated by the cyst and by surgery for the cyst.

Though your recent pain resembles TN Type II (Atypical), the presence of the over-fill material from your root canal in the nerve and jaw bone suggests that the root canal treatment may be the primary cause of the most recent pain. It's unclear to me what mechanism could be involved in the pain that has since emerged on the other side of your face. But I've heard of this kind of thing happening from other patients, particularly following complex dental surgery.

It's a safe bet that you do not have somatoform "disorder" or any form of conversion disorder since neither is a valid medical entity. All medical entities are defined in a manner which requires a consistent set of presenting symptoms, a natural course (a series of developments and events which are found in most or all patients), and one or more reliable treatments known to be effective. None of those requirements is met for the problems that the American Psychiatric Association tried to describe on this axis of the Diagnostic and Statistical Manual (DSM-IV). "Somatization" is not a diagnosis; it's a descriptive label by reduction -- and not a particularly helpful one at that. It's just another way of saying that your pain is primarily mental rather than physical, and that as you seem to know is a damned lie and a delusion on the part of the doctor who used the term.

It's also a safe bet that you don't have fibromyalgia, unless you also have wide-spread pain throughout the body and joints.

For the type of pain you are describing, current practice concentrates on the use of tri-cyclic antidepressant drugs which have a cross-action against pain. These include Amitriptyline, Nortriptyline, and perhaps 10 others in the same class. Such drugs may be combined with anti-seizure agents like Tegretol, Trileptal or Neurontin, or with anti-spasmodic agents such as Baclofen or Flexeril. Also helpful for some people as elements of a multi-therapy might be a tranquilizer. If other measures do not help, then the use of opiod drugs (Percocet, Oxycontin, Demerol, others) is accepted here in the US and throughout much of western Europe.

I hope this information gives you a starting point for talking with your doctors. Feel free to ask them to visit this site and read our Face Pain Info tab, on all of our page menus.

Go in Peace and Power

R.A. "Red" Lawhern, Ph.D.

Resident Research Analyst, LwTN