Invitation: Please Update Your Personal Profile at Living With TN

This note is to remind members that site administration has recently updated and refined the questions used in each member profile on Living With TN. The intention of these changes is to refine our knowledge and understanding of who is using the site and what their needs are.

We want to develop demographic data for our 1900+ members as a group, in hopes of publishing articles to influence the education and training of doctors and dentists who commonly see chronic face pain patients. Your individual data as a member will never be published or traceable to you as an individual. By contributing your information, you may help medical and dental professionals to treat face pain patients more effectively.

By analyzing and refining our member data since the site was founded, we have already learned some potentially startling things about face pain:

As of early February 2012, we had 1919 members -- nine of whom were site Admin or visiting medical professionals. We also had 97 relatives and 17 friends of patients. For 70 of our members, we did not have enough information to characterize their type of membership.

After reading the stories and treatment histories of patients, we are able to extract the following information so far.

1727 of our members appear to be patients reporting their own experience

73 members are relatives or friends supporting a pain patient

125 member profiles didn't have enough data to describe the patient helpfully.

(many gave no information in either the patient's story or their past treatments)

This leaves us 1794 patients for whom demographic data can be extracted.

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A question of intense interest to patients, doctors, dentists, and the insurance industry is "how old are facial pain patients when pain first emerges and is diagnosed?" At Living With TN, half of all our patients had their first pain at age 41 or younger. 314 of the patients first had pain at age 30 or younger. Several patients declared they had had face pain "all of my life", and several relatives or friends are supporting facial pain patients younger than 21.

Of the 1794 patients in our demographic sample, 73 provided their date of birth, but did not fill in data on their personal stories or treatment history. For these patients, we used their age when they joined the site as an "upper bound" on their estimated age when pain first came into their lives or the life of a loved one. Some of these records may declare the age of a relative or friend rather than the patient. But it is not believed the resulting statistical bias or error is significant or trends toward either younger or older, in a sample of 1794.

The "average" pain patient at Living With TN is 15 years younger than the medical literature indicates is usual for trigeminal neuralgia patients.

Disabling facial pain is affecting more people in their peak earning years than has been widely assumed by doctors and the insurance industry. This reality might influence the urgency felt by insurance companies and medical researchers concerning the search for better pain management and eventually cure.

Facial pain is sometimes caused by medical or dental treatment.

There is another possible reason for our relatively young member population. Our overall patient age statistics appear to be biased toward the younger years because the emergence of facial pain is less "spontaneous" than dentists and endodontists have long been taught. There is reason to believe that a significant number of facepain cases are caused by dental work -- root canals, dental extractions, or other procedures. Such cases are not "spontaneous". They are iatrogenic -- caused by medical or dental treatment.

In the stories told about themselves by 1721 patients, the term "dentist" or "dental" appears in 468 records (both terms occur in 71).

One or more of the following words appear in 719 of the patient stories (31%):

"tooth" (273)

"teeth" (330)

"canal" (as in root canal) (148)

"mouth" (118)

"bite" (19)

"TMJ" (76)

More than one of these terms appears in 245 of the 719 stories. We're looking at the patient treatments narratives for the same and other terms. I will post an update to this discussion when we have checked the treatment history records for these and other key words.

We are still refining our understanding of the several contexts in which these terms are used by patients or their supporters. It seems plausible that for over a third of our patient demographic, the first emergence of pain is either associated with a dental procedure, diagnosed (or mis-diagnosed) by a dentist, or mis-identified as dental in origin by patients themselves. This finding -- after we verify and refine it -- may be of interest to both patients and dental schools.

These findings are preliminary. In the coming months as our members update their profiles, we will reexamine and revalidate observations above. However, at this point there is considerable evidence in support of patients who have asserted that their pain was caused by a dental procedure.

Go in Peace and Power

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

Resident Research Analyst, Living With TN

Hi, Dr Lawhern.

I have just seen this invitation . I feel that the information supplied by us - TN patient will help any kind hearted soul who want to do some research to help us. By knowing the cause , remedies will follow. Therefore I quickly updated mine. However,I have some difficulties in rephrasing the words below the box because I can’t extend it. (I am very poor in computer) . From time to time , there need to make some changes so as to help the researchers with good intention.

Best regards,
Seow chin

Seow chin,

Thank you for updating your profile data.

I am now writing a draft article on our site demographics for web publication. I will circulate the article for review and comment by site members, as well as getting Ben and Scott to approve it for submission, before it goes anywhere else.

Regards and best,

Red

MY MIND-BOGGLING STORY:

About 3.5 years ago, after a bad dental experience, we (doctors and I) thought an MSRA infection had slipped into my right upper jaw. We could only go by symptomatology because every time my endo surgeon opened it up, there was no bone left to culture (it started destroying my sinus floor), just destruction and debris left to clean out. I have undergone every radiological test/study in the book, including gallium and thallium. The weird thing was; nothing showed up on any films (except for a big hole on the right side where my sinus floor used to be). But every time I went back to my surgeon and begged him to cut it open because the pain was unbearable, again, more bone destruction and chaos inside. I’ve had 11 surgeries, including a re-implantation of a molar that was taken out, cleaned, the molar bed cleaned, and then re-implanted. During one surgery, the infection had advanced so far, he had to go all the way up into my sinus. It took 3 hours and you can only locally sedate so much.

When the last molar was taken out, he could see all the way up my sinus, there was no sinus floor left.

It did not respond to any anti-biotic or anti-inflammatory, nor could I find any relief for the unspeakable pain, with the exception of IV morphine. I was finally given oral morphine, but could not tolerate that either (the list of meds I have been tried on is endless).

I spent a month on oral chemo (Decadron), which did nothing and I could not handle the side effects. A PICC line was inserted after that and I spent 6 weeks on 2/day Invanz and Vancomycin. We stopped the Invanz because of the effect on my lungs, but continued the Vancomycin for 7 months, which, of course, destroyed my body.

The list of doctors, specialists, hospitals, and ERs I have seen is endless. No-one could or wanted to figure out what was wrong, an MSRA has never been found inside facial bones. At one point, even my surgeon could not open it up anymore. There was nothing left to cut. No-one wants to touch it, including maxillofacial oral surgeons, because there is nothing to see on films. I’ve been sent away by specialists with “It’s impossible, I don’t believe you” – “you just need a root canal” – “can’t do anything, but here’s some oxycontin”.

I then started the route of nephrologist, neurologist, and pain specialist. Normal blood levels (creatinine, B12 and D) are between 30-100. Mine are at 4.2 (during all this time I had to hold down a fulltime job, I’d sit at my desk while my Vancomycin was dripping). So my body is depleted, sick, and fighting itself: I need extremely high dosages, yet cannot tolerate them.

The only thing that relieves pain is Alprazolam. 1-mg will last for 4 hours. My pain specialist said this is because I now have severe traumatic nerve damage to the sympathetic nerve and, of course, Alprazolam calms down nerves. He refuses, however, (as did my PCP) to prescribe Alprazolam (every doctor developed Michael-Jackson-syndrome and the medical profession is now about liability instead of patient care, which is why these spoiled dead celebs get not one ounce of sympathy from me); a pain specialist who refuses to prescribe the only thing that works for pain. I had to jump through countless hoops to see a psychiatrist (!) and throw in anxiety attacks (!) for pain relief!

The pain specialist gave me nortriptyline, which is on my list of meds that do not work and I cannot tolerate, and claimed it was all about “dosage”, so I took it. It caused severe rectal bleeding and did nothing for pain. I’ve had 2 ganglion stellar nerve blocks. I was pain-free for 1 day after each one and we decided to go for radiofrequency ablation. This provided very little relief and then got to a point where it was even worse than before. The RF was on January 20 and without pain relief. He then prescribed Cymbalta, which did nothing for immediate pain, and absolutely exhausted me (I also take Wellbutrin so it’s a double-up). After a couple of weeks I did get pain relief, but the exhaustion was completely disabling and I could not eat. I lost 8 pounds in 6 days and could barely stand up. He then suggested to repeat the RF. I asked him why if the first one did not work. He said this was because there are 2 areas around the nerve and they only did the 1 area. Why, I do not know. However, the surgeon who did the RF wants to wait another 6-8 weeks to repeat it and I really cannot tolerate the pain anymore and am completely a-functional with this, combined with the low blood levels and the symptoms accompanied with that.

Is it true that there are 2 areas that need the RF? Why were they not done at the same time? Should I repeat the RF? I read a repeat is usually done after 2-3 weeks, not 2-3 months. I cannot take this anymore after 3.5 years. I am so jaded, distrustful ,and tired of waiting rooms and so-called specialists, I ended up pulling out my own PICC line when the time came.

Please help. Thank you.

Winnie

I am SO sorry!!! Your experience sounds horrible!
At what point did they diagnose your TN? I just cannot begin to imagine what you’ve been through. But, you’re in my thoughts and prayers.

Winnie said:

MY MIND-BOGGLING STORY:

About 3.5 years ago, after a bad dental experience, we (doctors and I) thought an MSRA infection had slipped into my right upper jaw. We could only go by symptomatology because every time my endo surgeon opened it up, there was no bone left to culture (it started destroying my sinus floor), just destruction and debris left to clean out. I have undergone every radiological test/study in the book, including gallium and thallium. The weird thing was; nothing showed up on any films (except for a big hole on the right side where my sinus floor used to be). But every time I went back to my surgeon and begged him to cut it open because the pain was unbearable, again, more bone destruction and chaos inside. I’ve had 11 surgeries, including a re-implantation of a molar that was taken out, cleaned, the molar bed cleaned, and then re-implanted. During one surgery, the infection had advanced so far, he had to go all the way up into my sinus. It took 3 hours and you can only locally sedate so much.

When the last molar was taken out, he could see all the way up my sinus, there was no sinus floor left.

It did not respond to any anti-biotic or anti-inflammatory, nor could I find any relief for the unspeakable pain, with the exception of IV morphine. I was finally given oral morphine, but could not tolerate that either (the list of meds I have been tried on is endless).

I spent a month on oral chemo (Decadron), which did nothing and I could not handle the side effects. A PICC line was inserted after that and I spent 6 weeks on 2/day Invanz and Vancomycin. We stopped the Invanz because of the effect on my lungs, but continued the Vancomycin for 7 months, which, of course, destroyed my body.

The list of doctors, specialists, hospitals, and ERs I have seen is endless. No-one could or wanted to figure out what was wrong, an MSRA has never been found inside facial bones. At one point, even my surgeon could not open it up anymore. There was nothing left to cut. No-one wants to touch it, including maxillofacial oral surgeons, because there is nothing to see on films. I’ve been sent away by specialists with “It’s impossible, I don’t believe you” – “you just need a root canal” – “can’t do anything, but here’s some oxycontin”.

I then started the route of nephrologist, neurologist, and pain specialist. Normal blood levels (creatinine, B12 and D) are between 30-100. Mine are at 4.2 (during all this time I had to hold down a fulltime job, I’d sit at my desk while my Vancomycin was dripping). So my body is depleted, sick, and fighting itself: I need extremely high dosages, yet cannot tolerate them.

The only thing that relieves pain is Alprazolam. 1-mg will last for 4 hours. My pain specialist said this is because I now have severe traumatic nerve damage to the sympathetic nerve and, of course, Alprazolam calms down nerves. He refuses, however, (as did my PCP) to prescribe Alprazolam (every doctor developed Michael-Jackson-syndrome and the medical profession is now about liability instead of patient care, which is why these spoiled dead celebs get not one ounce of sympathy from me); a pain specialist who refuses to prescribe the only thing that works for pain. I had to jump through countless hoops to see a psychiatrist (!) and throw in anxiety attacks (!) for pain relief!

The pain specialist gave me nortriptyline, which is on my list of meds that do not work and I cannot tolerate, and claimed it was all about “dosage”, so I took it. It caused severe rectal bleeding and did nothing for pain. I’ve had 2 ganglion stellar nerve blocks. I was pain-free for 1 day after each one and we decided to go for radiofrequency ablation. This

The article described above has been published here on Living With TN as a sub-tab "Who Gets TN" below our Face Pain Info tab in the menu at the head of each page. I have invited a number of dental specialists to review the paper, and so far none have argued against the findings. The age demographic of our members seems to be the item that the dental folks find most surprising. The poor state of preparation by general dentists to recognize (much less treat) facial pain of other than dental origins does not seem to be new news. The rub, of course, may be how can we promote better neurological training for dental practitioners while they are still in school. I will begin talking with mainstream dental journals in the near future, to see if we can spread this word.

Regards all,

Red

Winnie, what a horrible experience you have gone through ! If the endo surgeon recognized that there is nothing wrong to your tooth , all these sufferings would be unnecessary. In the process , he did more damages instead of helping you. My endo surgeon also did a root canal treatment to my molar without taking an X-Ray. Luckily, I went to another dentist to seek a second opinion and abandoned the treatment before he completed it. I pray that you get help soonest . Take care.

Blessings and best wishes.

Seow

This note will announce publication of yet another demographic study grounded in the experience of patients on Living With TN. This was approached as a consistency check on earlier results reported above.

Demographics of 202 Neurological Facial Pain Patients at a Social Networking Website

Abstract

A demographic analysis was performed on 202 consecutive member registration records accumulated between February 4 and March 18, 2012 at an on-line social networking website focused on trigeminal neuralgia and trigeminal neuropathic pain ("Living With TN": http://www.livingwithtn.org). This analysis was conducted as a consistency check on an earlier and larger assessment of patient demographics and treatment outcomes. [1] Age and gender demographics in this limited sample were consistent with the earlier large-scale report. Patient outcomes of diagnosis and treatment by dental practitioners were also consistent.

Additional analysis of the limited sample assessed the average length of time between first emergence of chronic face pain, versus definitive diagnosis by a medical practitioner. In 110 patient records where an explicit time to diagnose could be extracted, about one-third reported a definitive diagnosis in less than one month, and one-fifth reported suffering more than one year before their pain was medically characterized. Among 81 records where time to diagnose was not explicit or the diagnosis had not yet been made, at least four patients had suffered facial pain for several years without resolution.



[1] Richard A Lawhern, "Demographics of Neurological Face Pain at a Social Networking Website", Web published at http://www.livingwithtn.org/page/who-gets-tn, March 16, 2012.

======================

This one I intend to try to get published in a mainstream dental journal./ The paper may be read in entirety at http://www.lawhern.org/DemographicsFacialPain202Cases.docx

Regards all,

Red