Its possible... The occurrence is about 19:1 women to men according to some studies The problem is that with the average average age of onset somewhere north of age 50, its hard to know WHAT hormones as the production of female hormones tends decrease and male hormones increase. There was an interesting study done years ago at UW that offered an interesting perspective that to me throws the whole thing into disarray.... The incidence of facial pain in women INCREASED in those receiving hormone replacement therapy (about a 70% higher chance) granted it was a broader category TMD:
http://www.washington.edu/news/1997/01/29/hormones-may-place-women-at-greater-risk-for-facial-pain/
Women in general have a higher rate of chronic pain diseases and autoimmune disorders. The interesting thing is they have more autoimmune disease as well except in the case of ankylosing spondylitis. Which leads us back to maybe Genome research has more credibility than I am willing to admit. I suspect its something more than hormones.
aiculsamoth said:
justjane37,
Not entirely on topic but neither far removed, hormones and female hormones in particular play a part in modulation of the trigeminal complex and in particular the caudal spinal trigeminal nucleus so I would propose even with a genetic predisposition these could play a part in an already excited trigeminal complex, due to a genetic cause. This (hormones) is recognised I believe in many head pain complaints.
19:1, are we talking TN or head and facial pain? why I ask the question I'm unsure whether the answer makes a difference but I hadn't heard that figure.
Respecting nature and the way it operates, should I be surprised that women receiving hormonal replacement ( which I consider in the main to be a bad idea) experienced more head/ facial pain? it would skew natures equilibrium.
To my knowledge the idea that anky spond affects more men than women was debunked, though I am not up on current thoughts.
ModSupport said:
Its possible... The occurrence is about 19:1 women to men according to some studies The problem is that with the average average age of onset somewhere north of age 50, its hard to know WHAT hormones as the production of female hormones tends decrease and male hormones increase. There was an interesting study done years ago at UW that offered an interesting perspective that to me throws the whole thing into disarray.... The incidence of facial pain in women INCREASED in those receiving hormone replacement therapy (about a 70% higher chance) granted it was a broader category TMD:
http://www.washington.edu/news/1997/01/29/hormones-may-place-women-...
Women in general have a higher rate of chronic pain diseases and autoimmune disorders. The interesting thing is they have more autoimmune disease as well except in the case of ankylosing spondylitis. Which leads us back to maybe Genome research has more credibility than I am willing to admit. I suspect its something more than hormones.
aiculsamoth said:
justjane37,
Not entirely on topic but neither far removed, hormones and female hormones in particular play a part in modulation of the trigeminal complex and in particular the caudal spinal trigeminal nucleus so I would propose even with a genetic predisposition these could play a part in an already excited trigeminal complex, due to a genetic cause. This (hormones) is recognised I believe in many head pain complaints.
Actually, the median age at pain onset may be a bit younger than reflected in some of the literature. When I did a demographic analysis on 1800+ of our member records in 2012, I found 80% of the members were women, with a median age at onset estimated at 42 years. A Third were age 30 or younger. When I checked this finding with a member of the TNA Medical Advisory Board, he confirmed it from his own experience: "The typical TN patient seeing a physician for the first time for face pain is a woman in her 40s." This is a near-exact quote.
Regards Red
ModSupport said:
Its possible... The occurrence is about 19:1 women to men according to some studies The problem is that with the average average age of onset somewhere north of age 50, its hard to know WHAT hormones as the production of female hormones tends decrease and male hormones increase. There was an interesting study done years ago at UW that offered an interesting perspective that to me throws the whole thing into disarray.... The incidence of facial pain in women INCREASED in those receiving hormone replacement therapy (about a 70% higher chance) granted it was a broader category TMD:
http://www.washington.edu/news/1997/01/29/hormones-may-place-women-...
Women in general have a higher rate of chronic pain diseases and autoimmune disorders. The interesting thing is they have more autoimmune disease as well except in the case of ankylosing spondylitis. Which leads us back to maybe Genome research has more credibility than I am willing to admit. I suspect its something more than hormones.
The 19:1 figure came from this study (also UW are you seeing a trend):
http://depts.washington.edu/rcdrc/leresche2.html
Here is the thing about AS. EULAR redefined the disease which was fine, but they still use the New York criteria to diagnose it. There are still bunch who believe that AS that actually involves ankyloses is different than the seronegative arthritis that most women have (and yes AS is A HUGE cause of facial pain especially TM) It further got compounded in Oct when undifferentiated spondyloarthritis (USpA) was recognized seperatly which removed a lot of folks from the AS ranks because they were borderline on the New York criteria. The problem of course was SI changes which weren't always present in women but were in men. I guess what you do is throw a dart for a disease.
That would make a ton of sense. That generally is the perimenopause period. There is lots of hormone changes and on the wrong day someone like me is concieved
Richard A. "Red" Lawhern said:
Actually, the median age at pain onset may be a bit younger than reflected in some of the literature. When I did a demographic analysis on 1800+ of our member records in 2012, I found 80% of the members were women, with a median age at onset estimated at 42 years. A Third were age 30 or younger. When I checked this finding with a member of the TNA Medical Advisory Board, he confirmed it from his own experience: "The typical TN patient seeing a physician for the first time for face pain is a woman in her 40s." This is a near-exact quote.
Regards Red
I would like to make an APP of your medical knowledge, obviously on a generous 80:20 split, I might then make the porche payments:)
ModSupport said:
That would make a ton of sense. That generally is the perimenopause period. There is lots of hormone changes and on the wrong day someone like me is concieved
Richard A. "Red" Lawhern said:
Actually, the median age at pain onset may be a bit younger than reflected in some of the literature. When I did a demographic analysis on 1800+ of our member records in 2012, I found 80% of the members were women, with a median age at onset estimated at 42 years. A Third were age 30 or younger. When I checked this finding with a member of the TNA Medical Advisory Board, he confirmed it from his own experience: "The typical TN patient seeing a physician for the first time for face pain is a woman in her 40s." This is a near-exact quote.
Regards Red
Toothache,
Thank you for the article on research , although I have skim read it, it is of interest. I haven't come to write the article written, as green to research methodology, but like I have said it is an article which was written to stimulate discussion and questions nothing more, it is not written to be submitted to medical publication sites.
Like the article, the link I posted, why do I have to analyse the strenghs/weaknesses of it, when the authors do themselves much like in the links I refer to in the article. In an article I don't see it as my job to play devil's advocate when referencing links, I see that as the job of the not unintelligent reader.
Toothache said:
If you want to make your article more "bomb proof" in the scientific community, here are some helpful resources:
http://www.ccace.ed.ac.uk/research/software-resources/systematic-re...
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3380258/
An important point that Red is trying to mention, which I am in total agreement with, is that you need to be more critical about the studies that you are using as evidence. For example, the study that you cite here is of very poor quality. It is a chart review, with no investigator blinding, no placebo control, and with a very small sample size. Something like this might make me dig deeper and try to find if anyone has done a more vigorous trial, but nothing more. Critiquing your own sources is not seen to weaken your argument in scientific writing - it actually serves to remind the reader that you are aware of the limitations of your research. Otherwise you can be sure that they will do it for you and dismiss your whole article as cherry picking the data.
There actually isn't much high quality evidence for trigeminal neuralgia at all, which is unfortunate. It is a rare condition so I suspect there isn't much funding. It's also hard to get a sufficient patient population to conduct a study. Ideally you would conduct a multi-centre, randomized, double blinded, and placebo controlled trial.
aiculsamoth said:
Some folk have stated the lack of a response in said article with regards to chiropractic/ osteopathic treatment, Whilst I have stated I don't in the article recommend osteopathy over any other treatment and nor was it my intention, I feel everyone in the medical profession has something to offer, as a starting point cervical nerve blocks- an interesting article,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3311831/
Should people have an interest in how this practitioner would assess and treat a TN patient, I am willing to write an article/ piece, though might take some time to make it Bomb proof against detractors. On the understanding I AM NOT advocating it as a treatment modality. Don't take this the wrong way, but I am sure/ know there are easier patients to treat, e.g. you have tennis elbow, we'll do our best (as always). I have enough patients, for my non Porche payment lifestle.
Mod support,
Do you have any link to the outcome of
Hormonal Changes and Other Related Factors in Atypical Facial Pain Patients
from UW ?
I'm thinking what I posted was proposal. (my office is a mess) She did and has done a lot of work in the area as I remember she did her first doctorate at Johns Hopkins. Anyway try this:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157596/
It has a GREAT bibliography
aiculsamoth said:
Mod support,
Do you have any link to the outcome of
Hormonal Changes and Other Related Factors in Atypical Facial Pain Patients
from UW ?
I have had symptoms of TN since my teens...some I thought were normal and some I didn't know what they were. I have read that within familial TN the age of onset is lower with each new generation. That is true in my family. 29 is when mine first exploded, then again at 37. My mom was in her 30's. My aunt has only had two flare ups. Once in her 20's and again only while she was pregnant...it went away directly after. Just interesting with the hormones I think
Just reading the forums/ net there seems to be a number of people, mentioning their menses, miscarriage, hysterectomy and menopause with TN. I know it has been mentioned before by forum users, but short of head pain, migraine tmd etc why has it not gained more focus. The trigeminal complex is indicated in these conditions as it is in TN, as in it is not a sole peripheral neuropathy complaint. So as others have said before, shouldn't it be investigated further? Cervical trauma sees physiological changes at the spinal trigeminal nucleus, hormonal changes, and ingestion of food stuffs alter spinal trigeminal modulation at the spinal nucleus. If all of these are competing for the same nerve receptors on or around the spinal trigeminal nucleus, an imbalance of these competing elements is likely, so an imbalance of these three, would likely have an impact on pain expression. The first three factors I would suggest, with a little research and help from the appropriate sources are in reach of the patient.
justjane37 said:
I have had symptoms of TN since my teens...some I thought were normal and some I didn't know what they were. I have read that within familial TN the age of onset is lower with each new generation. That is true in my family. 29 is when mine first exploded, then again at 37. My mom was in her 30's. My aunt has only had two flare ups. Once in her 20's and again only while she was pregnant...it went away directly after. Just interesting with the hormones I think
Anyone interested in the neck as a possible cause for their tn, an interesting article on chiropractic care/ approach to trigeminal neuralgia.
http://www.mccoypress.net/annals/docs/2013-1161_tn.pdf
I'm assuming/ hoping the maintenance care wasn't weekly.
Mod support why do you state MVD should never be considered for type 2 TN? Many forum members express having both, and it is hard to fathom that they have two causes for a rare disease and some neuros state TN2 is an extention of TN1.
NEVER is a bit strong. There may be times. TN2 lacks the MRI evidence of vascular involvement. In these cases the MVD is largely "exploratory" and involves simply "irritating" or "massaging" the Trigeminal nerve. There is a high rate of failure (longer term and initially) a history of worsening problems and more complications from the retraction nerves looking around. Its not something I would consider for one of my kids or myself. (and yes I have facial pain consistent with TN)
aiculsamoth said:
......Mod support why do you state MVD should never be considered for type 2 TN? Many forum members express having both, and it is hard to fathom that they have two causes for a rare disease and some neuros state TN2 is an extention of TN1.
Sorry I thought you stated never in a thread. I wouldn't want MVD for type 2 for my kids either. Can I conclude you don't support the idea that tn2 is an extension of typical tn or is that a little simplistic?
And thanyou for the links on tmd and your response to AS, I'm assuming Facial pain due to AS is as a result of the cervical spine and/ or TMD, having looked at he net when it comes to facial pain such due to AS do you have any prefered links, washington maybe? The last for tmd did indeed have a great bibliography. Sorry to be a burden.
ModSupport said:
NEVER is a bit strong. There may be times. TN2 lacks the MRI evidence of vascular involvement. In these cases the MVD is largely "exploratory" and involves simply "irritating" or "massaging" the Trigeminal nerve. There is a high rate of failure (longer term and initially) a history of worsening problems and more complications from the retraction nerves looking around. Its not something I would consider for one of my kids or myself. (and yes I have facial pain consistent with TN)
aiculsamoth said:
......Mod support why do you state MVD should never be considered for type 2 TN? Many forum members express having both, and it is hard to fathom that they have two causes for a rare disease and some neuros state TN2 is an extention of TN1.
Depends on whether you are Left Coast or Right Coast in the US as much as anything.... There is no consensus or agreed upon classification system for TN. TN1 is also known as classical trigeminal neuralgia. TN2 was once known as atypical or symptomatic TN. However the term "atypical" trigeminal neuralgia has been inconsistently used for individuals who do not have TN1 and remains a vague, undefined term. Consequently, many researchers and patients have advocated eliminating the term "atypical TN", which remains a "wastebasket" diagnosis that serves no useful purpose and is often a disservice to patients.
On the left Coast where I am the two major University Systems (UW and Oregon Health Sciences) tend more towards "idiopathic" than Type 2. They also tend more towards other surgical options than MVD usually gangliolysis, neurectomy, or sterotactic radiosurgery (including gamma knife) Both have HUGE sterotactic departments and research
So we have a wastebasket diagnosis in the case of atypical/ type 2., as a result we have a meaning in trigeminal neuralgia as in pain in the face so why does this site or any other for TN not state the potential causes, diseases of this wastebasket diagnosis, from autoimmune disease/ collagen disorders/ neck disorders/ tmd etc. At present it states, well everyone can find the link, I just think it might be useful if it was there for patients in order to be informed in case it was ignored by their medical professional, the patient could ask the questions. As it stands patients read atypical TN and the solution drugs which often happen to be the same as for TN1.
The following is not original to me. It is grounded upon nearly 20 years of reading medical literature as a technically trained medical layman, and talking to thousands of patients.
The terms "atypical" TN or "Type 2" TN are still in wide use. They are admittedly imprecise, and also widely recognized as such among professionals. However, even organizations like the International Association for the Study of Pain haven't been able to come up with a notionally distinct labeling system that most practitioners will accept as a consensus on the subject. The term "idiopathic" might as well be "spontaneous face pain, cause unknown". It really doesn't seem to connect to any explained process of cause and effect.
What seems more clear is that the "classic" bursts of electric-shock stabs that are associated with typical TN, are very often not the only kind of pain that a patient experiences. Chronic neuropathic or neuralgia facial pain is frequently co-morbid with migraine or TMJ Disorder (though not always). Likewise there seem to be two somewhat distinct "modalities" of face pain, which respond to different classes of meds. The volleys of electric-shock stabs often respond to anti-seizure meds. Burning, throbbing, constant, 24-7 pain frequently doesn't respond to anti-seizure meds, but may be manageable with tri-cyclic antidepressant meds used at low doses. Overlapping both are symptoms of tingling and numbness that are generally called "parasthesia". But parasthesia doesn't happen in all patients, and it really isn't a distinct medical "entity". It's a symptom.
Not sure how much this helps, but thought I'd try.
Regards,
Thanks, whilst I realise symptoms are often imprecise from what I understand from the official classifications, I haven't revisited them for a while, parasthesia and anastesia/ numbness would appear to be a sympton of trigeminal neuropathic pain and not TN1 or TN2. On occasion I have come across folk on forums who state TN with parasthesia and/or anaesthesia, but reading it is questionable as to whether this is in the area of the C2 facial dermatome area as opposed to the trigeminal dermatomes, and hence wouldn't be TN.
The following is not original to me. It is grounded upon nearly 20 years of reading medical literature as a technically trained medical layman, and talking to thousands of patients.
The terms "atypical" TN or "Type 2" TN are still in wide use. They are admittedly imprecise, and also widely recognized as such among professionals. However, even organizations like the International Association for the Study of Pain haven't been able to come up with a notionally distinct labeling system that most practitioners will accept as a consensus on the subject. The term "idiopathic" might as well be "spontaneous face pain, cause unknown". It really doesn't seem to connect to any explained process of cause and effect.
What seems more clear is that the "classic" bursts of electric-shock stabs that are associated with typical TN, are very often not the only kind of pain that a patient experiences. Chronic neuropathic or neuralgia facial pain is frequently co-morbid with migraine or TMJ Disorder (though not always). Likewise there seem to be two somewhat distinct "modalities" of face pain, which respond to different classes of meds. The volleys of electric-shock stabs often respond to anti-seizure meds. Burning, throbbing, constant, 24-7 pain frequently doesn't respond to anti-seizure meds, but may be manageable with tri-cyclic antidepressant meds used at low doses. Overlapping both are symptoms of tingling and numbness that are generally called "parasthesia". But parasthesia doesn't happen in all patients, and it really isn't a distinct medical "entity". It's a symptom.
Not sure how much this helps, but thought I'd try.
Regards,
Red,
"Chronic neuropathic or neuralgia facial pain is frequently co-morbid with migraine or TMJ Disorder (though not always)."
So why is this, when it is stated by certain commentators, the neck is a cause of migraine in some 70% of patients, it would seem there is a common link.
I would appreciate references to a source for the 70% statistic that you quote. I've never seen that figure anywhere else.