I've posted this on the Australia page as well, but as there are more members here, I thought I would see if anybody has had the same experience.
I've been seeing an orofacial pain specialist in Perth Australia at the SJOG Hospital in Subiaco now for quite a few months and he has diagnosed that I have Type II TN. I've had an MRI, which came up clear and was initially put onto 75mg Lyrica twice daily and now it's up to 150mg twice a day with no relief at all. I was also fitted with an interoclussal dental splint to wear at night. I have constant pain in the roof of my mouth and my tongue feels like I'm having an allergic reaction; then it moves into my cheeks.
He's now decided to try me on Nortriptyline and has also asked that I go to see a Consultant Psychiatrist! This has taken me quite by surprise as I really don't know what he can do to help me. When I asked my Specialist he said he will help with the medication, which is what I thought my Specialist was doing and why I'd paid him hundreds of dollars....
Has anybody else been referred to a Psychiatrist to help with Type II TN?
Please see this article, I feel you are not being taken seriously enough.
in particular the below copy and paste.
(1) Medical practice now acknowledges that chronic pain and chronic depression are co-morbid conditions. They tend to occur at the same time in many people.
(2) We also know that each of these conditions promotes or plays into the other. Pain exhausts us, disturbing our sleep and draining our energy for daily life. Depression can do the same, rendering us more sensitive to pain or more vulnerable to its emergence. This seems particularly true of breakthrough pain in facial neuropathy.
(3) The above being stipulated, the term "psychogenic" may still be inappropriate -- if by using it a doctor implies or legitimates the attitude that the pain is the patient's fault and can be cured by a change in the patient's attitude or obsessional thinking. Attempts to substitute psychiatric therapy for medical therapy are not valid medicine for face pain patients.
(4) When the referring physician makes a psychiatric referral with the parting words "there is nothing medically wrong with you -- you need psychological evaluation", a gross medical malpractice has just happened. Negative consequences to the patient of being explicitly or implicitly labeled a "head case" can be immediate, long lasting, and in some cases life threatening.
(5) Psychiatric or psychological support, counseling, Rational Cognitive Therapy, guided visualization, meditation, anti-depressant drugs, and anti-anxiety drugs for the management of mood, attention and personal energy, are appropriate support measures within a total program of pain management. The explicit goal for using such techniques should be to empower the patient to help themselves live more fully and with less personal suffering and less vulnerability to breakthrough pain associated with fatigue and sleeplessness.
Hi Jackie, yes I had read this too. My Specialist actually speaks on TN and has been asked to speak at the local TN support group. He acknowledges that I have Type II TN, that is why I was surprised at this latest avenue of treatment. He said to me yesterday when I asked him about nutrition, exercise etc that it is nothing that I've done wrong, it is caused by very invasive dental treatment that I've had recently. I am in no way depressed and considering all that goes with this, am considerably upbeat and positive. I sleep very well and am still able to exercise; I'm baffled, but I'm going to make my appointment and see what this guy can offer and then maybe I'll understand why he's sent me there - one appointment only mind...
Hi I went into a psychiatric clinic because I was so depressed from the pain. The psych there in conjunction with a pain specialist put their heads together and came up the best solution any medic has offered me so far. But I don't know why you doctor should send you to one. Why don't you ask him why.
I did ask him why, as I said in my initial post. I am in no way depressed and have a really Great support network.
I've decided to go back to my GP as she is open to exploring new avenues, easy to talk to and doesn't charge the exorbitant Specialist prices when they too don't really know what to do.
My neurologist didn't recommend it and I'm not depressed (at least not beyond the wierdness of the drug side effects) but I'm going to make an appointment with a pain psychologist just to help out. I feel like I'm loading too much on my family and that sometimes, even though they know they shouldn't, they have a hard time getting over the "just get over it" thoughts.
I think having someone to talk to who understands pain and what the effects are sounds lovely. Give the psychologist a shot, Lynndy, it may just be a great outlet your regular support system doesn't provide.
I was also told to see a psychiatrist by an ENT. He told me nothing was wrong with me & it was all in my head. He was a 30+ years ENT. My NS wrote him an "educational" letter.