Red & Others - How Many People Are Managing OKAY on meds? How Long?

Symptoms & Treatments Complimentary Therapies
21

Cases. Four cases from 31 to 68 years that meet the International Headache Association for trigeminal neuralgia, previously treated with anticonvulsants by different services, the patients had been submitted to anti-inflammatory blockades of different trigeminal branches without success. With time they show cervical symptomatology and were studied with X ray and magnetic resonance beneath other studies, we found cervical pathology, for this motive they ere treated with cervical nerves blockades and they improved in 80- 90%, they also get treatment for the specific cervical disease.
Conclusions. Even when trigeminal neuralgia as a presentation of cervical pathology is uncommon, it is a differential diagnosis that has to be ruled out. The anatomopatological explanation for this presentation is that the spinal nucleus of the trigeminal nerve ends at C2 -C3 cervical segments and the nociceptive impulses arriving from the neck can make synapses at this level and give rise to a clinical setting as this.

(From moth's link)

I think there is some connection between the neck and the TN pain, but my opinion is from my own personal experience. Seems that I may be a minority because even on this board, most TN people don't seem to mention any neck issues. So it can also be that the neck might not be a cause, but can affect or exacerbate the pain... there are many possibilities it seems. Until he cause of TN is discovered, the research will be slow and not all the current avenues are even being looked into by the medical community.

Definitely one problem is that the mainstream medical has not even really looked down this path regarding the upper cervical connection. I have barely even seen any research papers about this. I am no PhD or Dr. (and I am not sure what Red and Moth disagree about exactly) but I do know that the nerves in the upper cervical area do connect into the same ganglion that the trigeminal nerves are connected to (or something to that effect).

22

Another interesting link, below, describes the story of a trigeminal neuralgia patient having attended A&E for help, and being successfully treated with cervical nerve blocks. This from Emergency Medical News,

http://journals.lww.com/em-news/blog/BreakingNews/pages/post.aspx?P...

The previous link, mentioned by knowpain, if I remember correctly, also states you don't have to have pain in the neck for cervical pathology to cause TN.

23

Moth, there is a significant omission in the article you reference above. No information is offered on the persistence of reported pain relief after nerve blocks are delivered to the neck. Any thoughts on that?

24

Moth, I realize that the moderators and owners here really are not inviting controversy or contention between you and me. But please realize that anyone could have some difficulty maintaining civility when you use terms like "dogmatic" in reference to me as an individual. I am careful, and I try to honor the principle of "first do no harm" -- as should you.

Likewise, I cannot take you seriously when you go out of your way to smear MVD procedures and the physicians who perform them, by proclaiming a vague risk of mortality. In the more than 1200 MVD procedures reported by Janetta et al in the 1990s, I recall that there may have been three or four post-surgical deaths. Those deaths appear to have been caused by reactions to general anesthesia, not by the procedure itself. Anesthesia practice has come quite a way since, and more recent consecutive series of MVD outcomes have reported even lower mortality.

So I would encourage you to stick closer to facts, and drop the innuendos. They aren't constructive or helpful. Nor is your refusal to identify specific procedures that may aid patients who believe that their facial pain may have originated in the cervical spine.

Regards, Red.



aiculsamoth said in part:


As such, there would be no specific protocol beyond any other that would treat neck dysfunction/ pathology/ problems. The majority, I believe, of medical interventions, for cervical/ neck dysfunction have already established risk factors in the research literature, those that could be argued haven't, would not find it hard to compete with recognized risk factors for MVD - death.
25

There is no significant omission in the article,that pertains to my point. The link was quoted to highlight the fact the neck can cause TN (though not conclusive as a stand alone link), and might be useful to anyone who has to attend A&E with acute TN symptoms, as in print it off take it with them, it may be of some help.

Interestingly, the procedure isn't strictly speaking a nerve block, but a paraspinal muscular block in the region of C7, at the base of the neck, not near to the cervical spinal trigeminal nucleus extending to possibly as low as the fourth cervical vertebra, yet is stated to work. If I had TN that necessitated a visit to A&E/ ER, I'm pretty sure I wouldn't in the instance be asking if it lasted in the long term, I'd be more focused on, get me out of this misery. If I did ask, and was told it would only last in the short term, "get away from me with that big friggin needle", would not be passing my lips any time soon.

Nerve blocks, cortisone injections etc. for whatever area in the body are anti inflammatory, a more localised version of oral anti inflammatories, why would they be expected to have a lasting affect if the source of inflammation was not addressed?

Richard A. "Red" Lawhern said:

Moth, there is a significant omission in the article you reference above. No information is offered on the persistence of reported pain relief after nerve blocks are delivered to the neck. Any thoughts on that?

26

What I was getting at, Moth, is that in many reports I have read, the persistence of nerve blocks in other areas (sphenopalatine, peripheral distribution of the trigeminal nerve, etc), tends to be at most a few days and more typically a few hours. My instinct is that this may also hold true for the muscular block you have researched. This isn't to say that blocks aren't worth doing, to interrupt a disabling spiral of breakthrough pain. Only that some other treatment modality seems to be needed for more lasting effects -- addressing the "sources" of nerve inflammation. Otherwise, the patient may find themselves back at the ER repeatedly every few days.

27

I never mind apologising when I believe I'm in the wrong or indeed when it is pointed out to me. I remember apologising to you when called for on this forum. Dogmatic, not a word to be taken lightly, but neither is it rude. On the balance of the evidence, I have presented, denying TN caused by the neck, is taking a dogmatic point of view.

You imply, I don't conform to the principle of 'first do no harm', where did that come from??

I don't go out of my way to smear MVD and surgeons, in the last post I simply stated that the procedure can result in death, yet you comment on the alternatives of cervical treatment, that regardless of therapeutic action there are no reliable studies as to adverse events, unlike MVD. Why would that be?

You state out of 1200 MVD procedures by Janetta, only 3-4 deaths, I'd buy a lotto ticket on those odds, but it would be a last spin of the dice before I submitted myself to it as a treatment, as it should be but isn't for the case of many, whose medical prof doesn't even consider the neck as a cause. Show me stats that even come close to the mortality rate you state for MVD procedure, for non invasive treatment of any neck problem, then I will offer my apologies.

"I try to honor the principle of "first do no harm" -- as should you.", exactly want am I promoting that causes harm? the fact that I suggest TN patients look to their neck as a possible cause? and possibly avoid MVD- shame on me, after all I stand to make thousands of dollars from said argument, I've the Porche on order, in the hope I might win you over.

A difference of opinion is fine, but not "I try to honor the principle of "first do no harm" -- as should you", without justification- which you haven't stated. By comparison makes dogmatic sound like I'm trying to seduce my girlfriend.

My previous post on this thread explains clearly why-

"refusal to identify specific procedures that may aid patients who believe that their facial pain may have originated in the cervical spine."

For one, rules state describe not prescribe, and do you really think an example of the below helps the audience of the forum?

1) Strain/ counter strain to the dysfunctional structures

2) Neuromuscular technique addressed to the same structures

3) mobilisation of said same.

etc, which would actually differ depending on the individual, about as useful as explaining how to mend your car without the tools.

Like I stated the medical profession, in the main has already stated what helps cervical dysfunction, with evidence.

In summation do you or don't you believe the neck can cause facial pain, and considering the trigeminal nerve supplies the sensory area of the face, TN?


Richard A. "Red" Lawhern said:

Moth, I realize that the moderators and owners here really are not inviting controversy or contention between you and me. But please realize that anyone could have some difficulty maintaining civility when you use terms like "dogmatic" in reference to me as an individual. I am careful, and I try to honor the principle of "first do no harm" -- as should you.

Likewise, I cannot take you seriously when you go out of your way to smear MVD procedures and the physicians who perform them, by proclaiming a vague risk of mortality. In the more than 1200 MVD procedures reported by Janetta et al in the 1990s, I recall that there may have been three or four post-surgical deaths. Those deaths appear to have been caused by reactions to general anesthesia, not by the procedure itself. Anesthesia practice has come quite a way since, and more recent consecutive series of MVD outcomes have reported even lower mortality.

So I would encourage you to stick closer to facts, and drop the innuendos. They aren't constructive or helpful. Nor is your refusal to identify specific procedures that may aid patients who believe that their facial pain may have originated in the cervical spine.

Regards, Red.



aiculsamoth said in part:


As such, there would be no specific protocol beyond any other that would treat neck dysfunction/ pathology/ problems. The majority, I believe, of medical interventions, for cervical/ neck dysfunction have already established risk factors in the research literature, those that could be argued haven't, would not find it hard to compete with recognized risk factors for MVD - death.
28

I have tried acupuncture, chiropractic care, massage therapy, myokinesis (I like the prinicipal of this one), TENS units, etc. with no avail. Before I had my wisdom teeth taken out, massages would work the best but after I had the complications it just feels like I am a rock incapable of relaxing.

In regards to the acupuncture I even had one therapist put needles in my mouth. That did help either.

Alli said:

I am wondering if anyone has tried acupuncture? I was going to make an attempt with it, but after reading this I am wondering if chiropractic adjustment might be the better choice?