Striking Back! is the world’s most comprehensive, plain-English book on trigeminal neuralgia and related facial pain conditions. “Striking Back! The Trigeminal Neuralgia and Face Pain Handbook” is a 507-page paperback that covers everything from the earliest symptoms of neuropathic face pain to the many treatments to research that is under way – all in easy-to understand language.
Striking Back! is published by the Trigeminal Neuralgia Association and written by George Weigel, a TN Support Group Leader and former TNAlert editor, and Dr. Kenneth F. Casey, a Pittsburgh neurosurgeon and member of TNA’s Medical Advisory Board. It can be purchased either from the TN Association:
http://fpa-support.org/product/striking-back-the-trigeminal-neuralgia-and-face-pain-handbook/
or Amazon:
http://www.amazon.com/Striking-Back-Trigeminal-Neuralgia-Handbook/dp/096723932X
The bulk of literature about facial pain has been written by doctors for doctors, in language that isn’t always easy for laymen to understand. Most of the remaining information has been either brief overview articles or short pieces about specific issues, such as medicines or particular surgical treatments.
“This new book reflects our mission, which includes supporting, educating, advocating and research development for TN and all related facial pain conditions,” says former TNA Board President Michael Pasternak.
The book looks at past treatments for TN and related facial pain conditions; details the sometimes-tricky diagnosis and symptoms; explores causes; covers the many medicines now being used to treat the pain; helps patients decide when surgery is needed; gives a rundown of the pros and cons of each of the main surgical treatments, and describes many alternative therapies, such as acupuncture, chiropractic and herbal therapy.
The book also looks at the human side of the condition. It offers advice on coping with the pain day-to-day; tells what families can do to help; provides a helpful chapter on “tips from facial pain veterans” and includes a lengthy list of resources for further help.
Table of Contents
FORWARD by Peter J. Jannetta, M.D.
PREFACE by George Weigel
PREFACE by Kenneth Casey, M.D.
ACKNOWLEDGMENTS
1: LIKE A LIGHTNING BOLT
- Not just an aging disorder
- When TN first appears (chart)
- How the pain behaves
- TN snapshot (chart)
- A quick TN anatomy lesson
- What trigeminal nerves do
- A TN history lesson
- Trigeminal neuralgia in a classic (box)
- From blood-letting to boiling water
- Surgical break-throughs
- Treating it with medicines
2: JUST WHAT IS TN ANYWAY?
- Where and how TN strikes
- How people react to TN pain
- How a TN patient appears to others (box)
- That unforgettable first attack
- A warm-up for the real thing
- Diagnosis difficulty
- Unnecessary treatments
- Education and awareness
- Diagnosing by description
- 10 tips on getting a speedy, accurate face-pain diagnosis (box)
- Ruling out other problems
- Tests that doctors often do
- Changes in sensation?
- A family connection?
- Kids with TN
3: WHAT’S CAUSING THIS TERRIBLE PAIN?
- How nerves work
- The road to the brain
- A sample impulse
- Like a phone cable
- The trigeminal nerve’s duty
- The 12 pairs of cranial nerves (box)
- What’s going wrong
- Irritable nerves
- The remission cycles
- The suspected role of aging
- Compressions of all kinds
- Problems with compressed other nerves (box)
- Is it always a compression?
- Tumors and cysts
- The AAA of anatomy problems
- Some other things that could be causing TN
4: TN OR NOT TN?
- It must be atypical?
- Sorting out the atypicals
- A variation on the TN theme?
- What’s injured¦ and for how long?
- When do variations become something else?
- Changing the names
- TN-1 and TN-2
- Trigeminal neuropathic pain
- Trigeminal deafferentation pain
- Post-herpetic neuralgia
- Symptomatic trigeminal neuralgia
- Atypical facial pain
5: THE DENTAL CONNECTION
- How tooth pain factors in
- Flushing out tooth problems
- The straw that broke the camel’s back
- New pain but not TN
- Dental pain and TN
- Dental problems to consider
- The bony-cavity theory
- How NICO happens
- The other side of NICO
- Fillings as triggers?
- Dental care with TN
- Going to the dentist
6: OTHER FACE PAINS: NOT TN, NOT DENTAL, BUT IT STILL HURTS
- Cluster headache
- Cluster tic syndrome
- Migraines and facial migraines
- Trigeminal neuritis
- Lyme disease
- Glossopharyngeal neuralgia
- Geniculate neuralgia
- Occipital neuralgia
- Vagal/superior laryngeal neuralgia
- Sphenopalatine neuralgia
- SUNCT
- Temporomandibular disorders
- Myofascial pain
- Temporal arteritis
- Sinusitis
- Chronic paroxysmal hemicrania
- Raeder’s paratrigeminal syndrome
- Orbital myositis
- Tolosa-Hunt syndrome
- Lupus and Sjogren’s syndrome
- Atypical odontalgia
- Burning mouth syndrome
- The many faces of face pain (chart)
7: MEDICATIONS FOR FACE PAIN
- Anticonvulsants: Still the main type
- What usually doesn’t work
- Finding better anticonvulsants
- Beyond anticonvulsants
- No just-for-TN drug
- The path to medication
- Medication’s role in TN
- Picking the right medicine
- Conflicts with other medicines, conditions
- How to take TN medications
- A dosing schedule (chart)
- Allergic reactions
- The right dose
- Questions to ask when taking a new drug (box)
- What if the pain is gone?
- What if the medicine wears off?
- Dealing with side effects
- A drug-by-drug rundown
- Carbamazepine (Tegretol, Carbatrol)
- Oxcarbazepine (Trileptal)
- Gabapentin (Neurontin)
- Lamotrigine (Lamictal)
- Topiramate (Topamax)
- Phenytoin (Dilantin)
- Levetiracetam (Keppra)
- Tiagibine (Gabitril)
- Valproate (Depakote, Depakene)
- Zonisamide (Zonegran)
- Amitriptyline (Elavil)
- Imipramine (Norfranil, Tofranil)
- Nortriptyline (Pamelor)
- Venlafaxine (Effexor)
- Baclofen (Lioresal)
- Tizanidine (Zanaflex)
- Pimozide (Orap)
- Clonazepam (Klonopin)
- Opioids
- A look at opioids used for chronic face pain (chart)
- Compounding: Another way to take medicines
- Help paying for TN medications
- Seven ways to hold medication costs (box)
- Pregnancy and TN
- Pregnancy risk ratings of TN drugs (box)
- Comparing the medications used for TN (chart)
- Side effects and interactions of TN medications (chart)
8: IF MEDICINES DON’T HELP
- Choices, choices and more choices
- When is enough enough?
- The case for sooner surgery
- Is there a time window?
- What do patients want? (box)
- CAM options
- Making the surgery decision
- Need more help deciding what to do? (box)
- Wading through the options
- Which kind of surgery?
- Average life expectancies (chart)
- The nature and location of pain
- Complications and recurrence
- Prior procedures?
- Which came first¦ the surgery or the surgeon?
- Picking a skilled surgeon
- Seeing the cause
- Decisions in atypical or TN-2 cases
- Decisions in multiple sclerosis cases
- Decisions in post-herpetic neuralgia cases
- Decisions for trigeminal neuropathic and deafferentation pains
- No two cases alike
- What to do about surprise attacks
- Health insurance and disability issues
- Comparing the five main TN surgeries (chart)
9: RADIOFREQUENCY LESIONING: Fighting Face Pain with Heat
- How it’s done
- Radiofrequency’s role in TN
- Success rates and recurrences
- The possible drawbacks
10: GLYCEROL INJECTIONS: Fighting Face Pain with a Liquid
- How it’s done
- Glycerol’s role in TN
- Success rates and recurrences
- The possible drawbacks
11: BALLOON COMPRESSION: Fighting Face Pain by Squeezing the Nerve
- How it’s done
- Balloon compression’s role in TN
- Success rates and recurrences
- The possible drawbacks
12: RADIOSURGERY: A No-Incision Surgery Using Radiation
- The Gamma Knife
- Linear accelerators
- How Gamma Knife is done
- How a linac treatment is done
- Radiosurgery’s role in TN
- Differences of radiosurgery
- Success rates and recurrence
- The possible drawbacks
13: MICROVASCULAR DECOMPRESSION: Attacking the root of the problem
- How MVDs are done
- Dealing with the vessels
- MVD’s role in TN
- Success rates
- Pain recurrence
- The possible drawbacks
- Partially cutting the nerve
- A comparative look at surgical success rates (chart)
- A look at potential unwanted effects of surgery (chart)
14: IT STILL HURTS¦ NOW WHAT?
- Why did surgery fail?
- What if it worked but the pain comes back?
- Why pain might come back
- Surgery repeats
- Which one next?
- Dealing with surgical complications
- Pain and numbness both?
- Other avenues
- Peripheral nerve treatments
- Neurectomies
- Chemical injections
- Cryotherapy
- Peripheral radiofrequency
- If all else fails¦
- The DREZ procedure
- Deep brain stimulation
- Motor cortex stimulation
15: NOT SURGERY, NOT PILLS: THERAPIES BEYOND MAINSTREAM MEDICINE
- Rising CAM trends?
- Exactly what is CAM?
- CAM’s roots
- Why people are interested in CAM
- Who’s using CAM today
- How to determine if CAM is right for you (box)
- The issue of evidence
- Why there’s little research
- A few other caveats
- Worth trying?
- A closer look at some CAM and other options
- Hot-pepper creams
- Local anesthetics
- Botox injections
- TENS units
- Magnet therapy
- Low-intensity laser therapy
- Massage
- What the labels mean (box)
- Herbal therapy and aromatherapy
- Craniosacral therapy
- Therapeutic Touch/Healing Touch
- Tips on CAM shopping (box)
16: ACUPUNCTURE FOR FACE PAIN
- Understanding acupuncture
- Not always needles
- Finding a balance
- Why else might acupuncture work?
- How well does it work?
- Side effects and drawbacks
- Help finding an acupuncturist (box)
- Acupuncture’s role in TN
17: CHIROPRACTIC FOR FACE PAIN
- The spine and face-pain connection
- Searching for problems
- Fixing the misalignments
- Success rates
- Keeping the pain away
- What patients say
- What doctors say
- Chiropractic’s role in face pain
- How to find an upper-cervical chiropractor (box)
18: NUTRITION THERAPY
- Food links to face pain
- Pain-triggering foods
- Two main routes
- The healthy-nerve diet
- Seven guidelines for a healthy diet (box)
- Nerve-related vitamins and minerals
- The role of supplements
- Vitamin B-12 and myelin
- Nutrition-based plans
- The Lemoles’ TN program (chart)
- Other nutrition and lifestyle efforts
- For more information on nutrition and health¦ (box)
- Success, precautions and limits
- A few tips on supplement shopping¦ (box)
19: TIPS FROM THE VETERANS
- Cold compresses
- Heat treatments
- Hot creams
- Menthol creams
- Avoid burning eyes
- Gum-numbing gels
- Give the nerve the cold shoulder
- Eating tips
- A nerve-calming tea
- Teeth tips
- Chew gum
- Facial massage
- Massage the ears
- Chin adjustment
- Flex the neck
- Clever sleeping strategies
- Get proper rest
- Set the alarm for a nighttime dose of medicine
- Stay away from face-touching activities
- Cover the face outside
- Loosen those glasses
- Cut out nicotine
- Limit other stressors
- Prayer
- Strenuous exercise
- Fresh air?
- Keep a pain diary
- Play detective
- Prioritize your activities
- Avoid vibrations
- Avoid bright light
- Dry-eye help
- Attitude boosters
20: COPING WITH FACE PAIN
- Lots of exams, no answers
- TN affects more than just the face
- Reacting to the pain
- Fighting the mental battles
- Eight myths of pain (box)
- The depression connection
- Willing the pain away?
- You don’t have to learn to live with it
- Coping with sudden pain flare-ups (box)
- Relaxation
- Deep breathing exercises (box)
- Progressive muscle relaxation (box)
- Mental imagery
- Hypnosis and self-hypnosis
- How to hypnotize yourself (box)
- Meditation
- How to meditate (box)
- Biofeedback
- Prayer
- Americans’ thoughts on the healing power of prayer (box)
- Humor as therapy
- How to laugh your pain away (box)
21: HELPING PEOPLE WITH FACE PAIN
- Supporters help with coping
- How others react
- I Don’t Get It poem
- Hard to understand
- Things that don’t help
- Things that do help
- Walking that fine line
- The effect on children
- An effective doctor
- How to help your TN doctor help you (box)
- The burden on caregivers
- A support group for neuralgians
- The beginnings of TNA
- TNA’s purpose (box)
- How to contact the Trigeminal Neuralgia Association (box)
- Support makes a difference
- Finding a TN support group (box)
- Support can add years?
- Support group by Internet
- 18 ways to help a neuralgian in the family (box)
22: POSSIBILITIES
- A new view of pain
- Pain Care Bill of Rights (box)
- What we’re learning about pain
- Regenerating myelin
- Medications just for TN
- Better delivery of the medicine
- New and improved surgery
- MVD advances
- Stimulating the pain away?
- Better imaging
- More TN education
- Lots of hope
23: HELPFUL LISTS, QUESTIONNAIRES AND OTHER AIDS
- Questions to diagnose and treat face pain
- Sorting out the exact face pain you’ve got
- The McGill Pain Questionnaire
- How is pain affecting your life?
- Wong-Baker FACES Pain Rating Scale
- Are you and your doctor on the same page?
- How are you coping with your face pain?
- Measures for depression
- Understanding medical literature
- Navigating for health information online
- 15 points to look for in a good surgical study
- Thoughts to Myself poem
- Do You Know What I Did Today? poem
- Tic Douloureux My Darling song
24: RESOURCES
25: GLOSSARY
REFERENCES