I am getting confused. Is Trigeminal Neuropathy due to non dental trauma , the same condition as ATypical TN? and TN2 Are they all the same thing?
In another thread Red said that I was likely ATN or Trigeminal Neuropathy... when I googled for the difference, I could not see any difference.... I know that TN2 is type II which is Atypical. But I don't know about the neuropathy part....
After reading i think Trigeminal Neuropathy is due to trauma and atypical is when there is no known cause, is this correct?
If your not sure if it is trauma related or not, is there a difference in the symptoms of Trig Neuropathy and ATN? For example is it possible that Neuropathy can be felt on both sides of face like ATN can? Is ATN always 24/7?
Although there is still some imprecision in practice standards, the following is my reading of the literature.
1. Trigeminal Neuropathic Pain is not quite the same thing as Atypical Trigeminal Neuralgia.
2. Trigeminal Neuropathic Pain is pain of an origin caused by discrete events of mechanical or organic disease nerve damage in the trigeminal system, particularly damage in root canal, dental surgery, TMJ surgery, Sinus surgery, blunt force trauma to the face, or similar occurrences.
3. Atypical Trigeminal Neuralgia (Also called 'Type II" Trigeminal Neuralgia) emerges either spontaneously, or as a gradual transition or progression from Typical ("Classic" or "Type I") Trigeminal Neuralgia. The character of this pain is often the same as in Trigeminal Neuropathic Pain. But the courses of treatment are somewhat different. Both of these variants on trigeminal pain tend to respond poorly to surgical procedures, but ATN patients are marginally better surgical candidates -- especially if they have discernable vascular loops seen in FIESTA MRI imaging.
4. Any form of trigeminal pain can be bilateral. But to qualify as neuropathy, pain due to nerve injury would need to result from injuries to both sides of the face. There is no evidence that I know of, which suggests that neuropathic pain can "travel" from one side of the face to the other, except in two specific senses. There is some evidence that when neuropathy goes untreated for prolonged periods, it may cause forms of "CNS Sensitization", which can increase vulnerability to breakthrough pain distant from the original site of insult. Likewise "Complex Regional Pain Syndrome" is characterized by pain felt at sites distant from a discrete location where an earlier injury has occurred.
I hope this lends some clarity. Feel free to follow up.
Regards, Red
Red is states above that type 2 is a gradual transition or progression from Type 1. Is it possible for it to happen very quickly, in a matter of months? Is it possible it can emerge spontaneously very quickly after Type 1? Trying to work out if what I can feel is Neuropathic or Type 2. Apart from the bilateral aspects, is there anything to distinguish one from the other?
Type 1(classic or Typical) TN is distinguished by volleys of relatively brief "electric shock" stabs of pain that last from a few seconds to a couple of minutes. Type 2 (Atypical) TN has a more constant aching, burning, boring character, that approaches 24/7, at a slightly lower intensity than Type 1. It is possible for the two types to emerge at the same time or within a very short time, and there is no "rule" that establishes the chronological order of the two types. Trigeminal Neuropathic Pain as a diagnosis is distinguished from BOTH TN-1 and TN-2 by being closely associated with some form of mechanical injury to the nerve that does not emerge "spontaneously", but rather after a discrete event such as dental work or blunt force trauma.
Regards, Red
Red, I received laser on my upper lip for cosmetic reasons, it was quite a strong blast as it was to get rid of a spider vein. I felt as sharp feeling of pain as soon as the laser touched my skin. I felt the pain shoot up my face.
Tn1 then began 2 days later. This is now under control. A few months later aching began in different parts of my face, on the TN side.
I thought this was neuropathic pain from the trauma of the laser. My Neuro has informed me that he does not agree that the the laser caused my TN although he says it may have been a trigger. In that case does it mean it cannot be Neuropathic but must be Atypical?
Does the Neuro say this as 'Doctors stick together' or is the a reason why a laser could not have hit my nerve and caused damage?
Reading of others who have nerve damage from dental work, there pain is 24/7 and much greater then mine, which is very mild in comparison to my TN1, also mine comes and goes, and some days I am pain free. I have it approx 20% of the day and it goes from an ache to a mild throb at times.
I still think Neuropathy, what is your opinion Red. I did not ask the Neuro to give it a name, as we spent our time discussing the TN1.
I don't personally know of another case, Elstep, where a laser cosmetic surgery on the face has been traceable into a case of TN or Trigeminal Neuropathic Pain. Apart from any collegial instinct to cover one another's arses, coincidences do happen and relatively minor stimulus to a peripheral nerve does sometimes prove to be a "trigger" for emergence of longer lasting facial pain.
In your case, I would say that the distinction might not be meaningful except to a lawyer -- and my instinct is that a lawyer would have an awful time proving the connection. You might do best by simply seeking effective medication treatment for a combination of TN-1 and TN-2 symptoms. I don't think you would be regarded as a good candidate for surgery by most doctors, unless there is confirming MRI imagery of a vascular loop on the nerve where it emerges from the brain stem.
Regards, Red
thanks Red, I am not intending to sue or give blame for this, its just for my own peace of mind, of what i have? Does it make any difference to anything apart from surgery if it is TN2 or ATN? Do the symptoms differ, is the outlook any different? I do try reading up on both and cross referencing but I do get confused as they are both so alike.
Apart from possible eligibility for surgery, I believe there likely won't be much difference in medical treatment for trigeminal neuropathic pain versus ATN. See our face pain info tab for a sub-section on drug treatment options.
Regards, Red
I have been diagnosed with having TNP from an unknown source in my teeth on my right side, and I have now been getting pain in the same exact teeth on the other side. Obviously, if TNP comes from an injury or trauma, it sure is unlikely that I had the same trauma on both sides of my face, to the point where the same exact teeth are being affected.
Because of this, my doctor is reluctant to say I have bilateral TNP and is having me see an ENT, and go through the circle of doctors that started my journey in the first place. It kind of pisses me off, but I guess I can understand why, given the odds of this happening the same on both sides.
Maybe I have ATN? He refuses to use that diagnosis, but he didn't diagnose me TN2 either (he uses Burchiel's classification system, minus anything with the word "atypical"). His original TNP diagnosis was based off the fact that the pain was in one location, 24/7 without stopping, and I did not respond to Trileptal or Neurontin, but had great success with Amitriptyline. I guess I'll see what happens...
I have only two crowns in my mouth, which I've had for over five years, and both have become the epicenter of my pain, one on each side of corresponding teeth. I want to replace the crowns, because this seems like more than a coincidence, but my doctor feels that won't help and will just flare up the nerve. But that would explain TNP on both sides...
I guess an easy way out would be to say that while receiving the crowns, I had trauma and hence bilateral TNP. The right crown was received a year before the left crown, and all these years later, the pain arrived on the right side, and a year later on the left side.
These correlations are suspicious to me...
Crystal, I do not have a crown, but my epicenter is also a tooth. Mine is heavily filled and my dentist suggested a root canal might help the pain,but i wont let him as i am afraid of making things worse.
Like you i respond to Amitriptyline. But then i think ATN and TNP both respond to that?
Because i felt an electric shock when having the laser, i think it is TNP i have.
Mine is not constant and i think TNP is more likely not to be constant then ATN?
Cleo thanks for the guide to nerve damage, glad to see you have neuropraxia rather then one of the others, I guess all your pain must be coming from one of your other conditions?
How would one know which of those three you have?
Thanks Girls for the input and I wish you both a positive New Year xx
I believe that TNP is usually 24/7. I bet we could ask all the major players in the TN medical field and they'd all have different answers. I wish they'd all get on the same page!
How about ATN, is that not 24/7 also?
I believe it varies for ATN. Some have it 24/7, some have it come and go.
Crowns... hum. I just realized that the worst of my pain centers on the teeth above my crown. I have had this crown for years and it has never felt filed down correctly. I had it adjusted to the point the dentist said I could not have it filed down more. Yet, I know my bite when I chomp down is uneven...... and for some years now, I have clenched HARD at night when sleeping. That's why they suspected TMJ at first..... Makes one wonder, you know?
I have to be so careful with my teeth clenching. I do think this is one of my triggers. I get pain as soon as my top tooth meets my bottom tooth.
Happy New Year! Im preparing for dental surgery and grafts in may. I had whole face co2 laser and id did create some sensitive nerve areas and nerve roots that are a little painful. This derm eas really heavy handed. I also believe it can cause more scar tissue to form from increased collagen. suing is useless. swelling is normal. This was minor but face lift two caused the real damage. im off of well butin and on 25 amitryptaline. i was thinking about asking to increase it, no its nortryptaline. i would like to cut down on my oxy if possible. At least having a smart, savvy female dr. as my advocate and the surgeons are finally moving. i added alot of meditation and imagery. miss you! ive been so busy, but its good. I feel productive.
Richard A. "Red" Lawhern said:
I don't personally know of another case, Elstep, where a laser cosmetic surgery on the face has been traceable into a case of TN or Trigeminal Neuropathic Pain. Apart from any collegial instinct to cover one another's arses, coincidences do happen and relatively minor stimulus to a peripheral nerve does sometimes prove to be a "trigger" for emergence of longer lasting facial pain.
In your case, I would say that the distinction might not be meaningful except to a lawyer -- and my instinct is that a lawyer would have an awful time proving the connection. You might do best by simply seeking effective medication treatment for a combination of TN-1 and TN-2 symptoms. I don't think you would be regarded as a good candidate for surgery by most doctors, unless there is confirming MRI imagery of a vascular loop on the nerve where it emerges from the brain stem.
Regards, Red
i too have been on amitriptyline for years and have lost almost all my back (no dental ins) had a few crowns just break off but since i started taking pilocarpine that replaces the saliva that protects ur teeth -from the dry mouth side effect and i have had an unbelievable reduction in tooth/gum pain and still carry a drink w/ me all time but not have that extreme dry feeling all the time !!! i also have problems on both sides of mouth but left side had TN branch injured above left eyebrow!! good luck
crystalv said:
I have been diagnosed with having TNP from an unknown source in my teeth on my right side, and I have now been getting pain in the same exact teeth on the other side. Obviously, if TNP comes from an injury or trauma, it sure is unlikely that I had the same trauma on both sides of my face, to the point where the same exact teeth are being affected.
Because of this, my doctor is reluctant to say I have bilateral TNP and is having me see an ENT, and go through the circle of doctors that started my journey in the first place. It kind of pisses me off, but I guess I can understand why, given the odds of this happening the same on both sides.
Maybe I have ATN? He refuses to use that diagnosis, but he didn't diagnose me TN2 either (he uses Burchiel's classification system, minus anything with the word "atypical"). His original TNP diagnosis was based off the fact that the pain was in one location, 24/7 without stopping, and I did not respond to Trileptal or Neurontin, but had great success with Amitriptyline. I guess I'll see what happens...