I visit the neurologist Wednesday and plan to ask him about tricyclic antidepressants, which ones are you on and how much has it helped your pain? I don't know much about this line of medication and how it helps with nerve pain at all. Please all comments are appreciated.
hillsdale-
Medication dosing is VERY variable from person to person. If your physician is familiar with the use tricyclics (TCA's) for pain, they will usually start you on a standard regimen and titrate the dose up or down depending on your response.You don't need to give the MD a dosing guide; this is what they do :)
TCA meds are recognized by the International Association for the Study of Pain , as helpful against neuropathic pain. There appears to be a cross-over pain channel action of some sort between their effects in reducing or managing depression, versus their general quieting of the nervous system and reduction of neuropathic pain. The pertinent effect, however is not really the anti-depressant effect. TCA's are often effective against neuro pain at doses lower than generally considered effective for depression itself.
Regards and best,
Red
Mr. Red,
with what I have read on here most people take the dose of tricyclic antidepressants, or any type of antidepressant for that matter at night time before bed, is this a type of medication that will wear off by the time I awake the next day, or is it a medication that gradually works throughout the next day even if taking it at night. Very confused as to the working mechanism of these types of medications.
Richard A. "Red" Lawhern said:
TCA meds are recognized by the International Association for the Study of Pain , as helpful against neuropathic pain. There appears to be a cross-over pain channel action of some sort between their effects in reducing or managing depression, versus their general quieting of the nervous system and reduction of neuropathic pain. The pertinent effect, however is not really the anti-depressant effect. TCA's are often effective against neuro pain at doses lower than generally considered effective for depression itself.
Regards and best,
Red
Your dose pattern will be tailored to your patterns of pain, Hillsdale. You might take TCA meds more than once per day, to develop an even blood level of the med. That's also true of anti-convulsants, anti-seizure agents, muscle relaxants, tranquilizers, and other classes of meds used in TN and ATN. Be advised by your physician, please.
Regards, Red
This med takes time to get into your system so be patient. I started at 10 mg a day the next week went to 50 mg a day and i did find it somewhat relieving so i continued on to 75 mg a day. It def took a cple weeks to work into ur system. I read that about taking it at night so i did start like that but actually take mine at like 3 pm and it doesn't make me sleepy at all. I am up everyday at 9 and stay awake til 2 am. for the most part I try to take it around the same time sometimes i forget it will be like 7 and my face will remind me if i am off. I usually keep a checklist or count pills and mark on calendar. It also has relief for anxiety and depression which I have had all my life anyway so its kinda like a 2 for 1 for me. Hope u find relief soon my friend keep us posted!!!
My wife tried all of the medications generally prescribed for TN/ATN, including many used to treat migraine. She also had a tour with botox injections--all to no avail. During one of our visits to her neurologist, I stuck Dr. Casey's book, "Striking Back" in his face and said, "how about giving this a try." I was referring to nortryptiline. She started on a small dose and has gradually reached 100 mg/day. She takes 25 mg in the morning and 75 mg right before bed. She has since been diagnosed by Dr. Casey as having TN2. Thus far the nortryptiline has been so effective that we have stopped thinking about a MVD (for now anyway). I am amazed that none of the tricyclics were ever considered by her internist and two neurologists. It took this website, Dr. Casey's book, and a pissed-off husband to find something so simple that has brought about so much relief.
Has anyone used Ketmine?? I had never heard of this and am thinking of asking our doctor? Thanks..
During our visit with Dr. Casey, he wrote my wife a prescription for 10% ketamine cream. We had to have it compounded at a local pharmacy according to his instructions. I just checked with that pharmacy and this is what they told me told me. Your doctor must specify on the Rx that it is for ketamine 10% cream and it must be compounded. The dosage on my wife's container says, "Apply pea sized amount every morning and pea sized amount as needed." She used this frequently while waiting on the nortryptiyline to get up to speed. She now uses it on occasion for flair ups and gets moderate relief. I think it is definitely worth a try based on what I've observed. As far as internal ingestion of ketamine goes, I don't have any experience with that.
Grecio said:
Has anyone used Ketmine?? I had never heard of this and am thinking of asking our doctor? Thanks..
UKfan, did you apply the ketamine cream to your face, and did it relieve the pain some? thanks.
I used a compounded facial cream for a while from Dr Joseph (Jody) Vaughn in Dallas. It had ketamine, gabapentin, nifedipine, and several other drugs I can't recall. It helped, but was hard on my skin.
Ketamine is a dissociative agent, often used in healthcare for short-term anesthesia for brief procedures. I have had no personal experience with IV use (infusions) for pain, but I know others on the site who have. Do a search for "ketamine." It seems that IV ketamine infusion is reserved primarily as one of last resort for pain, after most other things have failed. that's the extent of my knowledge.
My wife, who suffers from TN2, applies this compounded cream to the area of her right temple where most of her pain is located. She doesn't rub it on her entire face. This medicine was prescribed by her neurosurgeon, Dr. Kenneth Casey, who co-authored the book Striking Back which I highly recommend. On pages 162-163 of his book, Dr. Casey discusses compounding in some detail. Topical application of medicine offers a useful supplement to those who are already taking multiple medications by mouth. In my wife's case, she receives noticeable but moderate relief from the topical application of 10% ketamine. She also takes 100 mg/day of nortriptyline, and ibuprofen as needed. This medicine (10% ketamine cream) is not available any other way except from a compounding pharmacy. You shouldn't have any trouble finding one of these in your area. When you approach your doctor with this idea, I suggest you arm yourself with Dr. Casey's book. I carry my copy around like a bible when I'm dealing with my wife's largely uninformed physicians. Good luck.
Grecio said:
UKfan, did you apply the ketamine cream to your face, and did it relieve the pain some? thanks.
How did your visit go?
Well lets just say I will not be going back to that neurologist. I visited her for the pain that I was in and it quickly turned into a meeting to talk about "my feelings". The only thing she gave me for the pain was some lidocaine cream to rub on the spot when it hurts, however its hard to rub that on the top of my head with my hair. She also prescribed me Citalopram, which I am not familiar with. She made it very clear that this is just a pain I will have to live with for the rest of my life and pretty much said I needed to toughen up, I don't think she understands how much pain I am in and have been in. She even said she's not sure this is trigeminal neuralgia, she just said that it was definitely some type of "neuralgia". I fear that I have been going to the wrong neurologist all along, as I went to her because I was familiar with her from where I had a concussion when I was a student-athlete in college. She has really disappointed me.
I'm afraid that your story is the norm more so than the exception, and that you may have to look regionally or nationwide to find a neurologist who has any experience or interest in TN. I recommend that you start by selecting a neurologist listed on this website from the listing of those who have been endorsed by other members. You may have already seen this list (I'm not sure how to link it). I have actually had to educate our internist and two different neurologists who my wife has seen. Only when we came back to them with an actual diagnosis of TN2 from a very experienced TN neurosurgeon (Dr. Kenneth Casey) did any of these physicians begin to pay attention. By that time we were asking ourselves, "why in the hell didn't we start with Casey in the first place?" The answer is that we didn't think a neurosurgeon would do anything but operate and only after first receiving a diagnosis by a neurologist. Where Dr. Casey is concerned, he would rather examine you, provide a diagnosis, and try various treatments before considering surgery. I wish someone had explained this to me 4 years ago. If your insurance will allow you to go to an "in network" out-of-state provider, then I highly recommend that you schedule a visit with Dr. Casey. You will totally forget about the cost of your plane ticket once he examines you.
hillsdale15 said:
Well lets just say I will not be going back to that neurologist. I visited her for the pain that I was in and it quickly turned into a meeting to talk about "my feelings". The only thing she gave me for the pain was some lidocaine cream to rub on the spot when it hurts, however its hard to rub that on the top of my head with my hair. She also prescribed me Citalopram, which I am not familiar with. She made it very clear that this is just a pain I will have to live with for the rest of my life and pretty much said I needed to toughen up, I don't think she understands how much pain I am in and have been in. She even said she's not sure this is trigeminal neuralgia, she just said that it was definitely some type of "neuralgia". I fear that I have been going to the wrong neurologist all along, as I went to her because I was familiar with her from where I had a concussion when I was a student-athlete in college. She has really disappointed me.
Thank you for this Ukfan. I have actually contacted Peter Konrad at Vanderbuilt University. He is listed on this list and is a neurosurgeon. However I do know someone who has been to him and he treats each visit more like an evaluation than a consultation for surgery. So it’s good that he doesn’t force a surgical operation on you before exhausting other options I am very interested in a supraorbital nerve block or possible trying botox injections since my pain is only in the top of my head.
ukfan said:
I’m afraid that your story is the norm more so than the exception, and that you may have to look regionally or nationwide to find a neurologist who has any experience or interest in TN. I recommend that you start by selecting a neurologist listed on this website from the listing of those who have been endorsed by other members. You may have already seen this list (I’m not sure how to link it). I have actually had to educate our internist and two different neurologists who my wife has seen. Only when we came back to them with an actual diagnosis of TN2 from a very experienced TN neurosurgeon (Dr. Kenneth Casey) did any of these physicians begin to pay attention. By that time we were asking ourselves, “why in the hell didn’t we start with Casey in the first place?” The answer is that we didn’t think a neurosurgeon would do anything but operate and only after first receiving a diagnosis by a neurologist. Where Dr. Casey is concerned, he would rather examine you, provide a diagnosis, and try various treatments before considering surgery. I wish someone had explained this to me 4 years ago. If your insurance will allow you to go to an “in network” out-of-state provider, then I highly recommend that you schedule a visit with Dr. Casey. You will totally forget about the cost of your plane ticket once he examines you.
hillsdale15 said:Well lets just say I will not be going back to that neurologist. I visited her for the pain that I was in and it quickly turned into a meeting to talk about “my feelings”. The only thing she gave me for the pain was some lidocaine cream to rub on the spot when it hurts, however its hard to rub that on the top of my head with my hair. She also prescribed me Citalopram, which I am not familiar with. She made it very clear that this is just a pain I will have to live with for the rest of my life and pretty much said I needed to toughen up, I don’t think she understands how much pain I am in and have been in. She even said she’s not sure this is trigeminal neuralgia, she just said that it was definitely some type of “neuralgia”. I fear that I have been going to the wrong neurologist all along, as I went to her because I was familiar with her from where I had a concussion when I was a student-athlete in college. She has really disappointed me.
I am sorry to hear that your visit was useless. I can't say I know the right answer because I am searching as. I personally searched the internet for atypical trigemenial Neuraglia neurosurgeons in Texas and looked at reviews to find one. I like him fine and he was pretty frank with me that the surgery did not work well on type two. But they have so helpful with my medications. I hope you find a balance soon.