Neuralgia

Question: Where can i get brochures or pamphlets on trigeminal neuralgia? at school we're going a health fair, and i choose to do my project on trigeminal neuralgia. One of the requirments that we need it some visualls and i think having a munch of pamphlets or brochures would be the best way for me to get that requirment filled. The only problem is, isi that i have no idea where request that sort of thing. is there a web site maybe?

Answer: A great deal of information can be found on www.fpa-support.org I suffer from atypical TN - glad to see someone bringing the information to the public. Have found very few people really understand - including doctors. Good Luck with the Health Fair.

Question: Trigeminal neuralgia: can it involve a constant pain instead of a fleeting pain? Classic trigeminal neuralgia involves a fleeting pain that is often triggered by an external stimulus. The cause is often found to be a blood vessel pressing on a nerve. Can that same situation (a blood vessel pressing on a nerve) cause a constant pain that is not triggered by an external stimulus? If so, is the blood vessel always apparent on an MRI? Or might an MRI miss it? Thanks for all replies.

Answer: Yes, TN can cause constant pain. When it does, it's usually classified as "atypical trigeminal neuralgia." If a blood vessel is pressing on the nerve, an MRI ordered to focus in tightly on the trigeminal nerve ought to catch it, but sometimes the cause of trigeminal neuralgia isn't as readily apparent as a blood vessel pressing on a nerve. Sometimes (as in my case) there's no visible cause at all to explain why the nerve keeps firing. There's a useful breakdown of the various types of TN and related facial pain problems here: http://www.umanitoba.ca/cranial_nerves/trigeminal_neuralgia/manuscript/types.html (Although bear in mind while reading it that this website is focused on MVD, so it tends to overstate both the probability of a blood vessel pushing on a nerve as the evident cause *and* the efficacy of the MVD operation as a cure for TN. Nonetheless, if you can overlook that, it's still a pretty decent breakdown.)

Question: Benefits available after losing my job due to neuralgia? I have been offered the option to be dismissed from work due to ill health,I am a community enabler and my job involves getting out and about supporting adults with learning disabilities.I cannot predict my attacks of neuralgia.

Answer: Before you take up this offer you need to check out the benefits available either via the Citizens Advice Bureau or the Job Centre which now covers Works and Pensions and Benefit etc. They no longer offer much without a medical assessment and they assess what you can do rather than what you cannot do and although you cannot predict the attacks they will assess you on the in between times. Many of the benefits do not apply with this sort of condition as in between times you are able to manage fairly normally. I suffer from neuropathic pain which despite 'waving' in (a term you will understand) and causing major issues I can when it is just there walk and function normally. I seem to fall between all the benefit categories and just cannot understand how other people manage to get them all. Just be very careful before you jump ship that you have all the facts and figures in hand and know where you stand and what you may be entitled to in the long term. Also some are affected by existing household income and savings. Also check with the CAB as what might sound like a good offer may be them side stepping some employment issues with regard to employing people with disabilities. If they are a large enough employer they have an obligation to employ x amount of people and to consider and help people with sickness issue. Spend a couple of weeks really checking your facts for your and your families sake as the benefit band wagon just seems to be so very hard to get on if you have genuine odd needs.

Question: Can neuralgia be flared up by the changing of the seasons? My neighbor suffers from neuralgia and it seems that she is often hit with it in the spring, all winter she has no problem all winter

Answer: I don't know what kind she has but I suppose it could. Some types, such as trigeminal neuralgia ,can flare up from almost anything. A change in pressure, temperature, a light touch...

Question: Can a toothache cause Trigeminal Neuralgia? I know Trigeminal Neuralgia can cause a "toothache", but can a toothache cause a trigeminal neuralgia flare up in someone predisposed to them? Please cite sources.

Answer: Yes it is possible especially those teeth supplied by the trigeminal nerve

Question: Can Post-Herpetic Neuralgia be connected to a badly broken wisdom tooth? I have a very badly broken wisdom tooth. The last week it has been excruiatingly painful, and now think me taking too many painkillers to numb pain. (Am going to dentist on monday so hopefully sorted out) Is this just the tooth giving me hell or could it be Post-herpetic Neuralgia? Wow sa_2006 great answer.

Answer: Pain is an unpleasant sensation that occurs as a result of injury to the body or as a manifestation of a diseased state. Pain can be classified in many ways. For example, pain can be classified based on its duration (acute or chronic pain) and by the underlying cause (nociceptive or neuropathic). [0004] Nociceptive pain results directly from local tissue injury whereas neuropathic pain follows nerve injury. Key features of nociceptive pain are that it can be experienced as sharp, dull, or aching, and that there may be radiation of the pain, or the perception of pain in a different area than where the nerves are being stimulated. For example, when a person experiences a heart attack, pain may radiate from the chest down the arms or up the neck, even though there is no tissue damage in these areas. Examples of nociceptive pain include pain from surgical incisions, bone pain from fractures or metastatic cancer, and pain from joint diseases such as osteoarthritis and rheumatoid arthritis. [0005] Neuropathic pain occurs as a result of damage to, or dysfunction, of the nervous system. Neuropathic pain is frequently described as burning, tingling or having an electrical shock-like feeling. Another key feature of this type of pain is its paradoxical occurrence upon stimulation that otherwise would not be expected to cause pain. For example, a condition called trigeminal neuralgia may cause patients to feel extreme pain upon a light touch on the cheek. Examples of neuropathic pain include the pain resulting from diabetes and HIV infection, and postherpetic neuralgia, commonly called zoster, which is a painful condition caused by the chicken pox virus long after the initial infection has healed, in many cases years later. Neuropathic pain frequently coexists or follows nociceptive pain, as for example when a patient that has had a surgical procedure continues to experience pain long after the wound has healed. [0006] Pain is a worldwide problem with serious health and economic consequences. The medical effort to treat pain, known as pain management, addresses a large and under-served market. According to IMS Health, the worldwide prescription market for pain drugs totaled over $23 billion in 2003, of which nearly $18 billion was spent in the United States. For example, in the United States medical economists estimate that pain results in approximately $100 billion of costs annually, as reported by the National Institutes of Health (NIH). Pain in the hospital is associated with increased length of stay, longer recovery times and poorer patient outcomes, all of which have health care quality and cost implications. Approximately 40 million Americans are unable to find relief from their pain, according to the NIH and more than 30 million Americans suffer chronic pain for which they visit a doctor. [0007] Drugs are the principal means of treating pain. The pain management market is anticipated to grow at a compounded annual growth rate of 10% through 2010 due to a number of factors, including a rapidly aging population with an increasing need and desire to address pain-related ailments; longer survival times for patients with painful chronic conditions, such as cancer and AIDS; patients' increased demand for effective pain relief; and increasing recognition of the therapeutic and economic benefits of effective pain management by physicians, health care providers and payers. [0008] Drugs that treat pain are referred to as analgesics. The type of analgesic selected for treatment depends upon the severity of the pain. For mild pain, the type of pain associated with many headaches or joint pain, weak analgesics such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and Celebrex.RTM. (Pfizer) are used. For moderate pain, the type of pain associated with wisdom tooth extraction, other minor surgery and some arthritis pain, NSAIDs, weak opioids such as codeine or short-acting formulations of strong opioids such as Percocet.RTM. (Endo) may be used. Severe pain, which may occur following major surgery, advanced arthritis or cancer, requires strong opioids such as morphine, oxycodone, hydrocodone or fentanyl. [0009] Despite widespread clinical use of drugs for pain, pain management remains less than optimal due to a variety of factors including: i) insufficient efficacy (NSAIDs are effective in treating only minor pain. Narcotics, the current standard of care for severe nociceptive pain, reduce pain less than 50% in most situations. Neuropathic pain is poorly treated by all existing analgesics); ii) side effects (NSAIDs often cause gastrointestinal ulcers, and more than 20,000 patients die each year from gastrointestinal bleeding induced by NSAIDs. One of the COX 2-selective NSAIDs, Vioxx.RTM. (Merck), has been shown to cause increased risk of heart attacks and possibly stroke. Use of narcotics is associated with nausea and vomiting in most patients. High-dose narcotics cause sedation and may also cause respiratory depression, or a decreased ability to breathe spontaneously. Narcotics used chronically can cause severe constipation that leads many patients to stop using them, and narcotics may sometimes cause severe itching. All of the drugs used to treat neuropathic pain frequently cause problems with coordination and sedation); iii) frequent dosing (Drugs used to treat neuropathic pain require frequent dosing that makes their use inconvenient, often leading to reduced patient compliance); iv) physical dependence (Narcotics, when used chronically, can cause physical dependence. Fear of physical dependence often influences clinicians to prescribe less than adequate doses of narcotic analgesics. Similar fears lead many patients to refuse narcotic analgesics); and v) diversion potential (Narcotics are often used by drug abusers, leading to considerable potential for diversion of legitimate narcotic analgesics for illicit uses. In fact, many pharmacies have removed high-dose narcotic analgesics from their inventories because of the risk of theft). [0010] Pain management is of particular importance for treating severe post-surgical pain. There are over three million surgeries performed in the United States each year that result in severe post-surgical pain. Morphine and related narcotics, which are presently the standard of care for acute post-surgical pain, have serious side effects including respiratory depression, nausea, itching and sedation. In addition, many currently marketed drugs that treat pain require frequent dosing, which makes usage less convenient for patients. [0011] As a result of the shortcomings of existing drugs that treat pain, capsaicin has become a front-runner of research and development for it use in treating pain. [0012] Capsaicin, a pungent substance derived from the plants of the solanaceae family (hot chili peppers) has long been used as an experimental tool because of its selective action on the small diameter afferent nerve fibers C-fibers and A-delta fibers that are believed to signal pain. From studies in animals, capsaicin appears to trigger C-fiber membrane depolarization by opening cation channels permeable to calcium and sodium. Recently one of the receptors for capsaicin effects has been cloned. Capsaicin can be readily obtained by ethanol extraction of the fruit of capsicum frutescens or capsicum annum. Capsaicin is known by the chemical name N-(4-hydroxy-3-methoxybenzyl)-8-methylnon-trans-6-enamide. Capsaicin is practically insoluble in water, but freely soluble in alcohol, ether, benzene and chloroform. Therapeutically capsaicin has been used as a topical analgesic. Capsaicin is available commercially as Capsaicin USP from Steve Weiss & Co., 315 East 68.sup.th Street, New York, N.Y. 10021 and can also be prepared synthetically by published methods. See Michalska et al., "Synthesis and Local Anesthetic Properties of N-substituted 3,4-Dimethoxyphenethylamine Derivatives", Diss Pharm. Pharmacol., Vol. 24, (1972), pp. 17-25, (Chem. Abs. 77: 19271a), discloses N-pentyl and N-hexyl 3,4-dimethoxyphenylacetamides which are reduced to the respective secondary amines. [0013] Capsaicin is listed in the pharmacopoeias of the United Kingdom, Australia, Belgium, Egypt, Germany, Hungary, Italy, Japan, Poland, Portugal, Spain, and Switzerland and has previously been listed in the United States Pharmacopoeia and the National Formulary. The FDA proposed monographs on analgesic drug products for over-the-counter (OTC) human use. These include capsaicin and capsicum preparations that are regarded as safe and effective for use as OTC external analgesics. Capsaicin is the only chemical entity of Capsicum recognized by the FDA. Capsaicin (USP) contains not less than 110% total capsaicinoids which typically corresponds to 63% pure capsaicin. USP capsaicin is trans-capsaicin (55-60%) and also contains the precursors dihydrocapsaicin and nordihydrocapsaicin. [0014] Capsaicin mediated effects include: (i) activation of nociceptors in peripheral tissues; (ii) eventual desensitization of peripheral nociceptors to one or more stimulus modalities; (iii) cellular degeneration of sensitive A-delta and C-fiber afferents; (iv) activation of neuronal proteases; (v) blockage of axonal transport; and (vi) the decrease of the absolute number of nociceptive fibers without affecting the number of non-nociceptive fibers. [0015] Capsaicin works to relieve pain by causing a localized degradation of the C neuron endings, and it is the only analgesic known to relieve pain by this mechanism. The activity of capsaicin results from its binding to, and activating, an ion channel called vanilloid receptor 1, or VR1. Under normal circumstances, when the VR1 ion channel is activated it opens for a short time, causing the C neurons to transmit a pain signal toward the brain. When capsaicin binds to, and activates VR1, it causes a series of events within the cell that degrade the pain-sensing endings, or terminals of the C neuron, thereby preventing the neuron from transmitting pain signals. [0016] The effects of capsaicin are confined exclusively to the region of application because of low distribution to other areas of the body after capsaicin is administered. For example, after injection into a joint space or after application in a surgical procedure to the cut surfaces of skin, muscle and bone, capsaicin enters the blood slowly by diffusion from its site of initial application. Thereafter, capsaicin is highly metabolized, or broken down, by the liver into various inactive compounds, none of which retain any of the analgesic properties of capsaicin. As a consequence, capsaicin does not usually act at sites in the body distant from its initial application, nor is the body exposed to any derivatives of capsaicin that could act in a similar manner. By contrast, opioids and many other analgesics must be given by mouth or by intravenous injection, thereby subjecting the patient to circulation of high concentrations of drug. These high circulating concentrations may exert undesirable side effects by acting on parts of the body unrelated to pain perception. For example, opioids may cause constipation when used chronically. Opioids also may cause alteration of mood, and alertness, and can cause patients to feel drowsy, euphoric, or sleepy. These effects, when experienced by patients in the hospital, tend to increase rehabilitation time because patients are often sedated and therefore unable to begin the recovery process. [0017] Humans have long been exposed to dietary sources of capsaicin-containing spices and to topical preparations used for a variety of medical indications. This vast experience has not revealed significant or lasting adverse effects of capsaicin exposure. The recent determination of potential therapeutic effects of capsaicin on unmyelinated sensory afferent nerve fibers require diligent consideration of this compound for further pharmaceutical development. [0018] Because of the ability of capsaicin to desensitize nociceptors in peripheral tissues, its potential analgesic effects have also been assessed in various clinical trials. However, since the application of capsaicin itself frequently causes burning pain and hyperalgesia apart from the neuropathic pain being treated, patient compliance has been poor and the drop out rates during clinical trials have exceeded fifty percent. The spontaneous burning pain and hyperalgesia are believed to be due to intense activation and temporary sensitization of the peripheral nociceptors at the site of capsaicin application. This activation and sensitization occur prior to the desensitization phase. The activation phase could be a barrier to use of capsaicin because of the pain produced. [0019] Prior publications describe topical administration of capsaicin for the treatment of various conditions. For example, U.S. Pat. No. 4,997,853 (Bernstein) describes methods and compositions utilizing capsaicin as an external analgesic. U.S. Pat. No. 5,063,060 (Bernstein) describes compositions and methods for treating painful, inflammatory or allergic disorders. U.S. Pat. No. 5,178,879 (Adekunle, et al.) describes methods for preparing a non-greasy capsaicin gel for topical administration for the treatment of pain. U.S. Pat. No. 5,296,225 (Adekunle, et al.) describes indirect methods of treating orofacial pain with topical capsaicin. U.S. Pat. No. 5,665,378 (Davis, et al.) describes transdermal therapeutic formulations comprising capsaicin, a nonsteroidal anti-inflammatory agent and pamabrom for the treatment of pain. U.S. Pat. No. 6,248,788 (Robbins, et al.) describes administration of 7.5% capsaicin cream in combination with marcaine epidural injections in patients suffering from long-term persistent foot pain. U.S. Pat. No. 6,239,180 (Robbins) describes combining capsaicin loaded patches with local anesthesia to treat peripheral neuropathy. The use of topical capsaicin has also been described in the art to treat conditions as diverse as post mastectomy pain syndrome (Watson and Evans, Pain 51: 375-79 (1992)); painful diabetic neuropathy (Tandan et al., Diabetes Care 15: 8-13 (1992)); The Capsaicin Study Group, Arch Intern Med 151: 2225-9 (1991); post-herpetic neuralgia (Watson et al., Pain 33: 333-40 (1988)), Watson et al., Clin. Ther. 15: 510-26 (1993); Bernstein et al., J. Am Acad Dermatol 21: 265-70 (1989) and pain in Guillian-Barre syndrome (Morganlander et al., Annals of Neurology 29:199 (1990)). Capsaicin has also been used in the treatment of osteoarthritis (Deal et al., Clin Ther 13: 383-95 (1991); McCarthy and McCarthy, J. Rheumatol 19: 604-7 (1992); Altman et al., Seminars in Arthritis and Rheumatism 23: 25-33 (1994). [0020] Capsaicin is currently marketed for topical administration in the form of over-the-counter, low dose, non-sterile creams and patches, which tend to be poorly absorbed. There are more than thirty brands of creams and patches, including Capzasin-P.RTM. (Chattem) and Zostrix.RTM. (Rodlen Laboratories). These formulations are generally crude preparations of capsaicin that may contain other chemical entities. These over-the-counter preparations can be purchased widely without a prescription and are used topically by consumers to relieve pain in conditions such as osteoarthritis, shingles (herpes zoster), psoriasis and diabetic neuropathy. [0021] It would therefore be advantageous to provide a topical capsaicinoid gel formulation and methods of use thereof that would be useful in different clinical settings as compared with current over-the-counter and prescription products. Specifically, it would be advantageous to provide a topical capsaicinoid gel formulation for use by physicians in the surgical setting prior to wound closure, e.g., in bunion removal surgery, hernia repair and other surgeries, by orthopedic surgeons and other physicians for the treatment of osteoarthritic knee joint disease and tendonitis, and for certain forms of localized neuropathic pain that are not amenable to treatment with currently marketed topical preparations.

Question: Does anyone have Neuralgia or Trigeminal Neuralgia and what pain relief and medication are you taking? Hi, I have Trigeminal Neuralgia and am not fining my pain relief effective or my medication but particularly pain relief i am taking up to 450mg of Codeine a day and Tramadol (not at the same time). It is not even touching the pain! Any advise from others who have this or from professionals who have come across this sort of problem? Any advise at all would be welcome even if it seems really obvious! Thanks, C x

Answer: Hi. I'm on Tegretol right now for my TN, and I also have oxycodone for breakthrough pain. The Tegretol isn't working for me at the moment, so I find I'm taking far more oxycodone that I'd like. I'm not in a very good place right now, pain-wise. I have an appointment with my neurologist coming up, but I'm sort of dreading it. I suspect he's going to want to titrate my dosage of Tegretol upwards, and I'm already having a really hard time with the side-effects. I think that it may be time for us to try a different anti-convulsant, but if we do that, then I'm going to need a lot more pain-killers to help me through the transition period, and even with that help, it's still going to be pretty awful. Are you on an anti-convulsant, like Tegretol, neurontin, or Lyrica? They've only been partially successful for me, but I know they've helped a lot of TN sufferers to live very nearly pain-free. If the one you're on isn't working for you, it may be time to try another and see if it does a better job. There are quite a few of them to choose from, and everybody seems to react differently to them, so it's definitely worth checking to see if another drug might be more effective for you. Pain-killers usually don't work on neuralgia nearly as well as they do on, for example, post-operative pain or muscle pain. For me, they don't stop the pain altogether; they just knock it down a few notches on the pain chart. But those few notches can make such a huge difference! I'm sorry that they're not even doing that much for you. Have you been to see a pain management specialist, or gone to a pain management clinic? If not, I very much recommend it. They're experienced in dealing with these problems, and might be able to find a pain management regime that works better for you. ETA: A good place to talk to lots of other people who suffer from this monstrous problem are the TNA Forums here: http://www.fpa-support.org/forumlanding2.html You have to sign up first, but it doesn't cost anything and they won't spam you. The people there are friendly, and even just lurking there can make you feel a lot less alone. It did for me, anyway.

Question: What caused my trigeminal neuralgia? I have trigeminal neuralgia, an agonising condition involving pressure on a nerve in my face. I am on epilepsy drugs but am tired and forgetful and still in pain. I really feel my life, which until last year was perfectly happy, isn't worth living. I have no idea why I suddenly got this. I am only 25. It first occured at quite a stressful time. I have also had root canal treatment on the same side of my face. Of course the dentist denies all involvement, but I can't help thinking this could have triggered it. Any ideas? Or remedies?

Answer: My mother has suffered from this on and off over the past few years, and I wouldn't wish it on my worst enemy. So I feel really sorry for you. She has had some really effective tablets. I'll find out what they are, but when she was referred to see a consultant, he gave her an injection which gave immediate relief and seemed to have quite a lasting effect. She was also told that if the pain got unbearable again, she could phone up and have another injection. It's worth asking about this, and seeing if you could have the same back up for any future attacks. Good luck.

Question: What is the success rate of motor cortex stimulation when a person has trigeminal neuralgia? I'm just wondering the success rate of it, and any other information about it.

Answer: It would be very difficult to determine a success rate for an individual person. I have included several sites that might be some help to you. http://facial-neuralgia.org/treatments/surgical/neurostimulation.html http://www.aetna.com/cpb/medical/data/300_399/0374.html http://brain.hastypastry.net/forums/showthread.php?t=3162 http://www.umanitoba.ca/cranial_nerves/trigeminal_neuralgia/manuscript/types.html Good luck with everything.pp

Question: What causes trigeminal neuralgia? What are the things that triggers the pain? Any suggestion on what to avoid? My mom suffers from trigeminal neuralgia I just want to know things on how to help her to ease the pain.. Thank You so much..Your info will be much appreciated..

Answer: I have suffered this awful condition, i was put on Tegretol (an epilepsy drug) and it went away. Im not sure what triggers it but....its tgh compression of the root of the trigeminal nerve by an abnormally positioned blood vessel is the most common cause of trigeminal neuralgia. The pressure on the nerve causes it to misfire, resulting in pain. Occasionally, the compression is caused by a tumour, and sometimes there is no obvious cause found. Other, rarer causes of trigeminal neuralgia include multiple sclerosis and strokes affecting the lower part of the brain.

Question: For those with trigeminal neuralgia or who know a lot about it? My mother experiences a lot of pain in both sides of her face. While most times you can't see any facial redness sometimes her face gets very red and almost looks burnt. She hads the pain all the time, don't in shocks...such as those described in trigeminal neuralgia. She is currently going to the neurologist and has tons of test run. The doctor is pretty much doing a trial and error as far as meds go. They are treating her fortrigeminal nueralgia, but from what I read it doesn't seem quite the same as what she is experiencing. Do people with TN every have constant pain on both sides? I can not find any other conditions that even come close to describing what she has besides TN. Thanks to anyone with advice.

Answer: i think it is normal to have pain on both sides but if she is being treated and it is not working maybe she could try other doctor

Question: Do you need surgery to remove Trigeminal Neuralgia? What can Trigeminal Neuralgia do to you? I have recently found out a family member has Trigeminal Neuralgia. I do not know much about this, or what could happed to her. If anyone could explain, I would be very happy. Thank you very much. :)

Answer: The trigeminal nerve carries sensation from your face to your brain. In trigeminal neuralgia the nerve's function is disrupted. Usually, the problem is contact between a normal artery or vein and the trigeminal nerve, at the base of your brain. This contact puts pressure on the nerve and causes it to malfunction. Trigeminal neuralgia can occur as a result of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Less commonly, trigeminal neuralgia can be caused by a tumor compressing the trigeminal nerve. In other cases, a cause cannot be found. A variety of triggers may set off the pain of trigeminal neuralgia, including: Shaving, Stroking your face, Eating , Drinking, Brushing your teeth, Talking, Putting on makeup, Encountering a breeze, or Smiling. It is treated with medications first, anticonvulsant agents, then antispasticity agents. If that doesn't work then it is treated with alcohol injection. Finally, if the previous therapies fail, they might try glycerol injections. If all fails then one of 4 surgical techniques, or radiation or a combination of therapies might be tried. Some other methods for controlling the symptoms are: Acupuncture, Biofeedback, Vitamin therapy, Nutritional therapy, and Electrical stimulation of nerves. For additional infor mation and support try this site: http://www.fpa-support.org/

Question: Can trigeminal neuralgia affect decision making? My wife( very smart by the way) was diagnosed 6 years ago. Her decision making is not good concerning daily, weekly, monthly tasks. In other words she forgets alot.

Answer: Is she on Tegretol, Neurontin, or another anti-convulsant for the TN? If so, then that's probably what's doing it to her, more than the TN itself. Those drugs are *notorious* for wreaking holy havoc with ones memory. Check out any trigeminal neuralgia support group online, and you'll see lots of people complaining and commiserating with each other about the memory loss and "brain fog" caused by these drugs. I also have TN, and I've been having terrible memory problems as well, especially now that I've had to go to a higher dose to control the pain. I also feel "dumbed down" a lot of the time, which is scary and frustrating, like I've suddenly stumbled into the lead role of "Flowers For Algernon." Brrrrr. What's helped me a lot is to start keeping one of those Day Runner type notebooks (the kind with not only weekly and monthly calendar sheets, but also phone/address and "note" sheets in it) on me at all times, and to write *everything* down in it promptly -- even things I think I'll be able to remember. It makes me feel a little silly sometimes, since I've been out of work and so don't really feel like I should need one of these big old yuppified corporate day planners, but it's really been a lifesaver for me. Your wife could probably also use a lot of emotional support. The 'dumbing down' effect can be really morale-destroying, even worse in some ways than the pain. But I'm sure you know that. :)

Question: Who is the best Doctor for trigeminal neuralgia, can you provide a list of 5 -10 doctors? My wife is suffering from TNA since past 4 Years, with regular medication she had relief from this pain for two years, but now it has again started and its intensity is growing inspite of regular medication. Kindly suggest the best doctors in india for this disease.

Answer: a neurologist would be able to help her

Question: Do you know of any effective treatments for trigeminal neuralgia? My mom is taking Lyrica and it doesn't work. She is in a lot of pain, so I was wondering if anyone has any ideas.

Answer: Care in the ED is generally limited to correct identification of trigeminal neuralgia (TN),consideration of alternative diagnosis, pain relief, and coordination of follow-up care. Because of the time-limited character of pain with typical trigeminal neuralgia, patients often do not present to the ED for pain medication. In some patients, the typically episodic pain becomes constant or so frequent as to be debilitating. Infusion of phenytoin is reportedly successful in interrupting such episodes, but the value of this therapy is anecdotal. Coordinate therapy for refractory pain of trigeminal neuralgia with the primary care physician or consultants. Patients with a typical history and normal physical examination may be referred to their primary care physician for further care. Neurologic or neurosurgical consultations may be helpful, particularly if atypical features are present. Referral to a neurologist may be helpful if the diagnosis is in doubt. Referral to a neurosurgeon may be indicated for patients whose conditions prove refractory to medical treatment. Percutaneous radiofrequency ablation of a portion of the trigeminal ganglion is commonly performed, as are anesthetic blocks of the trigeminal ganglion. Less commonly performed is decompression of the region of trigeminal root entry of impinging vascular structures. Comprehensive pain center follow-up care may be helpful. Medication The goal of pharmacologic therapy is to reduce pain. Carbamazepine is regarded by most as the medical treatment of choice. Some advocate a trial of baclofen since it has fewer adverse effects. The synergistic combination of carbamazepine and baclofen may provide relief from episodic pain though convincing clinical evidence is weak at best. Other anticonvulsants including phenytoin, oxcarbazepine, clonazepam, lamotrigine, valproic acid, and gabapentin are reportedly beneficial in some patients; however, controlled trials have not been performed. The American Academy of Neurology published a practice parameter that concluded that carbamazepine is effective in controlling pain of patients with classic trigeminal neuralgia, and that oxcarbazepine is probably effective. Baclofen, lamotrigine, and pimozide were rated as possibly effective. The practice parameter stated that there was insufficient evidence to support or refute efficacy of clonazepam, gabapentin, phenytoin, tizanidine, topical capsaicin, or valproate for pain control in patients with classic trigeminal neuralgia.1 The writing group was unable to find sufficient evidence to support or refute the use of intravenous medications in acute exacerbations of trigeminal neuralgia. Anticonvulsants These agents may help control paroxysmal pain by limiting the aberrant transmission of nerve impulses. Carbamazepine (Tegretol) Anticonvulsant effective in the treatment of psychomotor and grand mal seizure. DOC for TN. May reduce polysynaptic responses and block post-tetanic potentiation. Once patient responds to therapy, attempt to reduce dose to minimum effective level, or attempt to discontinue at 3-mo intervals. Dosing Interactions Contraindications Precautions Adult 100 mg PO bid on day 1; increase by up to 200 mg/d using 100-mg increments q12h prn; not to exceed 1200 mg/d Pediatric <12 years: Not established >12 years: Administer as in adults Skeletal muscle relaxants These agents are useful in the treatment of TN, although not FDA-approved for this indication. They have CNS depressant properties as indicated by the production of sedation with somnolence, ataxia, and respiratory and cardiovascular depression. most often used after therapy with carbamazepine has been initiated. Effects may be synergistic with those of carbamazepine. May induce hyperpolarization of afferent terminals and may inhibit both monosynaptic and polysynaptic reflexes at spinal level. As a structural analog of the inhibitory neurotransmitter GABA, may stimulate GABA-B receptor subtype. Dosing Interactions Contraindications Precautions Adult 5 mg/d PO tid on days 1-3; followed by 10 mg/d PO tid on days 4-6; followed by 15 mg/d PO tid on days 7-9; followed by 20 mg/d PO tid on days 10-12; additional increases may be necessary; not to exceed 80 mg/d divided qid

Question: Ways to relieve the pain of Trigeminal Neuralgia? I have a disorder known as trigeminal neuralgia... it is extremely painful! I was wondering if anyone knows of ways to relieve the pain? I currently use anti-convulsants and 'tons' of Tylenol (with doctor's OK, that is!)Any suggestions would be greatly appreciated, thanks!

Answer: DEAR Following is the inf I got for you if there is any other help I can get for I will keep intouch with you(MAMAKTSPRD@YAHOO.COM) MAMA IS MY NICK NAME Trignotab is a completely guaranteed and safe herbal treatment for Trigeminal Neuralgia. Trignotab works in two ways: firstly, it works to reduce pain in the trigeminal nerve and secondly it slowly helps the body repair damaged nerve cells. However, if the damage is due to an anatomical reason e.g. misplaced jaw etc, then it is not possible for Trignotab to repair it. However, Trignotab will still be helpful by significantly reducing pain. Trignotab consists of a formulation consisting of purely natural ingredients based on the Unani (Greek) system of herbal medicine blended together in a specific proportion to fight and treat Trigeminal Neuralgia. Thousands of patients have been successfully treated with Trignotab over the past few years. Trignotab is a completely outstanding product and there is absolutely no alternative to its unique formula. Had the effectiveness of Trignotab not been proven beyond any doubt, it would not be possible for us to make such a bold claim. The main ingredients of Trignotab tablets are: Strychnos Nux Vomica Piper Nigrum Salajeet Musaffa Iron Compund The exact proportion of each ingredient has been deliberately kept secret to avoid imitations of our confidential formula. Treatment with Trignotab is very rapid given the nature of the condition and obvious results can be noticed within one month (30 days) of use. A slightly longer period is required for serious cases and treatment can last up to two months (60 days). Trignotab is taken in an oral pill form and the normal dosage is two tablets twice a day, mornings and evenings. There are absolutely no side effects and the treatment is sold over the counter. Trignotab comes for a fixed price of $59 for a one month supply (120 Tablets) and can be ordered from our website by clicking here. We do not charge any shipping price. Treatment with Trignotab is fully guaranteed. We are so confidant about the effectiveness of Trignotab, that in the rare case you remain unsatisfied with the improvement in your condition, you may simply return the empty packaging and claim a refund of the amount you paid us. Since all payments are made via credit card directly to CCNOW (our credit card processing company), your money is completely safe. CCNOW will ensure that we honor all claims for refund. The only condition is that you have to be persistent in your treatment with Trignotab for one month (30 days). Skipping pills or being irregular will only delay the treatment. ..........................

Question: I am going about once a month for acupuncture treatments. Will this work for Trigiminal neuralgia? I'm worried that I'm not getting enough treatments because the acupuncturist is too busy. Will this even help me?

Answer: There is no evidence that acupuncture is effective for Trigeminal Neuralgia (or anything else for that matter) Increase frequency of useless treatments will not make a difference.

Question: Hi, anyone had any success getting rid of post herpes neuralgia pain by Homeopathy? I have tried all allopathic medicines but could not get relief from the pain that had started after Herpes Zoster.

Answer: new product on the market. look it up www.viralox.com here you can find reports. there are hundres of report on this. It is a virus killer . It is all natural !! There are all kinds of herpes, I had one of those very tender ones on in my nose, small red and very pain full I put some of the viralox on it, several hours the pain was gone in 2 days with only 2 application on it the dang thing was gone. this is a liquid you spray under your tongue or you can wipe on the infected arera. Taste good too!! Hope this helps God bless Jannette

Question: Is it possible to get prescribed a narcotic painkiller long-term for trigeminal neuralgia? They are the only thing that I have taken that really takes away the pain. I know doctor's are apprehensive about prescribing them at all. So is it even possible to get them long term?

Answer: You will probably have to go to a pain management clinic...the up and coming money grabbers these days. They monitor your pain, make you take urine tests at random, and call you in for pill counts. It's worth a try, life is to short for pain.

Question: Is trigeminal neuralgia curable or is it just something that has to be treated for the rest of a person life? Trigeinal Neuralgia is a disfunction in the brain nerve and causes ( to me) severe pain on my face that is unbearable for a limited amount of time. The pain comes and goes. Sometimes it is gone for several months then it will come back strong and last a short period or a long period of time. I am in the military but they won't relate this to being cause from banging my head on the trucks whenever I was driving or on the passenger side while I was in Iraq on those rough road conditions. I am currently taking a heavy dosage of Gabopentin to try to stop the pain from occuring often.

Answer: If you type in "trigeminal neuralgia surgery" in Yahoo! search, you will come up with some potentially useful information. Sometimes medications will help, but they may not be a cure-all. There is a procedure called microvascular decompression, where a tiny piece of felt is placed between the trigeminal nerve and underlying vascular structures, relieving the compression often responsible for the neuralgia. One website with information about this is: www.neurosurgery.pitt.edu/minc/cranialnerve/disorders/trigeminal_neuralgia.html.