Trigeminal neuralgia is a disorder of the fifth cranial nerve that causes
episodes of intense, stabbing, electric shock-like pain in the areas of the
face where the branches of the nerve are distributed - lips, eyes, nose,
scalp, forehead, upper jaw, and lower jaw. The electric shock-like pain
generally is on one side of the face and is spasmodic, coming in short bursts
lasting a few seconds. Several attacks can follow each other within minutes.
There are often trigger points, places on the face which, if touched, trigger
an attack.. Eating, shaving, applying makeup and talking can be triggers.
There can be periods of remission when pain is completely absent. These
periods of remission, which can last days, weeks, months, even years, are
unpredictable and without medical treatment, the pain usually returns.
Trigeminal Neuralgia is a very rare condition. Statistics vary, but TN occurs
in approximately 150 per million people per year. Medical literature notes
this condition is rare for anyone under age 50 but in reality, TN is known
to exist in many younger individuals including small children.
Trigeminal Neuralgia was described as early as the first century A.D. in the writings of
Aretaeus. Early treatments included bloodletting and bandages containing poisons such
as arsenic, mercury, hemlock, cobra and bee venom. An 18th century French surgeon,
Nicolaus Andre coined the condition "Tic Douloureux," which means "painful spasm."
Trigeminal neuralgia (TN) is not fatal, but it is universally considered
to be the most painful affliction known to medical practice.
Initial treatment of TN is usually by means of
anti-convulsant drugs, such as Tegretol or Neurontin.
I was first diagnosed with Trigeminal Neuralgia in 1998. I had started suffering
from intense pain in the face. At first my Doctor thought it was migraines, but
the normal migraine remedies had little or no effect. It was in the fall of that
year I suffered my first major attack. As a person that has always had a high
pain tolerance, I was totally unprepared to deal with that magnitude of pain.
I literally believed I was going to die, because I didn't think anyone could survive
that level of agony. My Doctor put me on Tegretol (carbamazepine) immediately,
as well as Tylenol 3 and Ativan. The Tegretol worked to a degree, however the
side effects were devasting to me. I could not drive, as my motor functions
were impaired. I also gained 35 lbs, which was totally unacceptable to me. After
a year, my attacks were increasing in severity, and my Doctor was suggesting
Morphine. I really didn't want to go that route. Fortunately, two years ago I was
switched to Neurontin (gabapentin). Since then my TN, for the most part is
controllable. I still suffer from extreme attacks periodically, however, with the
right combination of pain meds I am still able to function reasonably well.
Update
In July 2003 my trigeminal neuralgia flared up with a vengence that I was not
quite prepared for. My Doctor immediately increased my Neurontin and put me
on Amitriptyline in a low dosage. The ativan and Codeine were no longer
effective in treating my level of pain, so I bit the bullet and allowed my
Doctor to prescribe Morphine. Let me tell you its not all its cracked up to be.
I really expected that I would take the Morphine and my pain would magically
disappear. Unfortunately that was not to be the reality of my situation.
Instead I found the side effects of the higher dosage of Neurontin left me
basically feeling like a zombie, and the Morphine barely took the edge off. After
sharing my concerns with my Doctor we decided to slowly lower my Neurontin
until we found a dosage I could still function at without losing my identity.
We found that 600 mg a day was the magic number for me. Since I have been on the
lowered dose I have noticed that although I do suffer from pain more frequently,
when I do take Morphine I find the onset of relief is quicker and the
effects last much longer than when I was on the higher dosage of Neurontin.
