Help, Facial Pain

I was diagnosed with Trigeminal Neuralgia post trans labyrinth craniotomy for cerebopontine meningioma. Initially treated with tegretol and lyrica successfully. Now left with loss of sensation all over affected side of face,hypersensitivity in lips and continuous dull aching pain  over the regions of division 2 and 3 trigeminal nerve. Often there are periods of increased pain intensity, pain score 6-8. Taking Endep but not very effective.Is this trigeminal neuropathy, atypical facial pain? Any ideas anyone. Can anyone suggest something for pain relief?Does topical capsaicin work? Has anyone any experience with topical applications?

[BobbHilton]

Hi,
   from the description you have a trigeminal neuropathy (a much younger age of onset than the ideopathic TN, trigeminal neuralgia) where we find abnormalities on examing the face e.g the sensory loss,  but unfurtantly got complicated by atypical TN where the constant pain though somewhat controlled associated by peroidic intensification....enough of this yap yap..you are looking for a treatment.
   Actually you have a big room full of options, but first of all you have to give endep some time as it takes weeks to give you the best it can , and with a co ordination with your neurologist you could build up slowely (I never gone more than 75mg)
   Ask your doctor about Venlafaxin (some good news about it)
   You are on Tegretol, Lyrica...your doctor could try lamotrigine, or
   gabapentin, some report also of Baclofen usefulness.

About topical agents I never heard it usage on the face and have no idea about their side effects esp near the eyes?? ask your doctor first  
but they are
1-Lidocaine patch  5% benefits are moderate, and combination
therapy with other drugs is often necessary plus should be applied to intact
skin and to cover the most painful area...hard!.

2-Capsaicin, the active compound in hot chili pepper (will need at least 4 to
6 weeks to start the full desired effect). May cause coughing , Skin
stinging the first week of therapy

God Bless
Bob

[Pixiangelj]

Your situation sounds the exacy same as the one I'm in... I had a craniotomy for a brain tumor and when I woke from surgery the left side of my face was numb and now I have the facial pain, and increased hypersensivity at times, especially by my eyes. I have tried numerous things, I just wish there was something besides medication. What else have you tried, anything like accupuncture? or radiation different opinions... People have thrown these at me over the years... let me know

[Jolier]

Thank you both. I have tried a compound with endep, gabapentin and ketamine in an ointment applied to the face but it did not offer any relief. My pain management consultant advises that some people find good relief from this, applied 3/4 times a day.I am open to any suggestions as this dull pain has been present for 12 months now and is very distressing. I have tried acupunture with little effect. Thank you for your time. Good luck

[Bobbie33]

Hello Jolier,

I have since long time atypical Trigeminal Neuralgia. I had also Tegretol and Lyrica, but didn't help that much. Tegretol made me totally down, tired.
Then I went to Neurologist, paid extra, and he gave me new drug (now don't know origin name), called here RIVOTRIL 2 mg. In Spain, they have also Rivotril, but drops, what is much better. This drugs are for muscle spasm, because in my case, some muscle makes pressure on the Nerve. I take it only in the evening, because during the day I get tired, about two hours.
What happens in the night: there is relief of my muscle, and I have to go every two hours to the toilette, because water is coming out of muscles. It is very dark, when I have muscle and Neuralgia pain. When not, then is clear.
Many years ago, one Neurologist gave me shot (injection) between neck and shoulder, and was good for five years. Diagnosis was: Neuralgia Trigeminal. Nobody here has believed to me, because is not typical. I needed long time, to prove, that is this Neuralgia. In my right eye I always feel, like top of the knife pain.
Also, you should make all medical examinations. To be clear, what is wrong.
Ms.Bobbie, Slovenia