Treatment of Atypical Trigeminal Neuralgia

  Hello. I am a 44 y.o. female. I had dental implants in my two teeth 2and1/2 years ago. From the beginning I had pain that became worse and worse. A year later I finally found a dentist to remove the implants, he felt I had compression on a nerve. So I had yet a third oral surgery and a removal of two more teeth. Three months later I developed pain again while trying to be fitted for a new bridge and had a root canal on my canine tooth ( the terrible pain from the imlants had subsided and I thought this was over) . Then all the facial and head pain came back this time much, much worse.  I had classic ATN (pain was constant, bilateral and in all 3 branches). I finally found a neurosurgeon who put me on tegretol 800mg daily. I was already on nortriptyline 50mg (it helped some). It took months for the tegretol to work but gradually the pain did lessen but I have never been pain free for more than 4-6days and sometimes I have terrible facial and head pain( that is different from the nerve pain- more like a headache) that lasts for 4-5 days leaving me exhausted.I have tried to cut down to 600mg but every time do it only lasts for about 6-12 days and the pain gets worse. When I tried to cut the nortriptylne down I had a severe dull facial pain. Even when the nerve pain is minimal I have breakthrough pain. I have no parathesia or numbness, no lightning type pain.  My neurosurgeon believes this will heal but I am loosing faith. I quit my job but that has not helped much. I also am now taking librium prn for anxiety and fiorinal prn for the headaches - they both help sometimes and others not. From what I have read surgery is not effective on ATN. Is there a chance this will heal? How long might it take?  What other things can I do to assist this? If not is there any surgery that can help? Thank you for your help.
Dear Sarah:
I am sorry to hear about your ATN.  It seems that your pain medications are just esculating in numbers.  When we see this the issue becomes whether the medications are having much of an effect on the pain or psyche.  There may be too many captains trying to run the ship (meaning your treatment).  I think a possible solution is to gather all your records, revisit the neurosurgeon or seek a second opinion with a good neurologist or pain management expert and develop a plan.  You may be at the point of further surgery or a change in medication to something such as neurontin in combination with maybe one other medication.  Without examining you and going over the records it is tough for me to make a diagnosis or treatment plan.  But I think that sitting down and going over all your records might be a good starting place.  Let us know if we can help in this, if you live in the Cleveland area you can call 1-800-CCF-Care.  Good luck!
Sincerely,
CCF Neuro[P] MD

[Cheryl1948]

A related discussion, atypical trigemnal neuralga was started.