Atypical Facial Pian

[asja]

I am a 28-year old female from Sofia, Bulgaria. I have been suffering from severe pain in (mostly) the left side of my face and the back of the head, as well as the neck (and th epain is especially severe in the night). It all started about 4 months ago. I had a cavity repair that went wrong and I got acute pulpitis. And it was during the root treatment that this awful pain started and has been going on until now. I had consulted 2 dentists and they claim all teeth are fine now. I also had an X-ray of the skull and there's is surely no sinuits that might cause pain. I also tried some pills agains jaw-bone inflammation but they did no help. The blood tests are fine, so I surely have no infection. I had consulted a neurologist in Sofia, who put a diagnois "Trigeminal neuralgia" but ''Tegretol" (Carbamasepine) did not help alleviate the pain in the back of the head.

Finally, I was diagnosed with Atypical facial pain in Frankfurt, Germany and the drugs did some help; although only temporarily (I was prescribed "Amitryptilyn"). My major worry is that I have not done a nucleo-magnetic resonance (NMR) and I read somewhere that the pain might b edue to a brain tumor or multiple sclerosis. At the same time, no doctor proposed that I have a bran scan or NMR, so maybe it is not necessary? Also, I've been through a tremendous stress lately (my father was dying of cancer and I had to stay with him at home). This happened about a month and a half before I got the pains so maybe it's all stress-induced? On the other hand, I am not stressed out now; I actually feel rather relaxed and hings would've been fine if it weren't this pain...

I am quite confused about the whole thing and really scared what happens if no drugs help. I've been having these constant severe pains for 4 months now and I don't even want to think what if I have to bear it for some more months, not even to mention for years :-(.

All comments or advice would be very helpful. Thank you in advance!
Bests,
Asja

[Mickey50]

Wow - I hope your doctors know what they are doing, although I am sure they must.
Your daughter will probably have a long painful recovery. I is probably good she can
feel her foot, even if it is painful, better that then no feeling at all. Watch out for that
percocet, it can make a person crazy and feel like you are having a heart attack.
I was ok with the vicodent, but the percocet was to much for my system, so keep
a close eye on your daughter and watch for mood change, etc.
good luck.

[tacoma]

My 21 year old daughter had a bad car accident 5 weeks ago. She broke her pelvis and lost the feeling in her foot and the outside of her leg. To make a long story short...her last few days have been hell. She was doing okay for awhile and going to physical therapy, but she is in absolute chronic pain and crying all day. She says her foot in on fire. She is on Lyrica (150 mg twice a day), Cymbalta (30mg once a day and yhen in a few days she goes to 60mg once a day...taken at night), Percocet taken every four hours and cumadin for a blood thinner. I am waiting for her doctor to get ahold of me. I want to take her to a pain management specialist. To even make it crazier we are snowed in with no electricity.

I am scared. Is the pain her nerves regenerating or dying? Help! Thanks!

[jcverive]

The stress certainly can make neuropathic pain worse. Although it seems like the dental work may have caused pain in the front of the head, the back of the head is serviced by a different nerve network, so it might be that your nerves were already in a state of degradation.  Of the diseases that cause nerve degradation, MS is the most common, and it wouldn't hurt for you to ask your doctor for a nuclear MRI to confirm or rule out the disease.  On the other hand, if you happen to have just a couple of small lesions, an MRI may not detect them.  At this point, your doctor's "wait and see" approach might not be al that unreasonable, and treating your symptoms might also be the best therapy at this time.

Tegretol is basically the "go to" drug for treating facial neuralgias (especially trigeminal neuralgia), and amitriptyline is used widely for general neuralgia symptoms (mostly because it is cheap; it is not necessarily the best choice, and its side effect profile is rather long). Nortriptyline is better tolerated, since it is the active metabolite of amitriptyline. Until amitriptyline gets metabolized, it circulates throughout the body, potentially causing numerous side effects. Nortriptyline is not without side effects, but its side effects are generally milder.

Other drugs that may be considered include Neurontin, Lyrica, Effexor, Lexapro, Cymbalta, and Keppra are worth considering. For my occipital (back of the head) neuralgia, I am getting good relief from Cymbalta, Lyrica, and Keppra. Keep working with your doctor to find a drug or combination that works for you. Best of luck!

[Mickey50]

It sounds like your dentist caused some nerve damage. It is not a bad idea to get an MRI, you just need to find a doctor to give you a script. So sorry about your dad. Also, can you get pain meds from the neurologist? Good luck to you.