Transgeminal neuralgia

[connie710]

My mother has been experiencing crushing and excruciating pain in her mouth. The pain travels up her cheek and feels like an electric shock. The er dr last night would not listen to us and just prescribed more pain medicine. She got an injection of vicadin which only made her sick and did not take the pain away. She can't eat or drink w/o being in excruciating pain. I did some research and I believe it is transgeminal neuralgia. She has every symptom of it and all the drs want to pass it off as dental pain. I know it is transgeminal neuralgia but I do not know how to prove it. Can you help?

[Dr Sharma]

Hi there. Trigeminal neuralgia is one of the common facial pain syndromes caused by compressive blood vessels, tumors and vascular malformations and seen more frequently in patients with Multiple sclerosis. The main symptom is sudden onset, severe sharp facial pain that comes without warning like a lightning and may end abruptly. It can be triggered by a light touch on the face, teeth brushing and could be mistaken with dental pain. Diagnosis is based on history and description of pain, and CT/MRI is used to rule out tumor etc as the cause. The neurologist should examine the triggering stimuli; tender zones etc. management involves anticonvulsant therapy like carbamazepine titrated to pain. The side effects like dizziness and losing balance need to be understood to avoid anxiety. Other drugs are baclofen, gabapentin etc. the response to antidepressants and opioids is limited. Intractable pain would require nerve blocks with local anesthetics into trigger areas, glycerol injections, and microvascular decompression. Consult a neurologist to intervene immediately for symptomatic relief of your mom’s symptoms. Hope this helps. Take care.

[nancy99n]

With neurontin (or any of the other anti-convulsant meds used for TN), you have to wean slowly up in dosage until the pain is controlled -- with a doctor's guidance.
In the meantime, some non-medical alternatives to alleviate the pain include -- a warm compress -- I used a microwaveable beanbag.  Or Oragel rubbed on the teeth and gums -- can relieve the pain enough so she can eat/drink.
Let us know how it goes with the neurologist.
Take care,
Nancy

[connie710]

Thank you Nancy for your comment. We are going to make an appt first thing tomorrow morning. After a 2nd visit to a different er yesterday morning, the er doctor prescribed neurontin which I know is used for trigeminal neuralgia, so I am hoping after a few doses, the pain will start to ease up until she can see a neurologist.

[Nancys61]

Has your mother seen a Neurologist for evaluation? I had Trigeminal Neuralgia after shingles on my face, and the pain is worse than anything I've ever felt before. She definately needs to be checked out.

Nancy