Aa
Trigeminal neuralgia?
I've read all I can find in here about TN, and still can't determine if I might be experiencing it. (it's just not sinking in)
My issue started 3 days ago when I had a tooth ache come on suddenly on the left top moller area and last for about 10 minutes, 2 different times.
That night I woke up with a severe toothache on the left bottom moller area that lasted 4 or 5 minutes, then moved to the top and lasted another 15 minutes or so, involving what felt like several teeth.
Yesterday the pain came on 3 times, lasting over 2 hours the third time. I could feel the pain moving from top to bottom to top, back and forth several times. Wierd, and very painful!
Today I have had only mild discomfort a couple times, but so far no severe pain like the last couple days.
Q? Does this sound like it might be TN?
I'm a 53 yo male, I've got all my teeth, and I'm 'possible ms'.
My issue started 3 days ago when I had a tooth ache come on suddenly on the left top moller area and last for about 10 minutes, 2 different times.
That night I woke up with a severe toothache on the left bottom moller area that lasted 4 or 5 minutes, then moved to the top and lasted another 15 minutes or so, involving what felt like several teeth.
Yesterday the pain came on 3 times, lasting over 2 hours the third time. I could feel the pain moving from top to bottom to top, back and forth several times. Wierd, and very painful!
Today I have had only mild discomfort a couple times, but so far no severe pain like the last couple days.
Q? Does this sound like it might be TN?
I'm a 53 yo male, I've got all my teeth, and I'm 'possible ms'.
I am bumping this so that people can see that I am revising some of my wording about TN, MS and what the rest of the world thinks.
Since my neuro is the one who gave me the stat that 27% of MSers have TN or STN,( and he is associated with OHSU) I am going to ask him next visit about whether this revised Facial Pain classification (that I have bee telling you) is being accepted outside this region.
Quix
Since my neuro is the one who gave me the stat that 27% of MSers have TN or STN,( and he is associated with OHSU) I am going to ask him next visit about whether this revised Facial Pain classification (that I have bee telling you) is being accepted outside this region.
Quix
I do not like what I have been seeing online.
The great mass of info out there on TN is not what I hear and read from the Portland area and from OHSU. Some of the "overview" articles don't even mention MS. When they do they report that a few percent of TN actually have MS. And they parrot the old info that 5% or less of MSers will suffer TN.
I found an old study form the 1990's stating that only 1% of people with MS have TN. And I see a bunch of current articles echoing that old data. I will ask my neuro (who told me the number is 27%) to give me some data/references. I wonder if NARCOMS has queried it.
I see that there are different definitions of STN and of atypical facial pain. One site states that Atypical pain is another term for somaticized face pain and encourages "searching for a psychiatric disorder."
Sheesh!
Listening to the huge number of people here that have debilitating pain I do not believe for a second that TN (ofr any type) is limited to 5% or less of people with MS. NOT FOR a SECOND!
Hereafter I will preface my opinions with the statements that I believe the OHSU to be the more enlightened of the different sources of info on TN. And that is not because they are the home-town gig. I first saw this questionaire on the fpa-support.org site and it made TOTAL and perfect sense. Only later did I realize that the questionaire is a link from the Neurosurg department at OHSU.
Quix
The great mass of info out there on TN is not what I hear and read from the Portland area and from OHSU. Some of the "overview" articles don't even mention MS. When they do they report that a few percent of TN actually have MS. And they parrot the old info that 5% or less of MSers will suffer TN.
I found an old study form the 1990's stating that only 1% of people with MS have TN. And I see a bunch of current articles echoing that old data. I will ask my neuro (who told me the number is 27%) to give me some data/references. I wonder if NARCOMS has queried it.
I see that there are different definitions of STN and of atypical facial pain. One site states that Atypical pain is another term for somaticized face pain and encourages "searching for a psychiatric disorder."
Sheesh!
Listening to the huge number of people here that have debilitating pain I do not believe for a second that TN (ofr any type) is limited to 5% or less of people with MS. NOT FOR a SECOND!
Hereafter I will preface my opinions with the statements that I believe the OHSU to be the more enlightened of the different sources of info on TN. And that is not because they are the home-town gig. I first saw this questionaire on the fpa-support.org site and it made TOTAL and perfect sense. Only later did I realize that the questionaire is a link from the Neurosurg department at OHSU.
Quix
Hi, guys. I hadn't looked at this site for more than a year. STN is a new categorization. Clearly my TN is STN also. This does not mean that we don't a form of Trigeminal Neuralgia. The "Powers That Be" have conferred and determined that they will separate TN from MS from the classic TN which is caused from Compression of the nerve.
This makes sense and does NOT change what we have been saying about TN, its incidence in MSers or its meaning.
TN on MSers is caused by a lesion on the nerve and would not be amenable to surgical intervention. Classic TN is a "structural" problem out side the nerve causing pressure on the nerve. Both types can result in severe facial pain. It makes sense to place the MS type of Trigeminal Neuralgia into a separate category so as to be able to consider its cause and its treatment in a more appropriate way.
The words "trigeminal neuralgia" mean "nerve pain in the Trigeminal Nerve" - without any indication as to the cause. I think having the subsets is bery useful. Medicine doens't like lumping things together that have clearly different causes (and, therefore, treatments).
I will start to make this distinction also. If you have STN, you still have TN, but it is now designated as due to MS. Thus, we consider it a symptom of MS and we look at medication for treatment instead of surgery.
It's all still TN. It all still points to MS for the undiagnosed among us. If you are undiagnosed and you get a result of TN1, that doesn't mean that you don't have MS, just that your symptoms are identical to the classic TN. Once a diagnosis is made your classification would change to STN.
Does this make sense?
I apologize for not following this up and answering this sooner.
Remember that a good number of the neuros out there are not even aware that semi-constant face pain is also regarded as a type of TN (TN2 or STN). So don't be surprised when they won't regard anything but the stabbing pains as TN. The field is developing ahead of the education of many neurologists (Who would guess??).
I'm going to do some research to see if other TN descriptions are using this naming system.
Mike - Absolutely tell your neuro about this pain. I'll look up the official questionaire on a scientific site, if I can and give you guys the reference. Again, in the absence of knowledge that you have MS, the questionaire will diagnose TN1 or TN2, depending on whether most of your pain is constant. Knowing about the MS will likely throw it directly to STN.
Wobbly - STN is still TN, but now with the specification that it is due to MS.
Does my explanation make sense?
Quix
This makes sense and does NOT change what we have been saying about TN, its incidence in MSers or its meaning.
TN on MSers is caused by a lesion on the nerve and would not be amenable to surgical intervention. Classic TN is a "structural" problem out side the nerve causing pressure on the nerve. Both types can result in severe facial pain. It makes sense to place the MS type of Trigeminal Neuralgia into a separate category so as to be able to consider its cause and its treatment in a more appropriate way.
The words "trigeminal neuralgia" mean "nerve pain in the Trigeminal Nerve" - without any indication as to the cause. I think having the subsets is bery useful. Medicine doens't like lumping things together that have clearly different causes (and, therefore, treatments).
I will start to make this distinction also. If you have STN, you still have TN, but it is now designated as due to MS. Thus, we consider it a symptom of MS and we look at medication for treatment instead of surgery.
It's all still TN. It all still points to MS for the undiagnosed among us. If you are undiagnosed and you get a result of TN1, that doesn't mean that you don't have MS, just that your symptoms are identical to the classic TN. Once a diagnosis is made your classification would change to STN.
Does this make sense?
I apologize for not following this up and answering this sooner.
Remember that a good number of the neuros out there are not even aware that semi-constant face pain is also regarded as a type of TN (TN2 or STN). So don't be surprised when they won't regard anything but the stabbing pains as TN. The field is developing ahead of the education of many neurologists (Who would guess??).
I'm going to do some research to see if other TN descriptions are using this naming system.
Mike - Absolutely tell your neuro about this pain. I'll look up the official questionaire on a scientific site, if I can and give you guys the reference. Again, in the absence of knowledge that you have MS, the questionaire will diagnose TN1 or TN2, depending on whether most of your pain is constant. Knowing about the MS will likely throw it directly to STN.
Wobbly - STN is still TN, but now with the specification that it is due to MS.
Does my explanation make sense?
Quix
Thanks for the info Ren and Quix, I learned a lot (I think)
Hey Wobbly, I took the test too, twice. Because I don't have a dx, the first time I answered no to the ms ques. and it said I've got TN1
The second time I put yes to ms and I got STN...so I still wonder...
The pain dissapeared the day after I posted the question, so maybe it'll stay away for ever, i hope!
I had my annual dental check up a couple months ago, cleaning, exam and xrays, so my teeth should be fine, but I will go to the dentist if the pain returns.
I'm going to my neuro on the 29th, is this wierd tooth pain something I should report to him?
Thanks again Quix, i appreciate all your efforts in here!
Mike
Hey Wobbly, I took the test too, twice. Because I don't have a dx, the first time I answered no to the ms ques. and it said I've got TN1
The second time I put yes to ms and I got STN...so I still wonder...
The pain dissapeared the day after I posted the question, so maybe it'll stay away for ever, i hope!
I had my annual dental check up a couple months ago, cleaning, exam and xrays, so my teeth should be fine, but I will go to the dentist if the pain returns.
I'm going to my neuro on the 29th, is this wierd tooth pain something I should report to him?
Thanks again Quix, i appreciate all your efforts in here!
Mike
Hi, Mike,
TN is not as simple as it would seem. The first thing you HAVE to do is make sure that all tose teeth are healthy and that your TMJ (Jaw joint) is okay.
Assuming everything is hunky dory, then we do start talking about Trigeminal Neuralgia. If you looked at the picture of the Trigeminal Nerve (cranial nerve V) and read my description, you'll remember that the nerve has three branches (Tri = three, Geminal = roots). V1 handles sensation from the top of the face above the eye. V2 has the middle part of the face, nose, upper gums/teeth, and upper lip, + others.
V3 has the lower jaw, lower teeth and gums, lower lip +.
You can have TN in 2 branches at the same time. This means the compression or MS lesion is far enough back that it involves the base of both branches. The most common combination by far is V2 + V3.
I would assume that you are feeling it "bounce" back and forth between upper and lower, because the point of greatest pain is moving and you typically can be aware of just one point of pain at a time. The point you feel is the one screaming loudest. Perhaps one is screaming for attention, but then you somehow trigger the other one. I know for a fact that you are touching the area during this pain, unless you are something other than human.
Multiple teeth? Totally possible, depends on the extent of the lesion (in the case of MS).
I bumped a good discussion about dental pain and TN up. It's the post by JenEpicFarms called "Early exacerbations and TN"
Also here is a diagram of the course of the nerve:
http://www.stjosephsatlanta.org/gamma_knife_center/images/gamma_knife_trigeminal_neuralgia_profile.jpg
Also go to the site fpa-support.org
and take their test.
Quix
TN is not as simple as it would seem. The first thing you HAVE to do is make sure that all tose teeth are healthy and that your TMJ (Jaw joint) is okay.
Assuming everything is hunky dory, then we do start talking about Trigeminal Neuralgia. If you looked at the picture of the Trigeminal Nerve (cranial nerve V) and read my description, you'll remember that the nerve has three branches (Tri = three, Geminal = roots). V1 handles sensation from the top of the face above the eye. V2 has the middle part of the face, nose, upper gums/teeth, and upper lip, + others.
V3 has the lower jaw, lower teeth and gums, lower lip +.
You can have TN in 2 branches at the same time. This means the compression or MS lesion is far enough back that it involves the base of both branches. The most common combination by far is V2 + V3.
I would assume that you are feeling it "bounce" back and forth between upper and lower, because the point of greatest pain is moving and you typically can be aware of just one point of pain at a time. The point you feel is the one screaming loudest. Perhaps one is screaming for attention, but then you somehow trigger the other one. I know for a fact that you are touching the area during this pain, unless you are something other than human.
Multiple teeth? Totally possible, depends on the extent of the lesion (in the case of MS).
I bumped a good discussion about dental pain and TN up. It's the post by JenEpicFarms called "Early exacerbations and TN"
Also here is a diagram of the course of the nerve:
http://www.stjosephsatlanta.org/gamma_knife_center/images/gamma_knife_trigeminal_neuralgia_profile.jpg
Also go to the site fpa-support.org
and take their test.
Quix
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