Recurrent Breast Cancer

Monday, August 5, 2013

A Day in the Life of Orville: A Trigeminal Nerve Sufferer
Orville, a member of the Mile High Military Officers’ Association, has Trigeminal Neuralgia (TN). It’s a painful condition that affects the right side of his face. This disorder is caused by compression of the trigeminal nerve. Orville is fifty five. Most TN sufferers are over age fifty.

Light touch to his face, brushing his teeth, speaking, eating, and smiling triggers his pain. Episodes persist from one day to more than several months. However, he can have pain-free intervals that last several months to years. Orville’s pain attacks cause extreme pain that interfere with swallowing, drinking, and speaking. These symptoms are characteristic for TN. There are no specific tests to diagnose it. However, MRI (Magnetic Resonance Imaging) is recommended to eliminate possibility of nerve injury or tumor.TN treatment includes prescription medicines, surgery, and focused radiation.

Over the Counter Medicine (OTC) Treatment: OTC medicines, such as Ibuprofen, Aleve, Naprosyn sometimes control pain.

Prescription Medicine Treatment: AEDs (anti-epileptic prescription drugs) alleviate symptoms. However, daily doses might be needed to prevent attacks. AED side effects include drowsiness, dizziness, and difficulty speaking. Gum enlargement (gingival hyperplasia) could occur with long term use. AED side effects include allergic rash, bone marrow suppression, and liver injury.
Tegretol (Carbamazepine) is the first prescription medicine of choice. Pain relief with Tegretol verifies the diagnosis. Its side effects include drowsiness, nausea, dizziness, and blurred vision. Rare side effects could include rash, liver injury, and anemia. Gabapentin (Neurontin) is better tolerated than Tegretol. Side effects are dizziness, sleepiness, headache, nausea, diarrhea and ankle swelling. 

Pregabalin (Lyrica) is recommended for those who have no benefit with carbamazepine. Lyrica’s side effects include dizziness, sleepiness, blurred vision, swelling, and weight gain.Other prescription medicines are Topiramate (Topamax) and Sumatriptan (Imitrex). Botulinum toxin (Myobloc) injected around the trigeminal nerve temporarily reduces pain. However, repeat injections could cause facial muscle weakness. 

Surgery: Surgery is considered for people with debilitating pain not relieved by medicines. Gamma knife (radiation) radiosurgery is the least invasive surgery. It involves focused radiation to the TN nerve. A study of four hundred patients who had TN decompression surgery experienced pain relief. Seventy two percent reported no pain during at a followup of fifty six months. However, pain recurrence is possible. Those younger than fifty, people who had symptoms more than eleven and half years, women, and men with left-sided face could have pain recurrence. Alcohol injection into the TM nerve provides temporary pain relief for two to thirty months.

I’m keeping in touch with Orville. He’s my buddy. 

Questions or comments? Contact Dr. Clem at

There are three ingredients in the good life: learning, earning, and yearning.     

Christopher Morley.