Discussions By Condition: I cannot get a diagnosis.

Terrible Jaw Pain, Dont Know how much longer I can take this.

Posted In: I cannot get a diagnosis. 1 Replies
  • Posted By: SandyV
  • October 23, 2007
  • 03:33 AM

Hello,

I'm new to these forums and I found it out of desperation. My mother is suffering from a terrible jaw pain for the last 5 years. It's a terrible jaw pain that usually flares up when it's windy, cold or raining. She has seen several doctors, but no-one has been able to accurately figure it out. Several doctors have said it has to do with the 5th nerve. They have thought about going in there and severing it to relieve her pain. However, she would have some partial paralysis on her face.

They have given her all types of pain medications, but nothing really works. We have a reached a point where we don't know what to do.
She's at the point where she cant take it any longer. She has said a few things that have got me very worried. Please, if anyout there can help, please email me as soon as possible. My email is vasquez_sandy@sbcglobal.net. Thank you very much

Sandy

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  • Sandy, I'm replying on this site so other people who might read your posting might recognize their same problems. Where on the jaw, the upper? On the cheek? Just below and in front of the ear? Trigeminal neuralgia or tempero-mandibular joint pain? What Is Trigeminal Neuralgia? Trigeminal neuralgia (TN), also called tic douloureux, is a condition that is characterized by intermittent, shooting pain in the face.Trigeminal neuralgia affects the trigeminal nerve, one of the largest nerves in the head. The trigeminal nerve sends impulses of touch, pain, pressure, and temperature to the brain from the face, jaw, gums, forehead, and around the eyes.What Causes Trigeminal Neuralgia?The most frequent cause of trigeminal neuralgia is a blood vessel pressing on the nerve near the brain stem. Over time, changes in the blood vessels of the brain can result in a blood vessels rubbing against the trigeminal nerve root. The constant rubbing with each heartbeat wears away the insulating membrane of the nerve, resulting in nerve irritation.What Are the Symptoms of Trigeminal Neuralgia?Trigeminal neuralgia causes a sudden, severe, electric shock-like, or stabbing pain that lasts several seconds. The pain can be felt on the face and around the lips, eyes, nose, scalp, and forehead. Symptoms can be brought on when a person is brushing the teeth, putting on makeup, touching the face, swallowing, or even feeling a slight breeze.Trigeminal neuralgia is often considered one of the most painful conditions seen in medicine. Usually, the pain is felt on one side of the jaw or cheek, but some people experience pain at different times on both sides. The attacks of pain may be repeated one after the other. They may come and go throughout the day and last for days, weeks, or months at a time. At times, the attacks can disappear for months or years. The disorder is more common in women than in men and rarely affects anyone younger than 50.How Is Trigeminal Neuralgia Diagnosed?Magnetic resonance imaging (MRI) can be used to determine whether a tumor or multiple sclerosis is irritating the trigeminal nerve. Otherwise, no test can determine with certainty the presence of trigeminal neuralgia. Tests can, however, help rule out other causes of facial disorders. Trigeminal neuralgia usually is diagnosed based on the patient's description of the symptoms.How Is Trigeminal Neuralgia Treated?Trigeminal neuralgia can be treated with antiseizure medications such as Tegretol or Neurontin. The medications Klonapin and Depakote may also be effective and may be used in combination with other drugs to achieve pain relief. Some antidepressant drugs also have significant pain relieving effects.If medications are ineffective or if they produce undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity.Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis or meditation. Sandy, there is much literature on the internet about surgery and other alternatives. If your mom's docs aren't controlling her pain, or haven't adequately explained the surgery, maybe it's time to see someone else. I'm not sure which sub-specialty branch of medicine handles these cases. ENT's? Neurologists? MedicationsAnticonvulsants such as carbamazepine, oxcarbazepine, topiramate, phenytoin, or gabapentin are generally the most effective medications. Pain relievers usually do not help. Anticonvulsant effects may be potentiated with an adjuvant such as baclofen or clonazepam. Baclofen may also help some patients eat more normally if jaw movement tends to aggravate the symptoms.If anticonvulsants don't help and surgical options have failed or are ruled out, the pain may be treated long-term with an opioid such as methadone.Low doses of some antidepressants such as nortriptyline can also be effective in treating neuropathic pain.Botox can be injected into the nerve by a physician, and has been found helpful using the "migraine" pattern adapted to the patient's special needs.Many patients cannot tolerate medications for years, and an alternate treatment is to take a drug such as gabapentin and place it in an externally applied cream base by a pharmacist who compounds drugs. Also helpful is taking a "drug holiday" when remissions occur and rotating medications if one becomes ineffective. SurgerySurgery may be recommended, either to relieve the pressure on the nerve or to selectively damage it in such a way as to disrupt pain signals from getting through to the brain. In trained hands, surgical success rates have been reported at better than 90 percent.Of the five surgical options, the microvascular decompression is the only one aimed at fixing the presumed cause of the pain. In this procedure, the surgeon enters the skull through a quarter-sized hole behind the ear. The nerve is then explored for an offending blood vessel, and when one is found, the vessel and nerve are separated or "decompressed" with a small pad. When successful, MVD procedures can give permanent pain relief with little to no facial numbness.Three other procedures use needles or catheters that enter through the face into the opening where the nerve first splits into its three divisions. Excellent success rates using a cost effective percutaneous surgical procedure known as balloon compression have been reported. This technique has been helpful in treating the elderly for whom surgery may not be an option due to coexisting health conditions. Balloon compression is also the best choice for patients who have ophthalmic nerve pain or have experienced recurrent pain after microvascular decompression.Similar success rates have been reported with glycerol injections and radiofrequency rhizotomies. Glycerol injections involve injecting an alcohol-like substance into the cavern that bathes the nerve near its junction. This liquid is corrosive to the nerve fibers and can mildly injure the nerve enough to hinder the errant pain signals. In a radiofrequency rhizotomy, the surgeon uses an electrode to heat the selected division or divisions of the nerve. Done well, this procedure can target the exact regions of the errant pain triggers and disable them with minimal numbness.The nerve can also be damaged to prevent pain signal transmission using a gamma knife or similar radiosurgical device such as Novalis shaped beam. No incisions are involved in this procedure. It uses radiation to bombard the nerve root, this time targeting the selective damage at the same point where vessel compressions are often found. This option is used especially for those people who are medically unfit for a long general anaesthetic, or who are taking medications for prevention of blood clotting
    rad-skw 1605 Replies
    • October 24, 2007
    • 08:25 AM
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