Talk:Trigeminal neuralgia
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[edit] Re
Re: the Neurontin recall. Per Pfizer and the FDA, this was a recall of one lot of 100 mg capsules of Neurontin in 2005 and not a general recall of all Neurontin, which is still being prescribed. Unless someone has information to the contrary, this information should probably be corrected or removed. ~MD
[edit] agreed - comment should be removed
I agree. I saw that and was quite surprised since I use Neurontin like many other people. It's still on the market. Karn 23:46, 21 March 2006 (UTC)
[edit] Various
It says there is no cure, but then it says surgery is effective in 75% of cases. Doesn't that mean that surgery is a cure (though not a universal one)? The paragraph on homeopathy should probably get a NPOV warning stamp. Zargulon 10:57, 29 September 2006 (UTC)
- I've put a "verification needed" on the homeopathy section; I am of the opinion that if nobody can cite a source it should be removed. Opinions anyone? PeteThePill 23:49, 1 October 2006 (UTC)
________________________________________________________
Not sure this is how to do it but here goes:
Discussion always benefits from those who have suffered the disease and studied it widely.
Your Symptoms Section- needs more info:
I am an a-typical TGN case. Like you stated in your article under Symptoms, a-typical TGN is so severe and the constant stabbing pain is similar to and often mistaken for migraines. I was misdiagnosed with migraines, later chronic daily headache with associated a-typical facial pain. I also sought treatment of a dentist(tooth was crowed twice), endodontis( root canal in the same tooth- which incidentally was the trigger for the full out assault by the TGN) and oral surgeon whom I had remove the tooth and nerves in hopes of ending the pain. It only got worse. I also had severe sinus complaints and saw one of the finest specialist in the nation with no luck. This too is a symptom. It is well documented (by just about any article you can read on google or Web MD that these are early warning symptoms and there needs to be some discussion added to assist the searcher in discovering the many ways TGN is masked and hard to diagnose. Links provided to any one of numerous articles on this very issue should be added.
When discussing the treatments I believe some of the following should be added:
I was diagnosed with a -typical TGN by Drs. Casey and Jannetta who were instrumental in pioneering the micro-vascular decompression surgery. I had a MVD June 14, 2005. I'm scheduled for a revision MVD in December 2006. If your article icluded links published articles regarding the treatments and their sucess rates readers would find articles written by Drs. Casey and Janneta stating that on average only 57% of A-typical TGN patients beneifit from a single surgical procedure. Further, that among the remaining 43%, the sypmtoms will reappear on the avg. of 1.9 years and require a second MVD with an expected post operative success rate then ranging between 87-95%. (By the way numbers vary widely as to both sets of stats and this needs addressed and linked)
Drug therapies need some further discussion:
Two of the more widely used drugs for TGN as mentioned in the article are Tegretol and Neurontin. There exist numerous articles via Google that while these drugs are very useful both as a diagnostic tool for TGN and for managing the disease, there can be severe side effects and liver toxcicity which often prevent their long term use and thereby lengthen the disease process before ultimately resulting in other treatments avenues. It would be helpful to dicuss this so that the reader would be informed of the side effects and carefully monitor his/herself thus reducing the time wasted by the he/she on these drugs before exploring other treatment avenues. Crossed referennced articles or PDR info relevant to tolerance, severe side effects and possible toxcicity, should be included in an effort to truley inform the reader.
[edit] Comments
[edit] Dental?
My TN is not dental nor is any other TN by definition. While it's often misdiagnosed as a dental problem, I really don't feel it should fall under the class of 'dental' articles.--Asams10 03:50, 30 August 2007 (UTC)
- Because it is a condition of the head and neck, it is always in oral pathology textbooks dentists read. Also, it involves one of the most important nerves for a dentist- the trigeminal nerve. - Dozenist talk 10:39, 30 August 2007 (UTC)
That makes it a medical article more than a dental article. That's like listing lawn care as a golf article because golfers need to know about it.--Asams10 11:05, 30 August 2007 (UTC)
- I am not completely certain about your analogy, but trigeminal neuralgia would be a considered differential diagnosis for a patient coming in with pain of unknown origin. Although the initial treatment would be medical, the closeness to anatomic structures which dentists work with all the time makes it relevant to dentistry, I would say. All that said, I believe this article could also be placed within the scope of WikiProject Medicine as the projects are clearly not mutually exclusive. - Dozenist talk 22:46, 30 August 2007 (UTC)
I guess I'm at a loss. You don't go to a Dentist to TREAT this, though a dentist might refer you to a GP or Neurologist if you ask them about the pain. Yeah, dentists need to be trained but it's a non-dental nerve disorder.--Asams10 03:05, 31 August 2007 (UTC)
- Well, from the point of view of dentistry, I am trying to say that the disorder is very relevant. And, if I understand you correctly, I agree with you that the article falls under the scope of WikiProject Medicine as well. - Dozenist talk 10:30, 31 August 2007 (UTC)
Okay, I'm sure I'm not getting through to you. I believe any relationship Trigeminal Neuralgia has to dentistry is trivial and that this article should be listed under the purview of a medical article cross-referenced to Dentistry only in as much as any other of these MEDICAL disorders are taught to DDS's. Is that clear enough? I'm saying to remove the dentistry tag and tag it under medical conditions.--Asams10 11:46, 31 August 2007 (UTC)
As much as I'm sure that Dozenist appreciates being patronised, I'm also fairly sure that you are not qualified to make any assessment of where this article belongs. As you are so fond of the trivial relationship that dentistry has to TN, trigeminal neuralgia is diagnosed more often by dentists than any other branch of medicine, despite the possibility of onward referral. I consider myself, as a dentist, qualified to treat TN even though a neurologist or oral medicine/surgery specialist would definetely do a better job. I assisted in the treatment of double figures in number of cases of TN as an UNDERGRAD dental student. Also two of the three branches of the trigeminal nerve are concerned almost solely with innervation of the oral cavity and perioral tissues. Thirdly, dentistry is a branch of medicine that is concerned with treatment of disorders of the oral, perioral and head and neck tissues. Having said all of that, this could fall under the medicine category AS WELL AS the dentistry category. I feel this is possibly a moot point, definetely a trivial one.Dr-G - Illigetimi non carborundum est. 19:36, 31 August 2007 (UTC)
- Thanks for your input. Put very well. I completely understand the turf wars that Dentists and Doctors fight over such things and you're, indeed, technically correct.--Asams10 03:34, 1 September 2007 (UTC)
If I can chime in here, I am one who has this disease. I can tell you that I had great dental pain but the dentist cant treat it. My GP recognized what it was and because my current neurologist was not accurately diagnosing me, he told me to stop seeing this neurologist. The GP got me off of the meds the neurologist had me on that were making me sick and not treating my conditions (migraines + cluster headaches + trigeminal neuralgia following a severe blow to the head in a motorcycle wreck). My GP put me on different meds that were effective in treating me and he sent me to different neurologists until we found one that diagnosed me correctly and treated me effectively. I am now progressing well. I can tell you that this is a terrible disease to have and its not about the turf wars of doctors and dentists, its about you guys serving the people that use WIKI to get help - people like me. So you need to look yourself in the mirror and ask if you can treat the disease and if you are qualified.
Now, there is great dental pain and dentists should be aware. I can describe mine - imagine a filling being drilled or a root canal being done without anesthetics... now for me, I would get that pain in all the molars in the upper right jaw at one time. Or my front teeth - they were doing an electrical shock thing, like I had bitten into a live wire (really very bad shock!) and it went up thru my front teeth my nose and into my eyes - terrible pain. The lower is similar. So I get the dental implications.
But the dentist cant treat it - he just needs to know about it so that he doesn't try to "fix it" with dentistry. He needs to see the signs and refer the patient back to his GP/neurologist. This is no different than a GP treating a person with headaches, seeing that his teeth are excessively worn and saying, "You might want to talk to your dentist about that because you could be grinding your teeth at night and that could be causing the headaches." The patient might need a mouthguard - that is a dentist issue.
Therefore I totally agree with Asams10 that the TN article has little if anything to do with dentistry. It is a medical issue. I live with this so it is not a textbook thing for me. I am a life experience expert. [[[User:Xiinteractive|Xiinteractive]] (talk) 04:24, 5 February 2008 (UTC)}
[edit] Is Trigeminal Neuralgia a genetic/hereditary disease?
74.75.249.102 01:16, 3 October 2007 (UTC)nhhgrace@aol.com
If you read up on this you will see that TN can by nature be hereditary. TN is often attributed to damage to the trigeminal nerve from overlying blood vessels. The location of these blood vessels can be genetically derived. Simply put. Other trigeminal problems can be caused by nerve trauma from external forces. [[[User:Xiinteractive|Xiinteractive]] (talk) 04:33, 5 February 2008 (UTC)}
[edit] Treatment
In the sentence "During a TN attack, some patients may get quick relief by applying an ice pack or a readily available source of cold temperature to the area of pain." the moderator marked it for CITATION NEEDED. Actually I placed this sentence here. I do not know if there is any published material stating that ice is good pain relief for TN, but as we all know, ice packs are commonly applied to painful injuries of many kinds (sprained joints, mild burns, broken bones, bruises, etc). The action of ice is two-fold (1) it decreases swelling thereby decreasing pain (2) the cold has a well documented numbing effect on the nerves thereby relieving pain.
Now personally, I can tell you that I have an ice pack in my freezer at all times ready to be applied to my face in the event of an attack. I often carry a liter water bottle filled with ice with me to apply to the painful area immediately when the pain hits - drugs dont work that fast. The issue here is basically nerves-gone-wild and anything and everything a nerve can feel is what is happening. It is something you want to stop right now! I have discussed this ice technique with my doctors and they all agree that it is perfectly sensible. Any one that has ever known cold weather knows that your face feels nothing in the bitter cold, your hands and feet go numb too!
The point is that cold numbs pain. Noone needs a medical journal to figure that out. I think asking me to cite a reference is an overkill to common sense. I think maybe I can restate the sentence for you to something needing less proof. After I save this I will go back and change it. Xiinteractive (talk) 04:53, 5 February 2008 (UTC)
[edit] Severity and Honesty
re: ["are begging to be killed," this kind of words should not be used for any disorder] regarding Trigeminal Neuralgia
While perhaps this word choice is a little blunt for the taste of many it is indeed medically accurate. A recent patient commented after surgery "it's a good thing surgery was Monday because if it was not I would have been dead in a week". When exploring that further I discovered that the patient was fully prepared to commit suicide if relief was not found for the most recent attack.
Also medically accurate is the fact that this disorder/disease goes by the moniker "the suicide disease", I see that this was taken out as well. The pain of this thing is beyond the comprehension of many. I get the sense that the bias some people have with respect to suicide or near-suicide (perhaps from personal experience) is causing them to sanitize this article somewhat. That's not right.
This disease causes a type of nerve pain that is untouched by regular pain killers. Effective treatment is a very VERY recent thing, good neuroleptics have not been around that long. In the somewhat recent past people did one of two things when afflicted with this disease. They killed themselves outright or they killed themselves more slowly by drinking. Alcohol was probably the only thing readily at hand that would suppress the nervous system enough and cause some temporary pain relief.
So, yes, people with this disease do in fact "beg to be killed" and they really mean it. It's truth. It's not "oh I had a bad day kill me now" type sarcastic thing. And of course, don't think I mean to say you should do it. Surgical treatment options are very good now, and getting better.Greploco (talk) 18:15, 16 May 2008 (UTC) —Preceding unsigned comment added by Greploco (talk • contribs) 18:09, 16 May 2008 (UTC)
