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Author: Admin | 2025-04-28
Those refractory periods the pain cannot be brought on.The pain is often accompanied by a facial tic or contracture. This is why TN is also called Tic Doulereux.TN has a precise but widespread distribution that makes anatomical sense based on how the nerves course.The pain is virtually always during the day and does not wake a patient from sleep.If the pain has been present for weeks or months the gingival tissue on the pain side will be inflamed and the teeth covered with plaque due to toothbrush avoidance.The language of pain must be considered. The words bright, sharp, shooting, excruciating, tic like, radiating, twitching and traceable are common. (In fact, when I reviewed Shirley’s initial consultation notes the words “twitching pain” were recorded but were not meaningful to me at that time).Treatment after DiagnosisOnce diagnosed, TN is most commonly treated with medications which can be extremely helpful for many patients. At times medication combinations are considered if the effectiveness of one single drug drops off. The side effects of these medications can be problematic leading to surgical discussions.Ani-seizure medications are the first line options and the most commonly used are carbamazepine, oxcarbazepine, lamotrigine, pregabalin and gabapentin. A muscle relaxant, baclofen has proven to be helpful for some patients while duloxetine best known for it’s use in treating depression and anxiety has been effective as well. In the last few years Botox has been used to address TN pain and current research is investigating it’s use intraorally to treat stubborn tooth and gingival pain.For some, surgical options are necessary and have proven to be effective for extended periods of time. The most well -known and researched procedure is called MVD for microvascular decompression. Brain stereotactic radiosurgery, known as Gamma Knife and a variety of rhizotomies are also performed routinely with variable success and often a need to repeat within 3-10 years.Back to ShirleyOnce it was recognized that Shirley’s pain was of TN origin, she was provided medications which almost immediately reduced her suffering to a level never achieved with the prior therapies. Ultimately her dental work was completed without complication.ConclusionThe diagnosis
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