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Suggest Treatment For Trigeminal Neuralgia
Question: I have recently been diagnosed with trigeminal neuralgia. I already am on a regimen of opiates, elavil, gabapentin for conditions already existing. The medicine I have did not come close to aleviating the horrible pain of the nerves shooting, stabbing electrical etc. pain, so I ended up in the ER and they prescribed another opiate, and both a viral (prednisone) and antibiotic, in addition to adding tylenol 3. Should I get an MRI with contrast?
Brief Answer:
That is always an option
Detailed Answer:
Good afternoon....so sorry you've got that diagnosis. Let me ask this question. Was the diagnosis of Trigeminal Neuralgia (TN) arrived at by a neurologist or an internist/generalist, NP/PA, etc.? There are many conditions that mimic TN and are mistaken for it so I just want to make sure that's not the case. Now, you didn't say which medication you were tried on once the diagnosis was made but I can tell you that it's not always possible to "guess" correctly right out of the gate. There are as many people who will do beautifully on the first drug chosen for TN as there are people who don't respond at all. Remember, medicine is not an exact science and so in certain conditions both patients and doctors have to acknowledge that trial and error is sometimes the only thing we can do when confronted by an unknown patient. The other problem is that you're on other medications to begin with so there is a likely chance that you could be experiencing either some type of drug to drug interaction which reduces the effectiveness of what you were given initially or because you are on a variety of other drugs including pain relievers that your liver and kidneys are working overtime and basically are being very aggressive with metabolizing (i.e. ridding your body of) your medication as fast as you put it in.....Again these are not things we can easily predict out of the gate and so I tend to explain all this to patients because I don't want to seem insensitive and uninformed when patients come and say, "Hey, that doesn't work at all for me......you must have the wrong medicine.....or you didn't give me the GOOD STUFF!" So, JOB 1 is to make sure you have the right diagnosis. Step 2 is to make sure that whatever drugs your on for other problems that they are not potentially interacting or reacting with the medication you're taking and for that reason not giving you the type of expected relief. Step 3 is to potentially find the ROOT CAUSE of what could be causing this and that's where I would definitely agree with getting not only an MRI with contrast but depending on what it sees I would also consider some blood work and maybe even an electrical study of the face (EMG/NCV).
So bottom line: I would go ahead and get that MRI with contrast. That will put a lot of questions to rest as to the CAUSE of the TN (if in fact, you've got TN to begin with..which at least sounds possible).
If I've satisfactorily addressed your question then, could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and a 5 STAR rating to our transaction if you feel the response has helped you? Again, many thanks for posing your question.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 15 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
That is always an option
Detailed Answer:
Good afternoon....so sorry you've got that diagnosis. Let me ask this question. Was the diagnosis of Trigeminal Neuralgia (TN) arrived at by a neurologist or an internist/generalist, NP/PA, etc.? There are many conditions that mimic TN and are mistaken for it so I just want to make sure that's not the case. Now, you didn't say which medication you were tried on once the diagnosis was made but I can tell you that it's not always possible to "guess" correctly right out of the gate. There are as many people who will do beautifully on the first drug chosen for TN as there are people who don't respond at all. Remember, medicine is not an exact science and so in certain conditions both patients and doctors have to acknowledge that trial and error is sometimes the only thing we can do when confronted by an unknown patient. The other problem is that you're on other medications to begin with so there is a likely chance that you could be experiencing either some type of drug to drug interaction which reduces the effectiveness of what you were given initially or because you are on a variety of other drugs including pain relievers that your liver and kidneys are working overtime and basically are being very aggressive with metabolizing (i.e. ridding your body of) your medication as fast as you put it in.....Again these are not things we can easily predict out of the gate and so I tend to explain all this to patients because I don't want to seem insensitive and uninformed when patients come and say, "Hey, that doesn't work at all for me......you must have the wrong medicine.....or you didn't give me the GOOD STUFF!" So, JOB 1 is to make sure you have the right diagnosis. Step 2 is to make sure that whatever drugs your on for other problems that they are not potentially interacting or reacting with the medication you're taking and for that reason not giving you the type of expected relief. Step 3 is to potentially find the ROOT CAUSE of what could be causing this and that's where I would definitely agree with getting not only an MRI with contrast but depending on what it sees I would also consider some blood work and maybe even an electrical study of the face (EMG/NCV).
So bottom line: I would go ahead and get that MRI with contrast. That will put a lot of questions to rest as to the CAUSE of the TN (if in fact, you've got TN to begin with..which at least sounds possible).
If I've satisfactorily addressed your question then, could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and a 5 STAR rating to our transaction if you feel the response has helped you? Again, many thanks for posing your question.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 15 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I appreciate your prompt reply and detail of the steps made, and that you feel I should follow up with the MRI with contrast. I hope the diagnosis of TN is wrong. I will let you know the results of the scan and will speak with my pain specialist on drug interaction.
Brief Answer:
Good luck with the study....JUST REMEMBER:
Detailed Answer:
I think that's a good idea...but please remember:
1. The MRI is not able to MAKE any diagnosis of TN but rather to see whether or not anything inside the head (intracranially) could be affecting the trigeminal nerve either by pushing, squeezing, or otherwise irritating the nerve and for that reason you've got the symptoms.
2. The study should be done with GADOLINIUM CONTRAST to be absolutely complete.
3. You SHOULD get a screening of your renal function if you get the study with contrast. Specifically, you should have your serum CREATININE measured as well as the serum ESTIMATED GLOMERULAR FILTRATION RATE (EGFR) which should be >= 60 otherwise, if lower you should know that gadolinium contrast could represent a risk to your kidney function and you will need to have your nephrologist took a look to see what is going on with those numbers.
Cheers!
If I've satisfactorily addressed your question then, could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and a 5 STAR rating to our transaction if you feel the response has helped you? Again, many thanks for posing your question.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 25 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Good luck with the study....JUST REMEMBER:
Detailed Answer:
I think that's a good idea...but please remember:
1. The MRI is not able to MAKE any diagnosis of TN but rather to see whether or not anything inside the head (intracranially) could be affecting the trigeminal nerve either by pushing, squeezing, or otherwise irritating the nerve and for that reason you've got the symptoms.
2. The study should be done with GADOLINIUM CONTRAST to be absolutely complete.
3. You SHOULD get a screening of your renal function if you get the study with contrast. Specifically, you should have your serum CREATININE measured as well as the serum ESTIMATED GLOMERULAR FILTRATION RATE (EGFR) which should be >= 60 otherwise, if lower you should know that gadolinium contrast could represent a risk to your kidney function and you will need to have your nephrologist took a look to see what is going on with those numbers.
Cheers!
If I've satisfactorily addressed your question then, could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback and a 5 STAR rating to our transaction if you feel the response has helped you? Again, many thanks for posing your question.
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 25 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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