Difference in treatment between Atypical TN and Trigeminal Neuropathic Pain?

Dear brothers and sisters,

I hope your experience maybe can help to define my diagnosis and find right treatment.

As I live in small Post Soviet country (Latvia,population-only 2 millions), neurologists here are not very familiar with Atypical TN (I start realize that after coming to LwTN!) also we don't have specialists, who specializes on facial pain.

My pain started 5 years ago and was located at the one side of face in cheek area (smarting, stabbing, pressure like, lvl 2-7/10, almost 24/7) As I was just recovered from sinusitis (got them often, had 2 small nose partition correction surgeries before 2 and 4 years), went to ENT, x-rays showed nothing, neurologist wrote Nimesulide, Diclac - nothing helped. Then I went to dentist who find pulpitis in my upper mollar (same side where pain was) and did that root canal. Also I used medication course consistining of Coxtral, Solpadeine, Mydocalm, antidepressants. I was pain free for 6 months!

And then...it started again :( in same location&character of pain. I tried Carbamazepine, Gabapentin, Lyrica - nothing helped. I was so depressed and couldn't stand out it anymore so I went to neurosurgeon, who was certain that reason is my mollar. X-rays showed there was a cyst!!! I had that mollar extracted, but unfortunately it was connected with maxillary sinus, which suppurated in 3 days after extraction. I had to undergo 2 sinus-oral surgeries under full anaesthesia to move that crap out. Also camed out that reason why there formed cyst was root canal sealant, which was in jawbone and nerves :s !!!

To my sorrow pain didn't disappear. Even worse - 6 months after surgery I start to feel pain in another side of face! Same character&location - cheek, upper jaw&teeth, nose, temple. Teeth&sinus healthy there.Pain is not equal at both sides at same time. Have tried Anafranil, Baclofen, Mydocalm, Cymbalta, Lyrica - none of them giving remarkable relief. I have been to lot of doctors and got lot of diagnosis: Somatoform disorder (hahaha),Fibromyalgia, Somatization, Atypical TN...

I red Face pain info here and I had thought that maybe I have Trigeminal Neuropathic Pain?

I want thank everyone in advance who will answer me, especially thanks to this miracle web patrons - Richard A.Lawhern and Stef!

God bless You!

I just started tegredol and kadian about a month ago. It hasn’t totally stopped my attacks but they have definatley decreased. The tegredol was a little rough on my stomach at first but after a week stopped. I have tn and tmj and also had a bad root canal procedeure which ended up with an overfill all on the left side. Maybe you can talk to your doc about these medicines. Hope you can find relief soon. If you have any more qs just send me a message. Good luck. Jerry

Here is a link that explains the new classification system and allows you to take a test to determine your pain type:


I have Trigeminal Neuropathic Pain. I've been diagnosed by a facial pain specialist. I have pain in my upper right teeth 24/7. The only thing that has helped me is Amitriptyline, a tricyclic anti-depressant, which is in the same family as the Anafranil you listed. It didn't help until I reached 100mgs, and it took a while to reach that dose. I probably sound like a broken record, but it saved my life. I still have 24/7 pain, but at much lower levels.

Any doctor who tells you your pain is somatic is a doctor who doesn't know what they are talking about, and you should avoid seeing them further. There have been studies proving that this is not a psychological problem, so never believe them when they tell you that.

Hello, Stase.

I agree with Crystal that you should avoid any doctor who would dismiss your condition as any type of Somatiform illness. I also second the statement she made about there being no studies proving that Somatiform facial pain exists.

It is my personal opinion that physicians do not like what they don’t understand, and I’ve been hard pressed to find doctors who understand much at all about Type II Atypical TN, my final diagnosis from a Neurologist who specializes in head and face pain. She stated that “we don’t know what causes it”.

When speaking on the subject of Trigeminal Neuropathic Pain, this much I understand, if my layman’s research is correct, they know what brought it on. From what I am reading, there could be external factors which worsened your condition. What I also believe I understand is, although dental procedures, or other complications may be the cause of Trigeminal Neuropathic Pain, is not the result the same? Whenever you describe your pain, it does sound as if it is of the same character of a Type II TN, or Atypical TN. This leaves me wondering, once the cause of the damage to the nerve has been alleviated, would the course of treatment of the pain also be the same? I do not see why not, someone please correct me if I am wrong. Because, as we always say, “we are not physicians”, and do not diagnose or recommend treatment.

To direction answer your question, in my mind’s eye, no matter what the cause, if the result is the same, I don’t see a difference in the final wind-up. It would seem to me that one cause results in ATN as the long term pain disorder…

I am sorry for what you are enduring. Please keep your chin up with any doctor you see regarding this life-changing pain disorder and by all means do not let them dismiss your pain!!! It seems that from your medical history that they would know that the possibility that there could have been damage to your TN nerve, which may now be the cause of your current symptoms.

What I have always liked about the link that Crystal sent to you is that they call Type II by it’s appropriate name, rather than calling it “Atypical Facial Pain”, which is a generalization that can be confused for somatiform pain and is not substantiated by studies.

Thank you for the recognition, although I admit that, although I have made humble contributions to the group, I also need the emotional support and benefit from the exchange of information from other facial pain patients, like yourself.

I hope you find a good Neurologist, and possibly Pain Management Specialist soon, who are well versed in your condition, and are able to successfully treat your pain!

Best wishes from the Southeastern U.S.

God bless you, as well!