Hi this is my first post on here and it is a bit of a huge monster but hopefully helpful to someone! I suffered from TN 2 since 2005 and struggle a lot with pain brain fog. For me the best thing I have done is focus on how pain is processed in the brain instead of what is happening in my face…personally I feel I have much more control on my brain than my face and I can help myself make the most of my available concentration and feel happier now I understand more about the brain and pain. Now I don’t get as stressed trying to always fight the pain but make the most of what I can do and improve that while accepting some of my limitations that I did not have before TN2 without getting with a little more understanding and kindness for myself.
From a neuroscience perspective pain is thought to be mainly processed in the cerebral cortex where higher thinking is also carried out. It makes sense if pathways and systems in that area have become more developed and ingrained to dealing with pain that function for other higher thought processing is diminished and results in pain brain fog because the resources of this area and other areas of the brain can become more wired to deal with pain instead of other things. I am trying to make this as simple as possible because it is very confusing and still not fully understood by neuroscientists but these are the basic pain pathways…‘From these nuclei, nociceptive information is relayed to various cortical and subcortical regions, including the amygdala, hypothalamus, periaqueductal grey, basal ganglia, and regions of cerebral cortex,’ as described in this complicated but interesting if you stick with it document called 'Pain Processing in the Human Nervous System: A Selective Review of Nociceptive and Biobehavioral Pathways
If we work hard when we are well enough to focus to try and keep our brains flexible by learning new skills like languages and music the brains can help rewire other areas and reduce the amount of resources devoted to pain. This is obviously incredibly difficult with this condition and needs to be ongoing but in my experience it is worth trying. I have a heart condition that causes no problems but when discovered in 2009 it meant all my various strong pain medications were stopped overnight. I had med brain fog before that and slept much too many hours. Now having no medication I suffer very bad pain brain fog that comes in waves through the hours or days. With no meds available only heat, massage and physio it means focusing on improving my brains function in relation to pain management is a helpful and positive way to try and manage, at least in part, the nerve pain where it gets processed in the brain. It is well established that certain psychological conditions/situations can cause the cerebral cortex to temporarily shut down or go off line and the emotional zones of the brain take charge of the logical thought zones. With severe chronic repeated pain the research I have seen shows that normally small things like stress, tiredness even being hungry can trigger overwhelm of the cerebral cortex and make some pain sufferers, including me sometimes, temporarily run on emotional thought instead of higher logical thought as certain brain zones go out of action. This means getting easily grumpy, frustrated, annoyed or upset as a result of the way my brain has been impacted by all those extra pain pathways developing over time making my tolerance to stress and ability to concentrate much less than it was before TN2 simply because brain resources have been taken away and devoted to pain processing. The pain psychologists are clear that it is not my fault when I sometimes have less cognitive function and emotional tolerance, it is simply the way that all brains work. Obviously this is a simplified way of trying to explain things and has still turned out a very long post but I hope it might help someone understand a little about why pain brain fog happens. For me accepting my concentration ans emotional reactions are not all in my control helped, a large part of my suffering is simply the architecture of my brain and the chemicals released there, while at the same time knowing there are some things that I can do to improve my brain flexibility and function by building resilience when I feel able to has meant I feel a little more in control and that has made my stress levels more manageable. I think that is good going especially considering the TN2 pain both causes more stress and causes me to have a decreased tolerance of dealing with stress in my brain. I hope this mostly makes sense to people and might be interesting to someone