So confused

Thank you all for listening. I saw my neuro at a big teaching hospital in NYC yesterday and he is like this is not a neuro problem but a tooth problem that just needs time to settle down. Although he did agree with the oral surgeon about the tergernol as first line. When I told him how sick I was on it he tried to set up an appt with pain management but they were closed for the day. In the meantime my oral surgeon wants me now to up it to 800 mg. Omg, I am so sick already on 600 mg. My oral surgeon is still telling me I have TN. My DH is yelling at me that I first have to finish one protocol before going to the next. One says it’s a oral problem, one says it’s a neuro problem. I know you really can’t give an answer but I appreciate you letting me vent.

If you are in NY you may want to consider a consultation with Dr. Jeffrey Brown in Long Island. He is a neurosurgeon whose practice is focused on TN. He gave me my initial diagnosis, and did my three surgeries. I traveled from Georgia to NY to see him, and I highly recommend him.

Al great info for a TN in process! Big shout out of thx to everyone! Yes, the neurosurgeons seemed to be baffled & befuddled, but God… So glad that after over 2 yrs I finally hv an answer. Am now taking laser light treatments and hv a fabulous pain management dr.

Steph, is this cold laser treatments? How often do you go? Where does he put the beam. My chiropractor does them.

Dear Susan,

I am so sorry to hear of your suffering.

Have any of your doctors suggested a different medication. There are other meds that do the same thing, but have lesser side effects.

Hope you find some answers soon.


Rissmal, the NY neuro tried to get me into the pain clinic that day but they were closed early. My DH refuses to take me back into the city until I finish with my oral surgeons protocol, which is now to increase to 800 cause the pain is still there. Only then will he try me on something else if 800 does not work. IDK, I thought this was the TN wonder drug and everyone gets better on it?

I sorry about this NY surgeon that have left people worse. My heart goes out to all. I don’t think I’m a surgical candidate at this time but who knows. The diagnoses is still up in the air.

Hi Susan,

I couldn't figure out how to attach, so I just copied and pasted a few abstracts that reference "randomized controlled studies of TN and drugs that are effective". You can find more of these on PubMed.

I actually bring copies of these to my doctors. So far, they have been receptive to the information. For me, the combination of lower doses of gabapentin and the lowest dose (10mg) of amitriptyline have helped to manage my pain without bad side effects.

Good luck,


Treatment of neuropathic pain: an overview of recent guidelines.

O'Connor AB1, Dworkin RH.

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A number of different treatments for neuropathic pain have been studied, but the literature is sizable, rapidly evolving, and lacks important information about practical aspects of patient management. Under the auspices of the International Association for the Study of Pain (IASP) Neuropathic Pain Special Interest Group (NeuPSIG), a consensus process was used to develop evidence-based guidelines for the pharmacologic management of neuropathic pain that take into account clinical efficacy, adverse effects, impact on health-related quality of life, convenience, and costs. On the basis of randomized clinical trials, medications recommended as first-line treatments for neuropathic pain included certain antidepressants (i.e., tricyclic antidepressants and dual reuptake inhibitors of both serotonin and norepinephrine), calcium channel alpha(2)-delta ligands (i.e., gabapentin and pregabalin), and topical lidocaine. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in selected clinical circumstances. Other medications that generally would be used as third-line treatments include certain other antidepressant and antiepileptic medications, topical capsaicin, mexiletine, and N-methyl-d-aspartate receptor antagonists. Two other national and international associations recently published pharmacologic treatment guidelines for neuropathic pain, which are summarized and contrasted with the NeuPSIG recommendations. Recent guidelines for the use of neurostimulation for the treatment of neuropathic pain also are summarized. For all treatments for neuropathic pain, long-term studies, head-to-head comparisons, and studies of treatment combinations are a priority for future research.

Mayo Clin Proc. 2010 Mar;85(3 Suppl):S3-14. doi: 10.4065/mcp.2009.0649.

Recommendations for the pharmacological management of neuropathic pain: an overview and literature update.

Dworkin RH1, O'Connor AB, Audette J, Baron R, Gourlay GK, Haanpää ML, Kent JL, Krane EJ, Lebel AA, Levy RM, Mackey SC, Mayer J, Miaskowski C, Raja SN, Rice AS, Schmader KE, Stacey B, Stanos S, Treede RD, Turk DC, Walco GA, Wells CD.

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The Neuropathic Pain Special Interest Group of the International Association for the Study of Pain recently sponsored the development of evidence-based guidelines for the pharmacological treatment of neuropathic pain. Tricyclic antidepressants, dual reuptake inhibitors of serotonin and norepinephrine, calcium channel alpha(2)-delta ligands (ie, gabapentin and pregabalin), and topical lidocaine were recommended as first-line treatment options on the basis of the results of randomized clinical trials. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in certain clinical circumstances. Results of several recent clinical trials have become available since the development of these guidelines. These studies have examined botulinum toxin, high-concentration capsaicin patch, lacosamide, selective serotonin reuptake inhibitors, and combination therapies in various neuropathic pain conditions. The increasing number of negative clinical trials of pharmacological treatments for neuropathic pain and ambiguities in the interpretation of these negative trials must also be considered in developing treatment guidelines. The objectives of the current article are to review the Neuropathic Pain Special Interest Group guidelines for the pharmacological management of neuropathic pain and to provide a brief overview of these recent studies.

Ann N Y Acad Sci. 2006 Nov;1088:164-86.

Therapeutic management of chronic neuropathic pain: an examination of pharmacologic treatment.

Vadalouca A1, Siafaka I, Argyra E, Vrachnou E, Moka E.

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Neuropathic pain is defined as pain caused by a lesion in the nervous system and is common in clinical practice. Diagnosis can be difficult. Recommendations for first-line pharmacologic treatments are based on positive results from multiple, randomized, controlled trials, and recommendations for second-line pharmacologic treatments are based on the positive result of a single, randomized, controlled trial or inconsistent results of multiple, randomized, controlled trials. The results of published trials and clinical experience provide the foundation for specific recommendations for first-line treatments, which include gabapentin, 5% lidocaine patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants (TCAs). Gabapentin (up to 3,600 mg/day) significantly reduced pain compared with placebo; improvements in sleep, mood, and quality of life were also demonstrated. Adverse effects of gabapentin include somnolence and dizziness, and, less commonly, gastrointestinal symptoms and mild peripheral edema. Thus, monitoring and dosage adjustment are required, without discontinuation of the drug. Gabapentin combined with morphine achieved better analgesia at lower doses of each drug than each drug alone, with only mild adverse effects. The first medication that proved effective for neuropathic pain in placebo-controlled trials was TCAs. Treatment decisions for patients with neuropathic pain can be difficult. Interest in the mechanisms and treatment of chronic neuropathic pain has increased during the past years, resulting in significant treatment advances in the future. In this article all recent knowledge on therapeutic management of chronic neuropathic pain is presented.

Neurosciences (Riyadh). 2015 Apr;20(2):107-14. doi: 10.17712/nsj.2015.2.20140501.

Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options.

Al-Quliti KW1.

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Trigeminal neuralgia is a syndrome of unilateral, paroxysmal, stabbing facial pain, originating from the trigeminal nerve. Careful history of typical symptoms is crucial for diagnosis. Most cases are caused by vascular compression of the trigeminal root adjacent to the pons leading to focal demyelination and ephaptic axonal transmission. Brain imaging is required to exclude secondary causes. Many medical and surgical treatments are available. Most patients respond well to pharmacotherapy; carbamazepine and oxcarbazepine are first line therapy, while lamotrigine and baclofen are considered second line treatments. Other drugs such as topiramate, levetiracetam, gabapentin, pregabalin, and botulinum toxin-A are alternative treatments. Surgical options are available if medications are no longer effective or tolerated. Microvascular decompression, gamma knife radiosurgery, and percutaneous rhizotomies are most promising surgical alternatives. This paper reviews the medical and surgical therapeutic options for the treatment of trigeminal neuralgia, based on available evidence and guidelines.

A preliminary report on stem cell therapy for neuropathic pain in humans.

Vickers ER1, Karsten E2, Flood J3, Lilischkis R2.

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Mesenchymal stem cells (MSCs) have been shown in animal models to attenuate chronic neuropathic pain. This preliminary study investigated if: i) injections of autologous MSCs can reduce human neuropathic pain and ii) evaluate the safety of the procedure.


Ten subjects with symptoms of neuropathic trigeminal pain underwent liposuction. The lipoaspirate was digested with collagenase and washed with saline three times. Following centrifugation, the stromal vascular fraction was resuspended in saline, and then transferred to syringes for local injections into the pain fields. Outcome measures at 6 months assessed reduction in: i) pain intensity measured by standard numerical rating scale from 0-10 and ii) daily dosage requirements of antineuropathic pain medication.


Subjects were all female (mean age 55.3 years ± standard deviation [SD] 14.67; range 27-80 years) with pain symptoms lasting from 4 months to 6 years and 5 months. Lipoaspirate collection ranged from 102-214 g with total cell numbers injected from 33 million to 162 million cells. Cell viability was 62%-91%. There were no systemic or local tissue side effects from the stem cell therapy (n=41 oral and facial injection sites). Clinicalpain outcomes showed that at 6 months, 5/9 subjects had reduced both pain intensity scores and use of antineuropathic medication. The mean painscore pre-treatment was 7.5 (SD 1.58) and at 6 months had decreased to 4.3 (SD 3.28), P=0.018, Wilcoxon signed-rank test. Antineuropathic painmedication use showed 5/9 subjects reduced their need for medication (gabapentin, P=0.053, Student's t-test).


This preliminary open-labeled study showed autologous administration of stem cells for neuropathic trigeminal pain significantly reduced pain intensity at 6 months and is a safe and well tolerated intervention.