Trigeminal Neuralgia (TN)

Trigeminal neuralgia (TN) is a chronic pain disorder, where the trigeminal nerve (responsible for actions such as biting and chewing, as well as many other facial sensations) is damaged. As is to be expected, those who suffer from conditions such as multiple sclerosis, AIDS/HIV and diabetes are more likely to be affected, as the myelin sheath surrounding the TN nerve is damaged. An estimated 1 in 8,000 people a year develop TN, with onset usually beginning after 50 years old.

The pain of TN is extreme and has the unfortunate moniker of being a “suicide disease”, as 25% of sufferers commit suicide. The only condition with similar suicide rates are cluster headaches, and it is possible that the two conditions are linked in some way. The pain of both TN and cluster headaches are said to be so excruciating that it is often ranked alongside of even exceeds the pain of being bitten by a bullet ant, giving birth or even being shot by an actual gun! Burning and/or a persistent hammering or stabbing pain is often associated with TN, as well as “shock”-like pain.

Opioid and opiate-based medications are not recommended for TN, as they are ineffective at treating nerve pain to any significant degree. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are often used, as are anticonvulsants such as gabapentin. Antipsychotics may also be prescribed, as are antiepileptic and anticonvulsant medications. GABA receptor agonists are also often prescribed, but their side-effects can be extremely deleterious and sedative, making doing anything else difficult. It is not unusual for a TN patient to be prescribed a cocktail of drugs, including a low dose of opioids, even if they don’t help with nerve pain directly.

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