Research for Options in Treating Trigeminal Neuralgia

1
Research for Options in Treating Trigeminal
Neuralgia

• R.A. Red Lawhern, Ph.D.
• Webmaster TNA Homepage 1998-2001

2
Outline

• Types of Face Pain Disorders
• Trends in Visibility for Face Pain
• Recent Research
• General Pain Research
• Medications for TN
• Surgery for TN
• Alternative Treatments for TN
• Resources, On-Line and Off

3
Face Pain Disorders

• Trigeminal Neuralgia
• Typical, Atypical
• Glossopharyngeal Neuralgia
• Postherpetic Neuralgia
• Geniculate Neuralgia
• Vegal / Superior Laryngeal Neuralgia
• Occipital Neuralgia
• MS-related face pain
• Cluster headache
• Fibromyalgia

• Anesthesia Dolorosa
• Atypical Odontalgia
• Hemi-facial spasm
• NICO
• TMJ
• Facial Tendonitis
• Sinusitis, Dental Problems
• Atypical Facial Pain Syndrome

4
Trends in Visibility 1996-2003
1996
2003

• TN Hits at Google 24,500
• ATN at Google 475
• GN at Google 165
• TN Abstracts at Pub Med 3600

• TN Hits at Google 1800
• ATN at Google
• GN at Google
• TN Abstracts at Pub Med

5
Trends in Pain Research

• Medical profession has finally discovered pain
• More articles about under-treatment, standards
• More research on CNS neurologic pain
• Primarily neuralgia, spinal and cancer pain
• Increased public advocacy for new policies
• Treatment on demand, not on need
• Patient informed and participating
• Multi-disciplinary pain management

6
Research on Medical Treatment

• Studies of the adequacy of past trials
• AC1 / AC8 Animal studies (January 03)
• Proteins to suppress pain sensitivity
• Neuro-peptide studies (OSU)
• Anti-convulsants and Neuropathic Pain
• Shingles prevention study (trials)
• Topimirate Antidepressant (experimental)
• Valproic Acid (experimental)

7
Research on Surgery

• Use of templates in Gamma Knife focus
• Use of Endoscopes in DMV exploration
• Deep Brain Stimulation (Janetta)

8
Research on Alternative Treatments

• Magnets in treatment of Sciatica (trials)

9
Review of Treatments Medical

• Carbamazepine (Tegretol)
• Gabapentin (Neurontin)
• Baclofen
• Clonozepam
• Lamotrigin
• Oxcarbamazepine
• Phenytoin

• Amitriptyline
• Nortriptyline (Pamelor)
• Protriptyline
• Sumatriptan (cluster headaches)
• NSAIDS / Opoids
• Capsaisin (topical)

10
Review of Treatments Surgical

• MVD
• Radio Frequency Rhizotomy
• Balloon Compression
• Glycerol Rhizotomy
• Gamma Knife Radiosurgery

• Nerve Blocks
• Neurotomy
• NICO Surgery
• DREZ (Dorsal Root Entry Zone)

11
Review of Treatments - Alternative

• Acupuncture
• Ayurvedic Medicine
• Botulinum Toxin (Botox)
• Capsaisin
• Cervical Chiropractic
• Exercise / Running
• Homeopathy
• Hot / Cold Compresses

• Hypnosis
• Low Intensity Laser
• Lidocaine Cream / Patch
• Myotherapy
• Osteopathy
• TENS (Postherpetic N.)
• Vitamin B12
• Yoga / Biofeedback

12
Doing Your Own Info Research

• Striking Back A Laymans Guide to
• George Wiegel and Kenneth F. Casey M.D.
• Trigeminal Neuralgia Pathophysiology, Diagnosis
  and Current Treatment
• British Journal of Anesthesia, 2001, Vol 87, No 1
  (online)
• TNA Homepage http//www.tna-support.org
• Facial Neuralgia Resources http//facial-neuralgi
  a.org
• Google http//www.google.com
• Others Altavista, Medline, Yahoo