Crandies,
You are 100% correct that pain management should be tried prior to any surgery such as Gamma Knife, Cyber Knife, SRS or MVD. I did not think that any neurosurgeon would consider you for surgery without going through the pain management med trials. For example, Oregon Health and Science University diagnosed my ATN in 2006 but would not perform the surgery even at my request until I went through a second round of pain management and even then I had to go to UCLA Medical Center 2.5 years after trying many different meds with very bad side effects. But, everyone is different and some meds work for some people and not others - just like the surgeries. In addition, doctors are learning about TN and trying combinations of drugs. I'm glad that you have had some success with your meds because all the surgeries are truly major and have significant risks. After my MVD surgery completely resoving my original pain but causing new, constant burning pain in new locations (AD or deaffrent pain), I am in pain mangement again and have been on opiates for months just to get partial relief. Finding a good pain management doctor is almost as difficult as finding a good neurologist with TN experience. TNA has gradually built a recommended list of doctors or neurologists recommended by us patients but has not published a similar pain magement doctor list that I know about. Believe me when I tell you that finding a pain management doctor really familiar with TN is difficult because I have been to several over the few years. Most don't know that there is Type 1 and Type 2 TN and either start you on Tegretol or vicoden. Here is a trivia point that three pain management doctors have discovered independently on me - Tegrotol makes me dizzy, drowsy to the point of not waking without help and causes severe migraine headache. On the other hand, Lyrica worked for the shock-like pains but not the constant pain. Reading on this forum shows that every individual seems to respond differently to the meds and we have to keep trying to find what works for us.
I tried to say that I agree with you that pain management should be the first approach before surgery of any kind and that the great majority of doctors (especially family doctors) will initiate pain management before discussing or referring you to a neurosurgeon.Thanks for reminding everyone that pain management is the first line of defense for TN pain because new comers need this guidance.
Ron