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Old 02-17-2014, 05:33 PM #1
wombat42 wombat42 is offline
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Default Constant nerve pain in gum after injection

About 5 years ago I had a filling done on lower right 6. Ever since i have had constant pain in the gum under the front side of the tooth. This was where an injection was done - the injection did seem to me to be pressing hard against the bone when it was done. The pain is only at this location and is constant in intensity - I would say a medium pain level.

I had the tooth extracted recently yet the gum pain remained. My dentist referred me to a hospital oral maxillofacial consultant. He diagnosed neuropathic pain and said there's nothing he could do but said try Amitryptaline. I tried Amitryptaline but it completely zonked me out even on a low dose so i have given on them. Now I am just trying Benfotiamine and R-Lipoic Acid which some people say has helped their neuropathic pain.

Any help would be appreciated.
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Old 02-22-2014, 11:56 AM #2
justjane37 justjane37 is offline
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Hi,

The description of your pain, location and experience definitely fits with Neuropathic pain. Especially that you had the tooth extracted and are still in pain. Have you heard of Trigeminal Neuralgia? I have Atypical Trigeminal Neuralgia and I can relate very closely with your experience. You should do some research on TN (Trigeminal Neuralgia).

I am on Amitriptyline and have been on it for about five months. It has been my lifesaver. First of all, I increased dosage very slowly. I started off on 10mgs and worked my way up to 40mgs over a month and a half. How long did you try taking the Amitriptyline? and at what dosage?

I understand why you stopped taking it. The fatigue is a lot to handle but as you get used to the med that goes away. I feel completely normal now. When I started taking it I would take it in the evening, pass out by 8pm and wake up feeling hung over. Through the day I just felt very blurry and lacked energy big time. Now I take it around 6pm (once I am settled at home for the night), am asleep by 10pm, have an amazing sleep and feel pretty good when I wake up.

This medication really takes some time to start working, about four or five weeks. It is commonly used for this type of nerve pain. There are other medications to try such as Nortriptyline and Lyrica.

You are not alone in the pain you are feeling. There is a serious lack of information amongst the medical and dental communities regarding neuropathic pain and trigeminal neuralgia.

Any other questions you have feel free to ask.



Quote:
Originally Posted by wombat42 View Post
About 5 years ago I had a filling done on lower right 6. Ever since i have had constant pain in the gum under the front side of the tooth. This was where an injection was done - the injection did seem to me to be pressing hard against the bone when it was done. The pain is only at this location and is constant in intensity - I would say a medium pain level.

I had the tooth extracted recently yet the gum pain remained. My dentist referred me to a hospital oral maxillofacial consultant. He diagnosed neuropathic pain and said there's nothing he could do but said try Amitryptaline. I tried Amitryptaline but it completely zonked me out even on a low dose so i have given on them. Now I am just trying Benfotiamine and R-Lipoic Acid which some people say has helped their neuropathic pain.

Any help would be appreciated.
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Old 02-22-2014, 01:14 PM #3
wombat42 wombat42 is offline
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Quote:
Originally Posted by justjane37 View Post
Hi,

The description of your pain, location and experience definitely fits with Neuropathic pain. Especially that you had the tooth extracted and are still in pain. Have you heard of Trigeminal Neuralgia? I have Atypical Trigeminal Neuralgia and I can relate very closely with your experience. You should do some research on TN (Trigeminal Neuralgia).

I am on Amitriptyline and have been on it for about five months. It has been my lifesaver. First of all, I increased dosage very slowly. I started off on 10mgs and worked my way up to 40mgs over a month and a half. How long did you try taking the Amitriptyline? and at what dosage?

I understand why you stopped taking it. The fatigue is a lot to handle but as you get used to the med that goes away. I feel completely normal now. When I started taking it I would take it in the evening, pass out by 8pm and wake up feeling hung over. Through the day I just felt very blurry and lacked energy big time. Now I take it around 6pm (once I am settled at home for the night), am asleep by 10pm, have an amazing sleep and feel pretty good when I wake up.

This medication really takes some time to start working, about four or five weeks. It is commonly used for this type of nerve pain. There are other medications to try such as Nortriptyline and Lyrica.

You are not alone in the pain you are feeling. There is a serious lack of information amongst the medical and dental communities regarding neuropathic pain and trigeminal neuralgia.

Any other questions you have feel free to ask.

Hi thanks. The consultant said it wasnt TN as the pain was constant, wasnt worse in the morning, was only at one location. The consultant prescribed just 10mg amitryptaline for three months. I did reading up on the internet found out that amytryptaline was 1 of four first line drugs (here in the UK) the other 3 are duloxetine, gabapentin & pregabalin. They all have side effects and help around 30%. Everything i read said that the dose should be titrated to as high a level as possible. Medscape actually suggests that 150mg is a typical dose to go up to.

I spent about 9 days on 10mg, I went to my GP and asked for higher doses. I tried 30mg and felt no effect. I then went straight to 50mg and it zonked me out badly, gong to bed early and feeling drowsy during the day. After about 10 days still on 50mpg I felt absolutely just as bad so i gave up, partly because i thought i was obliged to keep pushing up to as high a dose as possible. Amitryptaline only helps about 30% of people and i thought at a low dose the success rate would be even less.

Another strategy i was trying to do was to get as fit as possible by going to the gym which should help me sleep better and therefore tolerate the pain better during the day even if it remained. The amytryptaline completely undermined that, it made me groggy just couldnt make it to the gym and i felt worse than i did before even with the pain affecting my sleep.

At present im back to trying to get fit again and taking food supplements Benfotiamine and R-Lipoic Acid which do help some people (maybe around 30%) as many helped by amytryptaline. At least they dont have side effects. Other options are cannabis or acupuncture.

A few years ahead, if you can wait that long there may be better drugs for NP on the market.

At some point in a few months if the food supplements and maybe acupuncture dont work i was thinking of trying duloxetine, gabapentin & pregabalin which have different side effects to amytryptaline. But your experience with amytryptaline suggests that even 40mg may have been helpful to me so ill consider trying that as well. Amazingly some patients taking amytryptaline for depression can be given daily doses of 300mg !

My pain level is medium, it isnt that terrible but all the same id like to get rid of it. If i was a superfit musclebound guy (something ill never be) id probably just ignore it as minor. I certainly wouldnt like this pain with me when im old and grey.

Are you going to try stop taking amytryptaline anytime ? Were you tempted to push to go for a higher dose?

Yes incredible ignorance amongst dental profession. Original dentist just threw me out when i suggested nerve damage, I saw an expensive private endodontist as i though root canal treatment was worth trying - afterwards when he didnt work he tried to refer me to someone called a "dental psychologist" !. That rather threw me off the nerve damage scent as I just couldnt believe at the time that a top expert in his field could get it so wrong.
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Old 02-22-2014, 01:21 PM #4
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Just glancing at your other posts I think you are saying you have Atypical TN. Funnily enough I thought the only first line drug for TN was carbomazepine.
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Old 02-22-2014, 01:54 PM #5
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There are two types of TN. Type 1 is the attacks that come and go. Type 2 (Atypical) is a constant, burning pain. I have done a lot of reading and a lot of research about TN. Many doctors will not DX if you do not show the normal, classic Type 1 symptoms. But Atypical TN (Type 2) is what you describe. The thing about it is that it can get better and go away but it may come back, and worse. Also with my experience my pain started out very localized, to one tooth, and over a year it spread through other teeth and into my jaw, cheek and ear.

I have had ATN for about eight years. My first attack was smack, dap in between two bottom teeth. Constant, burning, vibrating pain all day, every day! I saw many doctors, dentists and specialists. Begged them to pull teeth out. I was diagnosed with TMJ and was taking pain pills like there was no tomorrow. Finally my doctor told me to try Amitriptyline. I was put on 25 mgs and all of the pain went away. I stayed on it for two years and went off of it when I wanted to get pregnant. The pain never returned. Until early last year. It started on a back, bottom molar. I was in the dentist office about eight times. Antibiotics, pain pills and an unnecessary root canal later I finally came to the realization that it was TN again. Went on Amitriptyline and 40mgs is where it stopped hurting. About two months ago I tried to decrease to 30 mgs and the pain came back. So I went back to 40 mgs and all is good again. My dosage is low but it different for everyone and I thank the lord that I am fortunate enough to have found something that works!!

Everyone responds differently to these meds. And sometimes the side effects are too much. I was very careful to up the dose slowly and it took a long time for it to start working. I think going from 10mgs to 50mgs immediately is a lot. I also think it is wise to increase slowly so that you know what level is working. Sometimes TN can progress and meds can stop working so it is good to be able to increase it later if needed. The fatigue was a lot for me too. I am 37, a single mom, with two jobs. It was difficult. I am glad I stuck it out though because now I am pain free.

There are other meds to try. And meds that work for Type 1 TN are not necessarily the same ones that will work for Type 2.

There is a very good website. www.livingwithtn.org It is the largest community of TN sufferers I have found. You will read people's stories that are very similar to yours and there is wealth of organized information about symptoms, medical help and medications on that site. I urge you to join and post in the discussions. The moderators on that site know more than any doctor you will probably ever meet.

I am not a specialist by any means. I know how frustrating it is to have doctors and dentists just stare at you like you are completely nuts. TN actually runs in my family so I do know more about it then most.

Being active, eating properly, keeping stress low and sleeping well are all extremely important and beneficial. Even if you do not have TN the neuropathy you do have would probably be treated in the same way as Type 2 TN.


Quote:
Originally Posted by wombat42 View Post
Hi thanks. The consultant said it wasnt TN as the pain was constant, wasnt worse in the morning, was only at one location. The consultant prescribed just 10mg amitryptaline for three months. I did reading up on the internet found out that amytryptaline was 1 of four first line drugs (here in the UK) the other 3 are duloxetine, gabapentin & pregabalin. They all have side effects and help around 30%. Everything i read said that the dose should be titrated to as high a level as possible. Medscape actually suggests that 150mg is a typical dose to go up to.

I spent about 9 days on 10mg, I went to my GP and asked for higher doses. I tried 30mg and felt no effect. I then went straight to 50mg and it zonked me out badly, gong to bed early and feeling drowsy during the day. After about 10 days still on 50mpg I felt absolutely just as bad so i gave up, partly because i thought i was obliged to keep pushing up to as high a dose as possible. Amitryptaline only helps about 30% of people and i thought at a low dose the success rate would be even less.

Another strategy i was trying to do was to get as fit as possible by going to the gym which should help me sleep better and therefore tolerate the pain better during the day even if it remained. The amytryptaline completely undermined that, it made me groggy just couldnt make it to the gym and i felt worse than i did before even with the pain affecting my sleep.

At present im back to trying to get fit again and taking food supplements Benfotiamine and R-Lipoic Acid which do help some people (maybe around 30%) as many helped by amytryptaline. At least they dont have side effects. Other options are cannabis or acupuncture.

A few years ahead, if you can wait that long there may be better drugs for NP on the market.

At some point in a few months if the food supplements and maybe acupuncture dont work i was thinking of trying duloxetine, gabapentin & pregabalin which have different side effects to amytryptaline. But your experience with amytryptaline suggests that even 40mg may have been helpful to me so ill consider trying that as well. Amazingly some patients taking amytryptaline for depression can be given daily doses of 300mg !

My pain level is medium, it isnt that terrible but all the same id like to get rid of it. If i was a superfit musclebound guy (something ill never be) id probably just ignore it as minor. I certainly wouldnt like this pain with me when im old and grey.

Are you going to try stop taking amytryptaline anytime ? Were you tempted to push to go for a higher dose?

Yes incredible ignorance amongst dental profession. Original dentist just threw me out when i suggested nerve damage, I saw an expensive private endodontist as i though root canal treatment was worth trying - afterwards when he didnt work he tried to refer me to someone called a "dental psychologist" !. That rather threw me off the nerve damage scent as I just couldnt believe at the time that a top expert in his field could get it so wrong.
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Old 02-22-2014, 01:58 PM #6
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http://www.livingwithtn.org/page/info-8

Here is a link on that website I was telling you about. This page has a list of medications that are commonly used for Type 1 TN and Type 2 TN.
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Old 02-22-2014, 02:33 PM #7
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Thanks. I sounds to me like it would be worth me trying 25mg amytryptaline for a month or so as it may do me some good even at that dose and i dont seem to have side effect issues at that level. Then i may consider nudging up to say, 40mg which shouldnt zonk me too bad.
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Old 02-22-2014, 02:46 PM #8
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It is worth a try. Good luck and let me know how you are doing!
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Old 02-23-2014, 03:03 PM #9
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Im going to give another 6 weeks to Benfotiamine and R-Lipoic Acid plus B12 before switching to 25mg Amitryptaline. Theres a chance Benfotiamine and R-Lipoic Acid plus B12 may help. It would get confusing trying too much at once, if i started getting better i wouldnt know what helped and i could get side effect issues from more than 1 thing at once which could be confusing.
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Old 02-23-2014, 03:07 PM #10
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B12 needs fish oil also (a source of Omega-3 fatty acids)
to repair nerves. Two a day would be very helpful. Take with food.
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