Hi, Jessica,

Good for you for trying to help your mom with this - hard to do this kind of research when you're in pain.

Below are my notes from a TNA Conference presentation on Meds used for TN. Several TNers I know are on Trileptal, a cousin of Neurontin, that has lesser side effects. Also read through the sticky threads at the top of the forum and see if there's anything in there that helps.

As for neuros in your area, there are two TNA support contacts in LA who may be able to help you. Check under Patient Support at www.fpa-support.org

Or, Dr. Henry Gremillion is dean of the LSU Dental School and is the former Director of the Facial Pain Center at Univ. of Fla. and he would probably know any good TN-knowledgable neuros in your area. Just call and say you found his info on the TNA Web site and your mom has TN. His contact info is on the TNA Web site under Medical Advisory Board.

If you have any trouble getting through, let me know and I'll see if I can help.

Good luck to you both!
Jean


List of 20 Meds used for TN -

These are my notes from a National TNA Conference (Portland in 2006) presentation by Dr. Joseph Vaughn, a pain management doc, on Medical Management of Trigeminal Neuralgia. In 25 minutes he covered more than 20 different meds! As always, check with your doctor about anything that interests you, including dosages and combinations!

"He recommends patients keep a pain diary, and he acknowledges seasonal variations in pain. He'll use adjunctive narcotics until pain is under control and then avoids them unless necessary again. He'll adjust to test for remissions and taper to the lowest effective dose to reduce side effects if unable to discontinue them completely. Prefers monotherapy (one drug at a time) but will go to polytherapy, esp. with Baclofen (as adjunct).

Meds he discussed and my notes (which are very incomplete - for more info check your favorite drug website, or the one at the top of the page (above the flowers) Drug Info) -

Carbamazepine/Trileptal/Tegretol-XR/Carbatrol - felt to work in 70-80% of TN patients, with 90% experiencing significant relief within 48 hours (!). Note: this was where he said he rarely uses generic meds due to the variation in strength - which he said can be +/- 40%! (Could explain why some people don't get relief until they get to higher doses...just me conjecturing.)

Dilantin (phenytoin) - can be effective if Carbamazepine doesn't help (but not if there's a rash in reaction to CBZ).

Neurontin (gabapentin) - very effective, well tolerated, can titrate rapidly, take 3-6 times/day and up to 2400 mg./dose.

Lyrica (pregabalin) - New, longer-lasting than Neurontin and as easily tolerated. Good results for TN and ATN.

Baclofen (lioresal) - good booster, 2nd line med. Can be used at >300 mg./day.

Keppra (levetiracetam)- not usually front line, yet. No drug interaction so good in combination. Well tolerated.

Lamictal (lamotrigine) - slower titration. Easy to tolerate. Good if nothing else works. Don't use with Depakote --> rash!

Zanaflex (tizanadine) - good for sleep; adjunctive.

Orap (pimozide) - more effective than Tegretol, but more s/es - adjunctive?

Depakote (valproic acid) - sodium blocker, weight gain, drug interactions.

Topamax (topiramate) - good for migraines and so for TN.

Zonegran (zonisamide) - "remains to be seen" - watch for rash.

Gabitril (tiagabine) - good for 6 mos.; adjunctive.

Klonopin (clonazepam) - sedating, addictive, difficult to taper.

Clonodine - adjunctive, lowers BP, patch? Polytherapy.

Tricyclic Antidepressants (Elavil, Pamelor, Desyrel, trazodone) - sedating - use at bedtime. Adjunctive.

Selective Serotonin Reuptake Inhibitors (SSRI antidepressants) - Prozac, Lexapro and Celexa are rarely effective in treating pain and could make worse. Cymbalta, he said was disappointing in his practice except for some for severe, lancinating pain. Zoloft and Paxil sedating - good at bedtime.

Namenda (memantine) - Calcium Blocker. New one - very exciting, he says, but remains to be seen how good for TN.

Campral - New and untried, but exciting.

Cytotec (misoprostol) - no serious side effects, easy to use.

Topical Capsaicin - can be effective and used with oral meds but messy - requires gloves. "

There were also talks on Compounded Transdermal Delivery (custom formulated creams) and Botox injections. So there are more and more things to try, folks. Do your research and if something looks good, bring it up with your doctor.