January 27, 2003 Research for Options in Treating Trigeminal Neuralgia R.A. “Red” Lawhern, Ph.D. Webmaster – TNA Homepage –

January 27, 2003 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

January 27, 2003 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”

January 27, 2003 Trends in Visibility 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 <100 GN at Google: <30 TN Abstracts at Pub Med: <

January 27, 2003 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

January 27, 2003 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)

January 27, 2003 Research on Surgery Use of templates in Gamma Knife focus Use of Endoscopes in DMV exploration Deep Brain Stimulation (Janetta)

January 27, 2003 Research on Alternative Treatments Magnets in treatment of Sciatica (trials)

January 27, 2003 Review of Treatments – Medical Carbamazepine (Tegretol) Gabapentin (Neurontin) Baclofen Clonozepam Lamotrigin Oxcarbamazepine Phenytoin Amitriptyline Nortriptyline (Pamelor) Protriptyline Sumatriptan (cluster headaches) NSAIDS / Opoids Capsaisin (topical)

January 27, 2003 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)

January 27, 2003 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

January 27, 2003 Doing Your Own Info Research Striking Back – A Layman’s 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: Facial Neuralgia Resources: Google: –Others: Altavista, Medline, Yahoo