paul grant's Page

Paul, it's been a couple of months since we've interacted.  I beg your pardon for not monitoring this thread more closely.  But stuff comes up.  We've recently learned that our 47 year old daughter has Parkinson's.  That one was a real kick in the teeth -- and another subject in which I have needed to exert serious study in her support.

 

How is your pain picture developing today?

 

Go in Peace and Power,

Red

Hi Paul,

Before you seriously consider neurectomy (cutting of the nerve), I think it would be in order to discuss whether micro-vascular decompression (MVD) might be appropriate. Neurectomy is frequently associated with later problems resulting from re-growth of the nerve or re-routing ("referral") of pain impulses through the central nervous system to alternate nerve pathways. MVD may also be applied to the occipital nerve. See for instance,

http://www.livestrong.com/article/171551-what-is-occipital-neuralgia/

Do you happen to know which of the occipital nerves your surgeon believes is your primary source of pain? There are two of them. Diagrams in the following links may give you an idea of the physiology.

http://en.wikipedia.org/wiki/Lesser_occipital_nerve

http://en.wikipedia.org/wiki/Greater_occipital_nerve

Likewise, you might want to discuss the use of multiple nerve blocks in a series. Frequently a single administration of this procedure is not effective or "as" effective as desired, but a cumulative series can be successful in blocking pain for months to as long as a year. See also: http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/headache/procedures/greater_occipital_nerve_block.html

As for a nerve stimulator... I'm less personally informed concerning the outcome statistics for such a technique. Ask your neurosurgeon for references to published work that documents the range of outcomes and side effects for the equipment he proposes to use. It is always appropriate to ask how many times the doctor has performed such procedures, and what the persistence of pain relief has been. If the doc isn't doing periodic patient surveys and keeping outcome statistics, then I would have serious reservations about using that doctor's services. Nerve stimulators are considered "experimental" -- and there's no real experiment if long term outcomes aren't being tracked.

Regards and best,
Red

Hello, Paul, You asked whether I have "much experience with" Occipital Neuralgia. As a patient advocate and research assistant for 15 years, yes I have. The range of treatments available for ON is pretty much the same as for Trigeminal Neuralgia. However, the common presentation of ON tends toward the "Atypical" form of TN, with its constant aching, boring, burning pain, rather than Type 1 with its volleys of sharper, stabbing electric-shock pain. Thus, the tri-cyclic anti-depressive drugs tend to have greater effectiveness for some patients than do anti-seizure drugs like Tegretol and Neurontin. Muscle relaxants also have a constructive role for some patients (not all).

Cymbalta is often used against Fibromyealgia. It is one of the class of Selective Seretonin and Norepinephrin Reuptake Inhibitors (SSNRI), used both in depression and chronic atypical face pain. There is some evidence in the medical literature that this class of drugs has dual actions in a chemical channel which is shared by chronic pain as well a depression, so it's not just a matter of treating your bad feelings about pain. The anti-depressive drugs are effective against pain in some patients, at doses well below the range recommended for therapeutic effect against their primary target, depression.

Feel free to follow up with other questions,

Go in Peace and Power

Red Lawhern
http://www.lawhern.org
"Giving Something Back:"

What´s Cymbalta ? I have never heard that name.
Anna

Thank you Paul. I will do the same..Brother in Christ :)

Hi Paul, I was wondering if you have tried muscle relaxers, Doc put me on flexirall 10 mgs and it seems to help a bit for me but I have to take them every six hours and it took a few days to feel a difference. I also had nerve blocks and other meds that did not do well at all. Wish ya luck

Paul,
I hope you are having a better day today.
Liz

Hi Paul,
I am sorry you are in pain. I see you have joined the occipital neuralgia group. Please feel free to ask questions. I think you will find this is a very supporting group. I agree with you. Keep tying other medicines and/or treatments.
Liz