TN notes 2011
As with some similar items in the past, this one is mostly for me, and interested parties, to track the progress of my trigeminal neuralgia.
This year, the preliminaries have been different. Beginning in August or so, I experienced the usual warning pains pretty regularly, at a 2-3 level*. Now, however, I'm getting isolated stabs usually associated with Typical TN. That is, there would be a sudden attack of lancinating pain that lasted a few seconds, then subsided. This would happen one or twice a day, twice a week to start with, more often as fall went on. No doubt a relatively mild fall has helped. These attacks were confined to my chief trigger location in the temporal branch of the nerve. Probably about 4-5 on the pain scale, though they never lasted as much as 30 minutes. Had they done so, I'd rate them higher. Responded well to 0.5 mg of Clonazepam (I've left the 0.25mg dose far behind).
The first real episode as I've known them before was Nov. 25, the day after Thanksgiving. This was the first to follow my past pattern, with initial pain descending the temporal branch to the Gasserian ganglion, but no further. This reached a 7. Since I had the day off, I was able to retreat to bed. Required 1.0 mg of Clonazepam to get the Beast caged. For the next fortnight, it rattled the bars more insistently, with the isolated attacks. I've begun all the defence mechanisms--spending most of my time indoors, being careful what and how much I eat, drinking little, etc.
Yesterday (12/9) a full-blown episode appeared, inconveniently, at work. By full blown I mean the attacks repeated about once every 10 to 15 seconds, blowing past the Gasserian ganglion, descending the maxillary and mandibular branches, and threatening the trigeminal stem. Pain level 7 to 7-plus. I weighed up pain vs disorientation and went with the latter, taking 0.5mg Clonazepam. I figured--correctly--that this would contain the breakthrough whilst allowing me to function, since this was a half-day. The pain returned at home as the Clonazepam wore off. Took another and spent most of the afternoon in bed.
Before last winter, one benefit of Clonazepam had been that while it sometimes took as long to contain breakthroughs as breakthroughs naturally lasted (30-45 minutes), the drug left one fairly pain-free. Last winter, this often didn't happen, and so far it's not happening now. My exacerbations, untreated, are followed by a pain hangover lasting hours, usually until the next episode. It's much the same with Clonazepam now. One drops from a pain level of 7 to a 3, but one is only pain-free when asleep. Sleep usually resets the dial, and the day starts, at least, with little or no pain.
At any rate, the Beast is getting out of hand again, pretty much on schedule. This is a fascinating disorder. It helps to catalogue the signs and symptoms, because I'm long past the point where whining about it does anything useful.
As a side note, I was a skeptic about "seasonal affective disorder" almost since they named it. The coincidence of short dark days with my dueling this nasty disorder may alone account for my black moods, but I'm willing to be open-minded now about SAD.
*Note: one measurement most pain scales apply is whether NSAIDs and other mild analgesics relieve pain at a given level. When applying the scales to TN, it's well to remember that NSAIDs bounce off it like cannon balls off Old Ironsides, and that opiates might as well be sugar pills for all the good they do. Even Clonazepam's benefits have a predictable lifespan, as do those of the other mainstays I take, Tegretol and Neurontin.
This year, the preliminaries have been different. Beginning in August or so, I experienced the usual warning pains pretty regularly, at a 2-3 level*. Now, however, I'm getting isolated stabs usually associated with Typical TN. That is, there would be a sudden attack of lancinating pain that lasted a few seconds, then subsided. This would happen one or twice a day, twice a week to start with, more often as fall went on. No doubt a relatively mild fall has helped. These attacks were confined to my chief trigger location in the temporal branch of the nerve. Probably about 4-5 on the pain scale, though they never lasted as much as 30 minutes. Had they done so, I'd rate them higher. Responded well to 0.5 mg of Clonazepam (I've left the 0.25mg dose far behind).
The first real episode as I've known them before was Nov. 25, the day after Thanksgiving. This was the first to follow my past pattern, with initial pain descending the temporal branch to the Gasserian ganglion, but no further. This reached a 7. Since I had the day off, I was able to retreat to bed. Required 1.0 mg of Clonazepam to get the Beast caged. For the next fortnight, it rattled the bars more insistently, with the isolated attacks. I've begun all the defence mechanisms--spending most of my time indoors, being careful what and how much I eat, drinking little, etc.
Yesterday (12/9) a full-blown episode appeared, inconveniently, at work. By full blown I mean the attacks repeated about once every 10 to 15 seconds, blowing past the Gasserian ganglion, descending the maxillary and mandibular branches, and threatening the trigeminal stem. Pain level 7 to 7-plus. I weighed up pain vs disorientation and went with the latter, taking 0.5mg Clonazepam. I figured--correctly--that this would contain the breakthrough whilst allowing me to function, since this was a half-day. The pain returned at home as the Clonazepam wore off. Took another and spent most of the afternoon in bed.
Before last winter, one benefit of Clonazepam had been that while it sometimes took as long to contain breakthroughs as breakthroughs naturally lasted (30-45 minutes), the drug left one fairly pain-free. Last winter, this often didn't happen, and so far it's not happening now. My exacerbations, untreated, are followed by a pain hangover lasting hours, usually until the next episode. It's much the same with Clonazepam now. One drops from a pain level of 7 to a 3, but one is only pain-free when asleep. Sleep usually resets the dial, and the day starts, at least, with little or no pain.
At any rate, the Beast is getting out of hand again, pretty much on schedule. This is a fascinating disorder. It helps to catalogue the signs and symptoms, because I'm long past the point where whining about it does anything useful.
As a side note, I was a skeptic about "seasonal affective disorder" almost since they named it. The coincidence of short dark days with my dueling this nasty disorder may alone account for my black moods, but I'm willing to be open-minded now about SAD.
*Note: one measurement most pain scales apply is whether NSAIDs and other mild analgesics relieve pain at a given level. When applying the scales to TN, it's well to remember that NSAIDs bounce off it like cannon balls off Old Ironsides, and that opiates might as well be sugar pills for all the good they do. Even Clonazepam's benefits have a predictable lifespan, as do those of the other mainstays I take, Tegretol and Neurontin.
posted by Uncle | 14:14
1 Comments:
Wowzers...powerless opiates...
Post a Comment
Subscribe to Post Comments [Atom]
<< Home