It’s Not Just Kids Being Kids… Recreational Drug and Alcohol Use

This may be a little jarring to those of you with younger TNKids, but we are in contact with families of kids up to age 20, and not so out of the realm of possibility at all for older teens.  It may also seem inconceivable given how poorly your child is doing and the fact that you are with them all the time.  However, if your child’s pain is managed with medications for periods of time, this may come up.

DISCLAIMER:  First, we are not here to tell you how to parent.  That’s not our place, or the purpose of this site, and we aren’t trying to do so.  By posting this, we are not making a statement either way in regard to allowing or not allowing your child to use alcohol and recreational drugs.  We may or may not have strong feelings on this individually, and as the 4 of us TNMamas together.  HOWEVER, it doesn’t matter one way or the other for the purpose of this post.  Any comments degrading other parents will not be approved for post.

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Especially those of you with older teen TNKids may have kids who have experimented with alcohol and drugs.  This may be with or without your knowledge and/or permission.  If you have a child who is not wrestling with the TN beast, and all the medical issues that come along with that, this leads to family discussions, rules, policies, maybe punishments, whatever.  However, if your child is a TNKid, there are more issues involved that need to be considered, and that is what we are going to discuss here.

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Greater Risks with Recreational Drug & Alcohol Use for TNKids

Drug interactions:

First, you and your child need to understand the very real and extremely serious dangers of combining the medication they are on for Trigeminal Neuralgia with alcohol and recreational drugs.  What seems like an evening of ‘teenage fun’ or ‘rebellion’ can lead to reactions with long term consequences and even death.  Did you read that?  This is NOT something to be messed with.

According to drugs.com here one of the most common TN drugs, Carbemazepine/Tegretol, when combined with alcohol leads to “increase nervous system side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with carbamazepine.”

It says basically the same thing for many, if not all of the medications prescribed for Trigeminal Neuralgia.  Ingesting alcohol while on these medications worsens the side effects of the medications, including:  dizziness, confusion, insomnia, headache, visual disturbance, loss of motor coordination, etc.  This also includes the rare but serious side effects such as: chest pain, difficulty breathing and seizure.

This is true and even more unpredictable with recreational drug use.

According to the National Institutes of Health, as much at 25% of ER visits have drug/alcohol interaction as a contributing factor.  Linked here.

One evening of poor judgment can be very, very bad when combined with these medications.  Talk to your child about this.  Impress on them the seriousness of the consequences of this decision.

Another note:  Depending on what prescription meds your child is taking, these interactions can be true of things as innocuous as cough syrup.  So you need to be considering side effects and interactions with even the simplest of other medications.  We recommend asking your prescribing physician about safe over-the-counter options for any needs you may have.

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Greater Likelihood of Hospital Screening

When your child is wrestling with Trigeminal Neuralgia, the truth is that they will be seeing doctors and having tests, including blood tests, more than the average young person.  Much more.  And it will at times be very unpredictable.

That means that if your child thinks they can sneak one night and no one will know?  The odds are much higher for your child that someone will find out.  If you find yourself in the ER or at the doctor’s office the next day  – or even for some things (such as cannabis) up to 30 days later – they may wind up with a positive drug screen.

This can wind up being a very big mess.

First, pain patients often run into problems with being suspected of being drug seekers.  This can cause them to be turned away from ERs, pain management offices, or doctors who are in fear of feeding an addiction instead of treating a patient.  (Agree with it or not, it happens.)  If your child shows up positive for recreational drugs in their system, or with the morning after evidence of underage drinking and partying last night, this will wave red flags in front of medical professionals.   Some systems have very strict rules about this, and even if they still want to help you, medical professionals will face problems with doing so.  You don’t want to find yourself in a position where hospital systems refuse to give your child the help they need, or delay it substantially.

Second, with repeated visits to the ER with a minor on multiple medications, social services have been called on at least a couple of our families even without any drug or alcohol use.  Because these families were doing nothing wrong and were following proscribed usage of their medications – and nothing else – these situations were resolved as well you could hope for (though it is infuriating and a subject for another post!).  HOWEVER, if you show up in the ER for help and your child is shown to be “self-medicating” this could be an entirely different battle with a much worse outcome.

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Pain Patients have Greater Likelihood of Addiction Struggles

The last thing I’m going to mention is the longer term risks of recreational drug and alcohol use for our fighters.  See one study here.

The sad truth is, as chronic pain patients, our kids have a greater likelihood of struggling with addiction.   When I watched my daughter in the excruciating pain of TN, I could easily see how this could happen.  Who wouldn’t want an escape from that?  But what may just seem like a momentary escape can lead to a long term battle that snowballs the issues listed above.  As parents, we need to be aware of this risk, and fighting this battle for and with them.  We should also be talking to our kids about the long term ramifications of a momentary decision.

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It may seem like ‘no big deal’ or ‘normal teen rebellion’ to many, but for our kids (and even in some ways adults in this battle) it carries a much greater risk.  Talk to your kids.  Talk to them even if – and maybe best if – it can’t possibly be an issue at this point. Teach them about the dangers, risks and consequences they face beyond what most kids face.

Hugs to you families.  Fight on.

Why We Chose Microvascular Decompression (MVD)

My family and I have been asked by many people, for many different reasons, why we chose to pursue Microvascular Decompression for our daughter.  Friends and family were curious and trying to understand this crazy journey we are on.  TN friends and family are looking for information and to see if there is something to learn from our thought process. Others thought we were a bit crazy for jumping straight to the big, scary treatment for TN, even doctors we were going to.  But let me explain…

KatieRose before her 1st MVD, just days after her 12th birthday.

Before the first surgery, a rather small dose of Trileptal was managing KatieRose’s pain quite well.  So I can understand the questioning.  After all, if your choices are “invasive brain surgery” or a couple of pills twice a day, it seems pretty straight forward, right?  But it really isn’t.

We were told we should stay on medications, and this “is a disease of desperation.  Stay on these meds until they stop working.  Then we will add something else in.  When that stops working, we will switch to something else.” (My emphasis added.)  And that was from a neurosurgeon who would not perform MVD on KatieRose, because he didn’t see a compression on her MRI.  I was told this was just to be her life now.  I sat in my husband’s office and lost it.  I cried and sobbed.  I was absolutely defeated.  I did not want a life on these meds, with a future of more medications and breakthrough pain, to be our girl’s path.

We had been turned away from 2 neurosurgeons for MVD with KatieRose, so initially it wasn’t even an option.  Then we cold called Dr. Ben Carson’s office at Johns Hopkins and after a consult and new MRI  he told us that while he still didn’t see a compression, from her symptoms he really thought he would find one if he went in.  He was willing to do exploratory MVD if we were.  After recovering from my surprise (I took his call while driving down the road and had to pull into a parking lot until my brain could catch up!), and some discussions and prayer with hubby (exploratory brain surgery?!) we decided to go for it.

Following is the list of reasons my husband and I developed for pursuing MVD with KatieRose:

  1. There is no guarantee she is ever going to go into remission.
  2. If she does go into remission, it is temporary. It will come back.  The longest remission I’ve read about or heard about is 6 years.  It is overwhelmingly likely that, if she had a remission at all it would be short lived, in the range of a few months.  Then we are right back at this decision.  If she was fortunate enough to get a really long remission, that would make her how old – 16? 18? –  when it came back.  Is it going to come back and have us right back in this same place when she is a new driver? graduating from High School?  Or maybe our remission is amazing, and it’s when she’s graduating from College?  Getting Married?  Pregnant with her first child and can’t be on meds to help with the pain?
  3. These meds are not good for many reasons. For one thing, her academics are really hurting.  She has worked 3 extra hours a week with a private tutor – for three years – to read on grade level, and these meds are taking that all away.  And making her withdrawn and not herself.  For another thing, no one can tell me what the long term effects of this volume of medication is on a developing brain, but I can tell you no one is reassuring when I bring it up.
  4. We don’t like these meds, and they are escalating much more quickly than I am happy with. At this rate, there is no way these are going to be effective for the next 5 years, much less the 70 years we still have to manage TN.
  5. Other procedures are damaging (palliative is the medical term). That means they are going in and damaging part of her nerve to stop the pain.  But they are temporary, and it is assumed the pain will return and the nerve will have to be damaged again.  And again.  Each successive time the nerve is damaged increases the chances of nasty side effects that include permanent facial numbness and/or pain.  That is not a road I am ready to start down with my 12 year old.
  6. MVD *after* any of these aforementioned palliative procedures has a lower success rate, so doing any of those now hurts the chances of MVD being successful later.  Depending on what it done and the progression of her pain, MVD may not even be a viable option after years of other treatments.
  7. Right now, she is 12 and in 6th grade, and I can carry her through this.  If she misses some math class, no big deal.  We can make that up.  I can get her to appointments, get her home, care for her in her own home while she heals.  These things won’t always be true of her life.  Are we looking at juggling this surgery in college?  When she has her own kids?
  8. MVD is the only procedure that is directed at removing the source of the pain – any compression – also preventing continued damage to the nerve. MVD is the only procedure that does it’s best to not damage the nerve in the process.  MVD’s “success” is defined as pain-free & medication free for 6-10 years, which is a higher standard than any other procedure.  And I have spoken with 2 people who are at 20 years and counting, and heard from another who is at 30+ years.  It’s a shot.
  9. I understand that this may seem a drastic step. But I have to make decisions for her right now that are good decisions for the rest of her life.  TN has no cure right now.  I understand that.  But  I have to make a decision now that not only helps her pain now, but does the least damage with the long term in view.

This list of reasons still stood, even though that first MVD wasn’t successful and relapsed after 8 months.  We found ourselves with Dr. Mark Linskey at UCI Medical Center for a second MVD.  There is more to that decision, but that’s a story for another time.

In the interest of honesty here, the fact that we had reasoned this all out and were as sure as we could be of our decision, doesn’t mean I didn’t have some sleepless nights leading up to her surgeries.  It’s a big thing to hand your child over to a neurosurgeon.  Twice. There were still nights all the ‘what ifs’ plagued me.  But those things didn’t change the above, it just meant I was human, and I was afraid.

I realize that not everyone is  a candidate for MVD.  However, I do encourage you to get a second and third opinion, at least, if you have heard that your child is not a candidate.  Whether or not you are a candidate should be determined by a very thorough evaluation of your child’s pain by a top neurosurgeon who works with Trigeminal Neuralgia patients regularly with success.  We will be posting a list of questions to ask a potential neurosurgeon in the near future.

I wish all of you on this journey many pain free days ahead, and a cure for us all.

The Power of Not Being Alone

We have had an amazing experience this week.  We have a secret little corner of Facebook for parents of TN patients.  We share info, ask questions, and sometimes vent at the basic wrong-ness of having a child fighting this beast.

A couple of weeks ago, one of the families posted that they would be in CA for a doctor’s appointment with one of the doctors a number of us have traveled to see, would anyone else happen to be there at the same time?  Astonishingly, 7 families would be there about the same time, with ~40 hours of overlap.

So coordinating went into overdrive, and literal spreadsheets of schedules were made.  We unfortunately were unable to get all 7 kids together at the same time. But we did get 6 at one time, and then swap one child out and another in, and have 6 another time.

If you are a parent of a TN Kid, you need to talk to other parents of TN kids.  I can not tell you how beneficial this can be.  The first night when we got 6 families together, we were in an Italian cafe, and we toasted not being alone, and we shut the place down together that night.  It is powerful to not be alone.  To say “the pain” to someone, have them reply “I know.”  And they really do.  Really.  They’re not comparing it to that bad headache they had last week.  To meet others who are tearing up – Moms and Dads – because they have been fighting the same battle with their children.

You are not alone.

And you know what?  Your child needs to connect with other children with TN.  Because THEY ARE NOT ALONE.  They are not the only one.  They are not weird.  (Well, ok, they may be weird.  We have plenty of the best kinds of weird running around.  But it’s not because of the TN!)

It can be awkward: texting, skyping, whatever, with far flung other kids your child doesn’t know.  All of the kids who have done so have been hesitant at first.  Most of the actual “texting nights” have been precipitated by one of the kids being in a particularly bad place, motivating the other kids to throw caution to the wind and jump in.  And every one of them have said it was really awesome, and not nearly as awkward as they were worried it would be by the end.

They are not alone.

Don’t be alone in your fight.  If you want to get more connected with other TN families, you can email us at TNKidsRock@gmail.com.

TNKidsRock the News!

In a very last minute coordination, we were able to arrange a follow up interview with Eileen Frere of KABC news channel 7 this afternoon. Tracy and Ang were both there also, so the interview was with all three of our TN Kids!  To see the segment, check it out here.

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We are SO THANKFUL to Eileen Frere for following our story since we first met the day before my girl’s 2nd MVD.  She has always been quick to do a follow up with us, and has been thankful right along with us to hear of the number of kids and adults who have found hope, and even another avenue of treatment, through this story.

If you find yourself at the page because of seeing the story, welcome!  Thank you for your interest in Pediatric Trigeminal Neuralgia.  This site is newly launched, and we are just populating it.  Keep checking back for new information.

If this story has touched you, and you want to DO something – here’s what you do:  Go to The Facial Pain Research Foundation and make a donation of any amount at all.  This is the only organization researching specifically for a cure for Trigeminal Neuralgia.  Michael Pasternak is not only the founder of the foundation, but also a TN patient himself, and a dear friend.  The foundation is 100% volunteer, and is funding 3 different research projects right now – not counting the one that is so promising it has now been picked up for funding by NIH.  If you make a donation and mention TNKidsRock, Michael will know it is because of our work and send us a note letting us know it happened.

If you are a TN Patient, welcome, and gentle hugs to your non-TN side.  We fight on along side you, and are working for a cure for all of us.  For more info on Facial Pain and TN, check out TNA – The Facial Pain Association, including upcoming conferences where you can not only meet others with TN, but hear leading medical professionals talk about their work in the field.

If you are here as the family of a pediatric TN patient… You are not alone.  I know it feels that way so much of the time.  Pediatric doctors usually have never seen a TN patient before, and you are all learning together.  There are many unique challenges you will face, and you have to think about treatment differently than an adult patient.  We want to be here to walk alongside you, share knowledge, and learn together.  You can contact us through TNKidsRock@gmail.com.  Hugs to you.

To all in the TN world, fight on.

~Meg, Ang, Tracy & Stacie

The Pain Journal

I’m so sorry to be making this post.  I’ve stopped several times and had to walk away.  It’s hard to talk about the reality of the pain your child is going through.  At times you develop a clinical distance from the emotional part of it, because you have to in order to get through the conversations you have to get through.  But other times, well, that’s just impossible.  This is a very, very hard topic.  Yet it is also very important.  So we will discuss it.

One of the things we recommend is keeping a pain journal. If your child is younger, this will be you, asking questions and writing things down. If your child is older – or as your child gets older – this changes to them tracking this information.

The information in your journal is an extremely helpful diagnostic tool. When your child has pain like this, you think you will never forget, and in a way that is true. But after months of dealing with TN, things do start to run together.  Details get lost in the pile of details you are having to stay on top of every day.  So it is truly important to write details of the pain down.

The pain journal will allow you to go back and analyze things like: How did she react to that medication? or Is this action becoming a consistent trigger? How long has this new pain been involved in attacks? How often does she get attacks in the middle of the night? Is his pain more stabbing or throbbing or boring? Are these attacks getting longer? Or more frequent?

This information is very valuable to your doctors, and the more detail you are able to give a good doctor, the better diagnosis you will get. For several of us, our (or our child’s) ability to specifically describe the pain expanded the exploration during brain surgery, and caught compressions on other nerves that may not have been caught without that information.

Your doctor may or may not want to actually review your pain journal. However, I strongly recommend not only taking it to the appointment and referring to it, but reviewing it before your appointment and marking significant changes and/or anything that sparks questions for you.

So – what should be included in the pain journal?

The basics should always be included:

  • The date
  • What time did pain start and end?
  • What type of pain is it? (stabbing, throbbing, etc.)
  • Where was the pain located? (The more specific the better.  Does “ear” mean in front of the ear?  Or inside the ear?)
  • Is the pain constant? Or are there breaks?  Or are there both components?
  • Where was it on a scale of 1-10? (You will get this question A LOT.)
  • Was there any action immediately prior to onset that could be a trigger?

It’s also good to include information such as:

  • The current regular medication dosage. I would always note the day that we changed dosages and highlight it.  That would make it easier to find later.
  • Any medication taken for breakthrough pain, and dosage.
  • Whether breakthrough medication helped or not.
  • Things that may help you narrow down triggers: location, weather, eating/drinking, etc.

As far as what you should use, it can be as simple as a pocket –sized notebook, that’s all I used.  It fits in the purse, it goes everywhere with us.  Or as sophisticated as it helps you to make it.  The biggest thing is for it to be something you will have with you, and you (or your child) will use.

On the Resource Documents page is a downloadable spreadsheet called Jen’s Pain Journal, which one of our dear TN Mama friends developed for her teen daughter to use.  With it, she need only fill in blanks, and circle the correct information.  During pain, the quicker and simpler, the better.

When they are experiencing pain, it is sometimes very hard to impossible for our kids to communicate details clearly.  There were times I would just have to wait and cry through it with her, then once it was finished – or at least less – she would go through and answer questions for me.  Sometimes I would make notes of body language, and ask her about it later.  When she was actively trying to claw through her mattress and sobbing, I didn’t have to ask where she was on the scale.

It became a weird kind of sixth sense, to be able to look at her body language and mentally guess pretty close what level her pain was at.  For my daughter (and yours may be different, so don’t necessarily go by this) talking, school work, and life as normal could continue up through a “3” pretty easily.  Quiet and eyes closed happened at about “4”.  Fidgeting started around “6”.  Tears around “7”.  And I don’t like talking about the top of the scale, which seems to me to shoot past “10”.  Her scale also changed over time as she developed a high tolerance for pain.  I guarantee you that her “2” is not my “2”.

This can be a hard thing to do.  Who watches their kid in pain and takes notes for goodness sake?!  I know. Really.  At the same time, a good neurologist and neurosurgeon are going to be really helped by the details.  That part will be entirely worth it.  Once we started going to doctor after doctor, and they would ask so many questions about the pain, my girl became very cooperative in making the notes.  If I didn’t ask the right question, she would tell me about some new piece needed to be noted.

Again, if you are reading this, I’m sorry.  You’re probably doing so because you or someone you love needs this information.  It’s not an easy place to be.  We wish you all the best in your journey.

Semi-Related Articles

These articles are not necessarily specific to TN, but are good reads relating to the journey of chronic illness, chronic pain, illness in children, or being the parent/caregiver.  Some may help you understand your child better.  Hopefully some will resonate with you about your experience.

1. Why You Should Never Ask ‘Have You Tried…?’

http://www.huffingtonpost.com/lottie-v-ryan/why-you-should-never-ask-_b_6057062.html

My Child has Trigeminal Neuralgia, Now What?

Let’s talk about the first steps you need to take now that you believe your child may have Trigeminal Neuralgia.   Thank you to Stacie for developing the initial list on this!  I’ve added and augmented to create this post.

  1. Start keeping a Pain Journal

There is an entire post dedicated to this, so I won’t go into a whole lot of detail here.  However, it is important to get started on this.  The details of how and when the pain starts, the details of how it feels during, whether it’s constant or your child gets “attacks”, if the pain is over the eye, in the eye, in front of the ear or in the ear, etc. will be very important to a good diagnostician.  Grab any notebook, or the downloadable pain journal sheets we have posted, and start tracking the details of your child’s pain.

  1. See a Pediatric Neurologist

This is very possibly who diagnosed your child, but if not, this is where to start.  A neurologist is the one who should really go through your child’s symptoms and determine that it is in fact Trigeminal Neuralgia.  S/he should also do a full neurological evaluation to be sure there are not other symptoms that should be discussed.  These tests are, for the most part, noninvasive and include a lot of “does this feel the same as this” and “walk this way” and “stand on one foot” kinds of things.

Your Pediatric Neurologist can be your best friend.  If you can successfully partner together and maintain regular, clear communication the two of you can determine the best medication(s) to manage your child’s pain.

That being said… Pediatric Neurologists are not trained the same as Adult Neurologists.  I don’t mean this s a criticism, it’s just a reality that needs to be recognized when you are dealing with an “adult” condition.  They have almost never had the need to be well versed in conditions that are rare in the first place, and also considered by text books to be an “over age 50” affliction.  If you think about it, it wouldn’t make a whole lot of sense logically for them to spend all their time keeping up on conditions they will encounter so rarely, if at all.

You may think it would be better to just go to a regular adult neurologist, and you may be right.  However, in our experience it is very, very difficult, if not impossible, to find an adult neurologist who is willing to take on a pediatric patient.  So, in reality, we find the best situations are where parent and pediatric neurologist are working together to actively understand their child/patient’s situation, and find the best options for treatment.

  1. Get the right MRI.

It is very likely that one of the first things your Peds Neuro is going to want to do once they determine your child’s pain seems like Trigeminal Neuralgia is an MRI.  This will look at the overall brain health and rule out certain possible causes of TN, such as tumor pressing on the nerve.  Trigeminal Neuralgia is also a symptom, and sometimes an early symptom of Multiple Sclerosis.   An MRI cannot definitively determine MS, but can give an indication of whether further investigation in this direction is warranted.

However, we have run into a number of cases – including among us! – where the wrong, or at least not the best, MRI is ordered.  Following is a quote from our neurosurgeon in the MRI to get:

Every center calls it a different name. It also varies according to machine manufacturer. At UCI we call it a ‘with & without contrast cranial nerve protocol MR’. It includes general FLAIR & T2 non contrast scans to rule out Multiple Sclerosis. It includes SPGR contrast tri-planar thin cut (1mm) and magnified posterior fossa images. Most importantly it included T2 volumetric acquisitions with 0.8mm slice thickness in all three planes. Depending on the machine manufacturer, these latter series can go by the name of CISS or FIESTA. This last series in my opinion is the most important and informative for identifying vascular contact.

We will have another post on MRI results and the complicated discussion that can be.  For now, let’s leave it here.

  1. Start on anti-seizure medications.

The first line of attack as far as medication goes for Trigeminal Neuralgia are anti-seizure medications, the same meds that are given to epilepsy patients.  These have been found to be most effective for those suffering from classic Trigeminal Neuralgia.  These medications include:

  • Tegretol (Carbemazepine)
  • Trileptal (Oxcarbazepine)– a “brother” of Tegretol shown to have fewer side effects for many
  • Aptiom/Zebinix/Exalief (Eslicarbazepine) – the most recent derivation of Tegretol, hopefully even better than Trileptal when it comes to side effects.
  • Gabapentin (Neurontin) – while the above work to stop the Trigeminal Nerve from being triggered in the first place, Gabapentin works to shut down a trigger if it does occur. For this reason, Gabapentin is often used in combination with one of the above, if the pain is not as well managed with just the one medication.

One of these medications may be prescribed on the first visit to the neurologist, even before the MRI is ordered.  (However, we would recommend asking for both the prescription and the order for the MRI as soon as “Trigeminal Neuralgia” is on the table.)  Having the pain respond well to these medications is often used a s diagnostic indicator for TN: if several days after beginning the medication your child’s pain is measurably reduced, it is further proof you really are dealing with Trigeminal Neuralgia.  However, there is a lot of variation in response to medications, so not responding doesn’t necessarily mean you are not dealing with Trigeminal Neuralgia.

An important note on these medications:  These medications are made to work when being consistently taken, and take 3 to 5 days to build up in the body and effective at the dosage.  Therefore, you need to take them on a regular schedule, and not expect for them to start helping for several days.  This also means that taking a dose at the onset of pain will not help that pain.  (There is a fast-acting Tegretol pill, and that is a different situation.)  It also means if the pain goes away, the medication is working and you should stay on it, unless your doctor is in agreement on attempting to wean off or to a lower dosage.  Weaning off should be done carefully, and under a doctor’s supervision as the sudden stopping of them can actually cause seizures and other nasty effects.

Also, again just from our experience and WE ARE NOT MEDICAL PROFESSIONALS, we have found that not throwing a number of different medications at this at one time is very helpful in determining what is actually working and not.  Plus, the drug interactions start stacking up and it can quickly get very complicated when you just need an over the counter cough medicine one day.  Over time these kids may wind up needing drug cocktails of multiple medications, but the slower the progression of that, the easier your life will be.

Note on Steroids:  It is not unusual for a short dose steroid pack to be recommended.  Trigeminal Neuralgia, while not at its root caused by inflammation, can be aggravated by inflammation of the nerve due to some other health issue.  Some kids find that an “increased flare time” can be helped somewhat by a short-term steroid, if some form of inflammation of the nerve is causing their pain to spike or occur more frequently.  Even post-surgery several of our kids had their TN pain kick up, only to find later they were fighting a cold, bronchitis, or ear infection that also happened to inflame their damaged/healing nerve.  The steroids may be worth a shot.

We will say more about life on these meds in another post.

  1. Keep your child’s overall health and immunity functioning well.

As our neurosurgeon has explained to us, damaged nerves can be affected by Sickness, Stress, and Sleepiness.  Therefore, it is our goal to minimize those things in our children to avoid making a tough situation even worse.  This means doing those “healthy lifestyle” things that were always good suggestions before, but maybe allowed to let slide more than you want to now.  So keep in mind things like:

A solid 8 hours of sleep a night.  Or more.  Pain, medications, and the upheaval your child is going through right now take a toll, so 8 hours is a guideline.  In our (Megs) house, we made sure our girl got to sleep at a reasonable hour, and let her naturally wake up in the morning.  I realize not everyone’s life allows for that, but seriously look at your schedule and make sure enough sleep is gotten at night.  Also, the medications, especially at first, tend to really cause exhaustion.  So don’t be surprised if LONG nights sleep and naps are needed.

Nutrition is important.  On high pain days we would often allow treats and not be strict at meal time.  And that’s totally understandable.  When your child just spent hours in intense pain, how do you say no to chocolate dessert?  However, overall, really try to keep them on a balanced diet with good vitamin-rich foods, and add a multi-vitamin if they are not on one already.  Their bodies are carrying them through a lot and need the strength to do so.

Avoid exposure to communicable sickness.  A bit of a cold can really amp up their pain because of the aforementioned inflammation issues, and complicate their TN in ways you won’t anticipate.  Our girl had the worst time with a congested cold because breathing over her teeth was triggering her pain, but she couldn’t breathe through her nose.  While your child still has to have a life, and still has to see friends and enjoy themselves whenever they can (that’s a topic for another post!), be conscious of the ramifications of those decisions and use wisdom.

Avoid excessive stress.  I hate even listing this one, because we all know if you are wrestling TN, stress has moved right into your house and camped out in the living room.  However, just keep this is mind.  An overload of stress can cause damaged nerves to fire up, causing pain.  So whatever helps your child with stress relief, try to build it in to life.  A little exercise if s/he is up to it?  Curling up on the couch and watching a movie with you?  A good back rub some time?  Listening to their favorite music?  If you notice a higher level of stress coming from them, try to learn their stress relief needs and suggest it.

You may think it’s going to be really hard to get your child to go along with these things, and I’m sure there will be days it’s a real pain.  We found though, that when we framed the issue with minimizing TN attacks and pain, we had a far greater cooperation.

  1. Try a variety of pain management techniques.

There are probably as many strategies for dealing with the pain as there are TN patients, so experiment.  It is pretty common for TN patients to want darkness and quiet.  Often they can’t stand to be touched.  Other possibilities are movement, vocalizing (otherwise known as moaning/yelling), heat or cold packs, etc.  At some point we will dedicate a post to a master list of things to try.

In the meantime talk to your child some time when they are not in pain about their ideas and be prepared to try it when needed.  We slowly built a standard assortment of things she wanted with her during pain.  Her favorite stuffed animal.  Her own pillow.  Super-soft blanket.  Box of tissues.  Pain journal & pen (for mom).  Moms cell phone in case we need to text/call doctor.  We literally hauled these things wherever we went – which was mostly doctor’s appointments – during the bad times.

Hopefully this will help you get started as well as you can.

Hugs to you.