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Last Updated 09/15/06














Drug Treatments for Facial Neuralgias


The use of opiates to manage pain related to Trigeminal Neuralgia, Atypical Trigeminal Neuralgia, and Atypical Facial Pain (ATFP) is somewhat controversial. Some neurologists go so far as to assert that opiates have no value in the treatment of pain due to TN, ATN, and ATFP. Some patients counter that if it were not for the relief which such agents provide, they would be dead of suicide years ago. Clearly, these extremes can become polarizing. We urge anyone contemplating the use of opiate drugs under medical supervision, to recognize the controversy involved. We likewise urge doctors to keep in mind that facial pain patients frequently suffer from more than one syndrome simultaneously. We also offer patient experience which suggests that pain patients respond in highly individual ways to mixtures of pain drugs. Like antihistamines, it is sometimes necessary to experiment and observe results, in order to find a mixture which is effective in reducing pain for a specific patient.

Over the last 20 years, in response to the "War on Drugs" the medical community was heavily policed for their prescription practices. One of the most heavily hit areas was opiate prescribing. As a result, many doctors became very reticent about prescribing appropriate pain medication. A result of this heavy control has been that pain patients -- even cancer pain patients -- have suffered needlessly. Patients and a few brave doctors have more recently been at the forefront of a relatively strong movement to educate practitioners and patients about the value of treating pain respectfully. Attitudes and public policy are slowly changing.

 In late summer 1996, a consensus statement was issued by the American Academy of Pain Medicine and the American Pain. This consensus proposes a necessary balance between the relief of pain and possible addictive process. It likewise addresses legitimate concerns that powerful opiates should not be diverted into the drug black market.

By patient and physician report, many face pain patients do get some relief from their pain with prescription opiates. It is documented that pain precludes healing, if there is a disease or injury process causing the pain. If there is no disease process evident, the benefits of relatively controlled pain may outweigh the negative impacts on the patient. In patients with the kind of overwhelming pain produced by TN and ATFP, addiction is seldom a problem. Frequently, the increase in functionality afforded by appropriate pain control will far outweigh the negative impacts of opiate use.

Face pain patients report success (success being defined not as an absence of pain, but of an increased level of control of the pain) using continuous doses of morphine and its derivatives. Please consult your physician, if you feel that you may be a candidate for opiate therapy. If he or she is adamant about the inappropriateness of this type of treatment, you might wish to seek referrals to a physician more sympathetic to the needs of patients in chronic pain.

The resources offered below may help you to understand the effects of medications which are prescribed for you. Some of the resources also include on-line assistance by physicians or pharmacists.

Doctors' Answers to "Frequently Asked Questions" - Percodan

Doctors' Answers to "Frequently Asked Questions" - Vicodan and Percocet

Oxycodone and acetaminophen-RX Monograph


MS Contin RX Monograph

Is Methadone Maintenance the Last Resort for Some Chronic Pain Patients?

Credit: Research and writing for this page by Cindy Fleishman.

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