
6.1 A Summary of Research on Medical Marijuana for Neuropathic Facial Pain

Trigeminal Neuralgia Association Australia are delighted to provide our link to the webinar presented by Dr Jeremy Russell in Dec 2022.
This webinar completes our program for 2022
Dr Jeremy Russell is one off our distinguished Medical Board Advisors, and has generously provided his time and expertise to assist all sufferers of trigeminal neuralgia.
 TNAA Webinar – Dr Jeremy Russell Trigeminal Neuralgia Treatment Options – YouTube
Our Vice President and Tasmania support group leader, Helen Tyzack, updated her group about neuromodulation for trigeminal neuralgia back in 2021. She has provided the information she gathered, and we hope it may provide education and understanding about this treatment
Neuromodulation. In italics below I have added the contents of emails I previously sent to all those on my database. The first email was dated 22nd May 2021.
Yesterday it was exciting to watch and listen to the Webinar from the USA at 9am; chaired by the president of the Facial Pain Association of America Dr Jeffrey Brown interviewing a Member of their Medical Board, Dr Konstantin, (an expert in neuromodulation of facial pain). Previously, thanks to member Peter, I had sent you the information for you to link in. I received an immediate response yesterday from Peter after the Webinar and I wonder how many others took up this excellent opportunity.
 This free opportunity was excellent but whether it was useful depends on your circumstances. So, what did I learn?   In brief,
Main point:Â Not every treatment will work for every person. No treatment will work all the time.
 I am fortunate at the moment not to be taking medications or in pain. But I am mindful that the time will come when the pain returns. This Webinar was helpful because I now know more about my options for managing the pain. In Tasmania where would I go for advice? I would be talking with members of the Trigeminal Neuralgia Associations of Australiaâs Medical Advisory Board.
My second email was dated 10th August.
A few months ago, I told you I had listened to/watched webinars on the topic of Neuromodulation as a treatment for Trigeminal Neuralgia pain. Afterwards, I set out to determine if a specialist might come to Tasmania and talk to people in our Support Group and any others who might be interested.
Since then, I have been exchanging emails with Dr Nick Christelis, the President of the Neuromodulation Society of Australia and New Zealand. Recently, we talked by phone about the options, but a visit to Tasmania by a specialist to meet with TN sufferers is not on the cards. However –Â
Firstly:
Nick confirmed there was not a specialist in Tasmania, but he explained that he had used neuromodulation on patients with Trigeminal Neuralgia. He would welcome contact from any Tasmanian sufferers and be prepared to do an initial Telehealth consultation. His contact details are on the website: https://painspecialistsaustralia.com.au and his consultation and surgical location is within Warringal Private Hospital in the Melbourne suburb of Heidelberg, Victoria. Phone 1300 798 682. If you read through this page and watch the video, then you will understand more about the services he offers. His site has this to say about Nick:
Nick now practices 100% within the field of pain medicine. He is an interventional pain specialist combining a multidisciplinary team approach with advanced pain interventional techniques like nerve and joint blocks, epidural injections, radiofrequency ablation, pulsed radiofrequency, spinal cord stimulation and other advanced neuromodulation techniques.
Secondly:
Nick explained that a quarterly webinar is offered from within his organisation and can be accessed on the bellow link
Please note that I have no experience of neuromodulation and no experience of Nick’s capabilities, so this email is not meant to be a recommendation. Rather, I am letting you know about this option, in case neuromodulation is a process which could improve your quality of life.Â
If you decide to try this, I would be very interested to know what the process is and all the ins and outs. Not to mention whether it was useful for you and reduced, removed your pain. I am sure other sufferers would also be interested so please keep me posted.Â
For facial pain sufferers in other mainland states, I recommend you read through the Neuromodulation Society of Australia and New Zealand website to find specialists close to you.
Extra Q&A after the recent webinar on neuromodulation pain management produced by the USA Facial Pain Association
1. Can a TENS unit applied somewhere help? Is the concept of neuromodulation similar to using a TENS unit? thank you.
The TENS is indeed one of the types of neuromodulation, and we do recommend trying it in patients who can tolerate placement electrodes onto painful regions. It tends to be much less effective than other neuromodulation approaches, but is definitely worth trying due to its low invasiveness. Keep in mind, that pain that does not respond to TENS may still be relieved by invasive neuromodulation with implanted devices.
2. Explain the relationship between neuromodulation and neuroplasticity?
Neuromodulation in many ways relies on neuroplasticity â we are trying to modify neural activity by adding neuromodulation signals, and neural plasticity plays a major role in cooling down hyperactive parts of the nervous system that are responsible for development of pain in the first place.
3. âExplain foramen ovale stimulation?â Whatâs the difference
I am not aware of âforamen ovale stimulationâ â most likely, the procedure which is referred here is the stimulation of the trigeminal ganglion (Gasserian ganglion) that is reached through foramen ovale. This approach is known for many years but is rarely used, mostly because it is difficult to keep electrodes in that location as they tend to migrate over time. In principle, however, the trigeminal ganglion stimulation is a very effective approach to control neuropathic facial pain and may be considered if the pain involves several trigeminal branches at once.
4. Can it be used for a patient with a pacemaker?
Yes, neuromodulation can be used in presence of pacemakers and defibrillators. Your doctors need to be aware of these devices so the proper precautions may be made in choosing the device and its location in the body.
5. What is the success related to pain as a result of acoustic neuroma surgery/radiosurgery?
The mere presence of acoustic neuromas, the surgery to remove the tumor, and sometimes radiosurgery for the tumor may result in development of facial pain. Sometimes it presents as secondary trigeminal neuralgia and its treatment resembles trigeminal neuralgia management algorithm, but in some cases the patients develop trigeminal neuropathic pain or occipital neuralgia, and these conditions may great indications for neuromodulation.
6. Would it help with Geniculate Neuralgia?
The pain of geniculate neuralgia has not been investigated as an indication for neuromodulation, or at least I have not heard of it. The classical geniculate neuralgia may require either microvascular decompression or, more often, an open rhizotomy of nervus intermedius â this is what I normally recommend to my patients.
7. Once implanted, can the patient stop taking medications?
Yes, it is possible â but we usually start considering weaning pain medications only after the patients report symptomatic improvement from neuromodulation. Majority of patients are able to significantly reduce the amount of their pain-relieving medications as a result.
8. How much experience does Dr Slavin has with this? How many has Dr Slavin done?
Neuromodulation is a large part of my practice ever since I completed my fellowship in 1999 â and I do between 100 and 150 neuromodulation surgeries every year. Very few of these surgeries are done for facial pain as most facial pain patients I see end up having other interventions, including microvascular decompressions, percutaneous rhizotomy, radiosurgery, etc. Most neuromodulation surgeries in my practice are still done for pain in lower back and extremities, Parkinson disease and tremor, epilepsy and other functional neurosurgical conditions.
9. If I had an MVD without any pain relief, would this help?
Neuromodulation is generally recommended for trigeminal neuropathic pain and not for trigeminal neuralgia. If the patientâs typical trigeminal neuralgia did not improve with microvascular decompression, we would usually consider either repeating the decompression or proceeding with percutaneous interventions. If the pain is non-neuralgic but rather neuropathic in nature, neuromodulation would be an appropriate thing to consider.
10. Are the electrodes ever implanted into the brain and if so, where?
The brain stimulation for facial pain is usually reserved for patients with anesthesia dolorosa â the electrodes are placed either over the surface of the brain (so called motor cortex stimulation) or in the depth of the brain in the area of thalamus or brainstem (so called deep brain stimulation).
11. I am just finishing TMS therapy. It has not helped me. I like Dr. Brownâs suggestion to âadjust the magnet.â How can the Dr. find the correct âspotâ for neuropathic pain?
It may be challenging to find the right spot for TMS. We usually recommend finding the face representation in the contralateral motor cortex or focusing stimulation at pre-motor area (which is used for treatment of depression).
12. Following left craniotomy for Trigeminal Schwannoma I have a mix of numbness on lower jaw but extremely sensitive and continuous pain on temple, cheek, and upper jaw. Is the neuro modulation compatible when both numbness and sensitivity are combined?
To answer your question, it would be important to find out whether the numbness is complete or partial. Stimulation of peripheral branches may help in case of partial numbness. Complete numbness may necessitate stimulation of the uppermost cervical spinal cord, the deep brain structures or the motor cortex.
13. Hi, I have a question from the webinar. Dr. Slavin described neuromodulation, if I understood correctly, as an option for trigeminal neuropathic pain but not trigeminal neuralgia and described TN2 symptoms as neuropathic pain. Just to clarify before I get my hopes up, is âtrigeminal neuropathyâ the same thing as TN2?
Trigeminal neuropathic pain is different from TN2 but there is certain overlap between them. As a matter of fact, about 20 years ago we published a theory that postulated a possible transition from TN2 to trigeminal neuropathic pain as a part natural history of this condition. Right now, we do not recommend neuromodulation for TN2, but use it routinely and frequently for trigeminal neuropathic pain.
The original webinar published by the FPA can be watched below –
Facial Pain Association Neuromodulation – YouTube
Dr. Deborah Barrett offers a framework and tools to help people improve their quality of life, just as they are, while also reducing pain and suffering. Her work draws from empirically based cognitive and behavioral interventions, and she practices what she preaches every day.
We thank the FPA for the great work they are doing publishing webinars in this field.
In July 2022 we were delighted to host a webinar chaired by A/Prof Liam Caffery and presented by Prof Arun Aggarwal
Professor Arun Aggarwal is a highly experienced neurologist with expertise in chronic pain management.
Professor Aggarwal graduated from the University of Adelaide in 1987 and went on to specialise in neurology, rehabilitation medicine and pain medicine and is a Fellow of the Royal Australasian College of Physicians, the Australasian Faculty of Rehabilitation Medicine, and the Australasian Faculty of Pain Medicine.
Professor Aggarwal completed his PhD at the University of Sydney on motor neuron disease. He currently oversees a number of research trials at the University of Sydneyâs Medical School including trials on trigeminal neuralgia and chronic neuropathic pain.
Professor Aggarwal sits on the on the Medical Advisory Board of Trigeminal Neuralgia Association.
In this webinar he will speak on âWhen trigeminal neuralgia pain is too much: presenting to the emergency department for pain managementâ
You may download the presentation with this link Acute Pain Management for Trigeminal Neuralgia - A/Prof Arun Aggarwal
Our Association is working hard to provide clearly understood information, not only to our sufferers but to the medical and dental profession. We thank all who logged in to watch the webinar live and they had the opportunity to ask questions and receive replies.
We would like to thank our Medical Advisory Board Members for the work they do and the advocacy they provide to all sufferers. Contact details for our MAB members can be found here
012 – YouTube TNAA – Prof Arun Aggarwal – When Trigeminal Neuralgia pain
is too much Presenting to the Emergency Department
Most sufferers with trigeminal neuralgia have heard of the surgical treatment, Microvascular Decompression (MVD for short), but fewer know about percutaneous balloon compression.
I can speak from first-hand experience of both procedures, and of the success with the latter. That is, I remain pain and medication free after five and a half years since a simple and fast balloon compression procedure crushed my trigeminal nerve. But I have always wondered and worried that the pain may return. To date I am extremely happy with the situation as are others I know who have undertaken this procedure.
The article âFactors that may affect recurrence of trigeminal neuralgia after percutaneous balloon compressionâ, was researched and written by Wenming Lv, Â Wenjing Hu, Lingyi Chi, and Liangwen Zhang and published in Journal of Clinical Neuroscience Volume 99, May 2022, Pages 248-252, can be read here
If you are considering asking for a Balloon Compression procedure, be aware there are risks and side-effects and that your research should be thorough. You need to trust that your neurosurgeon has considerable experience with this procedure, and has informed you of all aspects.
One of the possible side-effects about which I was warned, was that I might have some or a lot of facial numbness on the affected side of my face. I did have numbness on half an eyelid, half my nose and half the top of my upper lip. In the above article the finding was that numbness, on average, disappeared around three years. That is about right for me, although on rare occasions in the past couple of years I have a sense of it in my upper lip and nose. I am delighted to report that the numbness never caused my face to slump or change and has never been visible, it has always been mild, and it has never inconvenienced me. Having said this, each person is different and the results for another could be dramatically different â so please gather all information from a knowledgeable professional if considering this. For me, losing the pain and reliance on medication was worth some numbness. I was fortunate to be able to reclaim my life.
Helen Tyzack
Facial pain can make even the most routine outings no longer seem fun or meaningful. But going out can help you maintain your normalcy, which will help you to distract yourself from the pain. And with the warmer weather, there can be many more opportunities for such distractions. Below are tips on how to deal with pain in public, so that you can still enjoy yourself while out with family, friends, a significant other, or by yourself.
Weather
Know what causes your attacks and know how to recognize when is a good time to stay in and when is a good time to go out
Barometric PressuresÂ
Fluctuation in the barometric pressures can cause swelling, which can cause increased irritation to the nerves which could lead to an attack
Force yourself to go outÂ
This can be beneficial for your mental state. By surrounding yourself with good friends or family, you are distracting yourself from facial pain attacks. Creating memories that donât have to do with the pain can be called upon when you are suffering and need to escape. In addition, positive environments create positive thinking- and we all know the power of the mind.
Alone or with someone?Â
Know your limits- if you know that going out may cause an attack and you donât want people to see you like that then opt to go alone. If you know that you want the support in case of an attack, bring a loved one. Having someone with you can distract your mind and then you wonât have time to worry about an attack (the mind is a powerful thing!)
Coping Mechanisms
When you are out, being able to draw on some simple coping mechanism can alleviate your anxiety about the possibility of a pain flare, and if you should have one, these exercises can be very helpful:
Calming breaths
This helps to calm your mind and relax your muscles.
Pressure point
The skin between your thumb and pointer finger is a pressure point. Locate it by pressing the thumb against the index finger. The point is located at the highest spot in the bulge of that muscle. Applying pressure to this point helps to calm your body and mind. Warning: do not try this if you are pregnant.
Whatever works at homeÂ
If you have successful strategies for coping with the pain when youâre at home, donât hesitate to try these when out. These could include:
Excuse Yourself
If you feel uncomfortable letting others know you are having pain and donât want to draw attention, these are some tricks for excusing yourself without drawing attention:
How do you say no?Â