Understanding the Treatment Options for Trigeminal Neuralgia

Trigeminal Neuralgia, or Tic Doulourex as it is sometimes known, is a rare neurological condition affecting approximately four people in every 100,000. It causes sudden and severe stabbing pains recurring in the face stemming from one or more branches of the trigeminal nerve. Trigeminal Neuralgia can be misdiagnosed as dental pain, but our pain specialists in Knoxville have a wealth of experience in treating the condition and can usually spot it quickly. Once diagnosed the appropriate course of action can be taken to manage the condition through medical or surgical options to relieve the sometimes-debilitating pain Trigeminal Neuralgia can cause.

Non-Surgical Treatment Options for Trigeminal Neuralgia

When it comes to treating a patient with Trigeminal Neuralgia, pain specialists in Knoxville know that medication is the first step. When dealing with nerve based pain, even the most minimally invasive surgical procedures carry risk and should always be the last resort. Following ongoing research and study, the most effective drugs for Trigeminal Neuralgia are those originally developed to treat epilepsy.

Anti-convulsant medication is commonly prescribed by pain specialists in Knoxville for treating Trigeminal Neuralgia. It is possible to provide partial, if not total pain relief for between 80 to 90 percent of patients. Muscle relaxants can also be prescribed either on their own or combined with pain relief. However, the drugs do not always remain effective over time, and a higher dosage may be needed. There can also be some unpleasant side effects including the following:

  • Dizziness
  • Drowsiness
  • Forgetfulness
  • Nausea

Surgical Treatment Options for Trigeminal Neuralgia

As briefly covered above, surgical treatments are often the last resort for Trigeminal Neuralgia. Even minimally invasive surgery can carry substantial risk. Pain specialists in Knoxville will usually reserve surgery for patients who are still experiencing debilitating pain even with the best possible pain management. If surgery is a possibility, the first step is to carry out a surgical evaluation on the patient. The evaluation will first confirm the trigeminal neuralgia diagnosis by way of an MRI, which can also eliminate other causes. The evaluating surgeon will then assess the severity of the pain, the general health and physical condition of the patient and discuss treatment goals.

The most common surgical procedure offered to Trigeminal Neuralgia patients is Microvascular Decompression (MVD). The treatment is also known as the Jannetta Procedure. The operation involves making a small incision behind the ear and drilling a hole in the skull. With the help of microscopic visualization, the trigeminal nerve is exposed. It is then possible to see if a blood vessel is compressing the nerve. If this is the case, it can be moved away from the vein, and a Teflon felt pad inserted. The pain is almost always relieved by the procedure.

MVD is considered major surgery, and as with any open-skull procedure, there are some potential risks that need to be taken into consideration. These include infection, excessive bleeding, hearing loss and stroke. When you consider the possible side effects, it is easy to understand why pain specialists in Knoxville prefer to try medical treatments before turning to surgical options.

Associated Pain Specialists (APS) has two Pain Management Clinics (one in Johnson City, TN and one in Knoxville, TN). Both locations can provide pain management options for patients including those living with chronic pain conditions. APS also operate the Smoky Mountain Ambulatory Surgery Center with its own on-site interventional pain specialist, orthopedic spine surgeon, and fellowship trained anesthesiologist.


Phone: (865) 673-5000

Please reference APS’s content disclaimer (located in this channel’s profile description) in regard to this shared content.

Pain Management Options for Phantom Limb Pain

When a patient undergoes a surgical amputation, they could develop Phantom Limb Pain – an ongoing and extremely painful condition characterized by pain radiating from the amputated limb. The limb may no longer be there, but the pain is very real and will require pain management. Let’s take a closer look at Phantom Limb Pain and some of the treatment strategies that can be used to combat the condition.

What is Phantom Limb Pain?

Phantom Limb Pain usually begins soon after amputation surgery. Sufferers describe it manifesting as some different sensations including burning, itching, twisting or pressure. In the majority of cases, the sensation feels like it is starting in the fingers or toes of the missing limb. As many as 80% of amputees will experience Phantom Limb Pain (PLP) at some stage. The severity of the condition will vary from one patient to the next. For some amputees, the sensation lasts for only a few minutes or hours. For others, the pain lasts for days or weeks. In most cases, the symptoms of PLP reduce in both frequency and severity over the first six months until it ceases altogether. However, for some amputees, the pain continues for years, and that is when ongoing pain management becomes necessary.

Treating Phantom Leg Pain

Phantom Limb Pain is a complex condition, and as such, it requires a multifaceted approach to treatment. The most successful approach is a combination of medication and complementary therapies. Regarding the pain management element, the medications administered will be those designed to interrupt the pain signals in the brain. Various drugs may be offered, depending on the type of pain sensations and their severity. These include:

  • Acetaminophen & Non-Steroid Anti-Inflammatory Drugs (NSAIDs)
  • Opioids (Narcotic Pain Medication)
  • Anticonvulsants
  • Muscle Relaxants
  • Beta-Blockers
  • Antidepressants

However, medication is only one small aspect of pain management for PLP. Often, pain relief is used in conjunction with alternative and complementary therapies, such as acupuncture, massage, TENS (transcutaneous electrical nerve stimulation) and also treatment to retrain the way that the brain interprets pain signals from the missing limb. Essentially, that means training the amputee’s brain to accept that the limb is no longer there and can therefore no longer feel pain and other sensations.

Invasive Therapies

Sometimes, pain management for Phantom Limb Pain can include invasive or semi-invasive procedures including the following:

  • Injection – In some cases pain relief injections, steroids or local anesthetics will be injected into the stump to relieve PLP.
  • Nerve Blocks – A nerve block can be used to interrupt the pain signals sent from the brain to the phantom limb.
  • Spinal Cord Simulation – Small electrodes are inserted along the spinal cord, and an electrical current applied to help relieve pain.
  • Brain Stimulation – Deep brain stimulation and motor cortex stimulation work in a similar fashion to spinal cord stimulation, but the electrical current passes through the brain. Although it is a relatively new procedure with limited data, there are promising results concerning pain management for phantom limb pain.
  • Stump Revision or Neurectomy – In many cases, phantom pain can be triggered by nerve irritation in the stump. If this is the case, then one pain management option is to perform a surgical revision to the stump. However, this does carry a risk of intensifying the pain.


Associated Pain Specialists (APS) has two Pain Management Clinics (one in Johnson City, TN and one in Knoxville, TN). Both locations can provide pain management options for patients including those living with chronic pain conditions. APS also operate the Smoky Mountain Ambulatory Surgery Center with its own on-site interventional pain specialist, orthopedic spine surgeon, and fellowship trained anesthesiologist.


Phone: (865) 673-5000

Please reference APS’s content disclaimer (located in this channel’s profile description) in regard to this shared content.

Is Your Dizziness a Result of Vestibular Migraine?


Up to 3% of the population are thought to suffer from a vestibular migraine. Half of these people are undiagnosed or are not being treated with the appropriate pain management because a vestibular migraine is hard to diagnose. There is no set test, but if a patient’s symptoms fit several statements about this particular migraine type, then they may be a candidate for diagnosis.

Let’s discuss some of the signs that indicate you could be suffering from a vestibular migraine.

What is a Vestibular Migraine?

First, it might be helpful to understand the definition of Vestibular Migraine. The official name is ‘migrainous vertigo’ and it is so much more than just a headache. In fact, you may not suffer headache pain at all. Some debilitating symptoms can affect your ears, vision, and balance. The most common symptom is vertigo, accompanied by dizziness and neck pain. It can be almost intolerable for sufferers to bend down or turn their head and it is not unusual to experience tinnitus (ringing in the ears) or blurred vision. These symptoms mean that finding the right pain management plan can be a challenge.

5 Signs That You May Be Suffering from Vestibular Migraine

If you find yourself agreeing with all the statements below, then you could be a likely candidate for a vestibular migraine diagnosis. Seek advice from an ENT or neurologist to discuss treatment and an effective pain management plan.

1.     You or Your Family Have a History of Migraines
Vestibular Migraines have a strong genetic component. If a relative has a history of migraines or if you already suffer from migraines, then the chance of vestibular migraine increases.

2.     You Suffer from the Symptoms of Vertigo
One of the key indicators of vestibular migraine is that you suffer from vertigo during a migraine headache. You may not necessarily have pain, which is why pain management can be tricky. Symptoms include vertigo, dizziness, motion sensitivity, poor balance, spatial disorientation, spinning and rocking. These symptoms can last from 5 minutes up to several days.

3.     Your Symptoms Can Vary in Severity
Another hallmark of a vestibular migraine is that the severity of your symptoms will change over time and worsen with exposure to migraine triggers. Some triggers (including behavioral factors, hormonal triggers, environmental factors and dietary/chemical triggers) can cause migraines. If your symptoms are steady, without fluctuation, then it is unlikely to be a vestibular migraine. If they worsen after exposure to a known trigger, then vestibular migraine is more likely.

4.     You Also Suffer Classic Migraine Symptoms

If you are suffering from a vestibular migraine, it is also common to have classic migraine symptoms simultaneously. These might include a headache, sensory sensitivity, nausea, aura and tinnitus.

5.     These Symptoms Are Negatively Impacting Your Life
If your symptoms are severe enough that they begin to reduce your quality of life, this is another strong indication that you could be suffering from a vestibular migraine. Your ability to do everyday tasks like driving, going out with friends or even walking becomes difficult. Some patients who have vestibular migraines find it difficult to even get out of bed without appropriate pain management and treatment.

Treating the Pain

A vestibular migraine is often treated similarly to a classic migraine. However, sometimes finding the correct pain management plan can be difficult since pain is not always present. Medication can be given to treat the most common symptoms and making lifestyle changes to eliminate triggers can also help.

Please reference APS’s content disclaimer (located in this channel’s profile description) in regard to this shared content.

Is Your Dizziness a Result of Vestibular Migraine?

Avoiding Overuse Injuries in Sports: Seeking Pain

Overuse injuries are common in sports of all levels and ages, from your child’s after-school soccer league to the professionals in the NFL. An overuse injury is any muscle or joint injury, such as tendonitis or a stress fracture, that is caused by repetitive trauma. Sports and even some jobs require repetitive motion of muscle groups, and over time these muscles, tendons, and bones can become weakened. Sometimes these injuries are just a nuisance while others can be career-ending if not taken care of appropriately. Follow these easy precautionary measures to avoid overuse injuries.

‘Warm-up’ before stretching and ‘cool-down’ after training

A common mistake made by many is stretching before warming up. Performing a warm-up before stretching increases your heart rate, which sends more blood flow to your muscles and tendons making them stretch more easily. Proper warm-ups include jogging, biking, and jumping rope. You shouldn’t stretch until you have performed a warm-up.  Just as important as the ‘warm-up,’ is the ‘cool-down.’ Your cool-down should take place after training. Following the activities of your warm-up, the cool-down is twice as long, but with half the intensity. Performing a cool-down allows your body and muscles to enter a mode of rest gradually.


After your warm-up and cool-down, it is vital to stretch to maintain your muscle’s strength and flexibility. Many injuries can be prevented just by stretching, especially before physical activity. Injuries can occur without stretching due to muscles becoming short and tight during periods of non-movement. When they are called upon abruptly, they are in a weakened state, therefore causing overuse injuries.

Avoid increasing workouts too quickly and training too much

Training excessively and increasing workouts plays a various role depending on what activities you do. For example, if you’re a runner, the rule of thumb is not to increase the amount you run by more than 10% each week- a word of advice is to not push through the pain. Pain is your body’s way of communicating to you that something is wrong, however many times the “I’ll be fine” mentality gets in the way and pain is ignored thus causing injury. If you are ever in excessive pain, don’t question it, seek advice from a pain management specialist.


Simply put, drink water, it’s the stuff you’re made of!  Most everyone is aware of the importance water plays in our diet and health, but it is just as important to understand the role water plays on our muscles, tendons, and bones when living an active lifestyle. Being dehydrated amplifies muscle strains and cramps by not providing the electrolytes needed, which are lost in sweat. This can cause tears from abrupt movements. Make sure you are drinking the daily recommended water intake every day, a half-gallon or eight 8-ounce glasses.

Seek pain management help from a doctor or pain specialist

If you are at a point where you are experiencing consistent pain, seeking professional help is the only step to take next. The Associated Pain Specialists Knoxville (APS Knoxville) specialize in helping individuals with pain management.

Please reference APS’s content disclaimer (located in this channel’s profile description) in regard to this shared content.

Avoiding Overuse Injuries in Sports: Seeking Pain