atypical facial pain

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Date Joined Jan 2013
Total Posts : 3
   Posted 1/15/2013 7:13 PM (GMT -6)   
I've had an undiagnosed "atypical," bilateral facial pain condition for the past 8 years, the symptoms of which began subsequent to a head trauma. The initial manifestations were tightness in the mandibular area that resulted in intense and continuous clenching of the teeth. The salient conditions are tightness and constriction spread throughout the face but predominately localized bilaterally in and just above my upper teeth as well as the lower jaw. The masseter muscles are intensely constricted resulting in a feeling of being unable to fluidly open my mouth. The constriction radiates to the temporalis, behind the eyes, just above the eyes, the nasaslis area, as well as the top of my head and forehead. It is not an acute or electrical type pain and is is also not intermittent which has lead my doctors to conclude that it is not trigeminal neuralgia. I notice that there is an interplay between my spine and the tension I feel in the front of my face insofar as when I roll my neck there is an intensification in the level of tightness manifesting in the above mentioned areas. I have seen a few TMJ specialists and they've ruled that out. The various MRIs and CT scans I've had done have revealed no observable muscular or skeletal damage, leading most of the specialists I've seen to believe that it is some form of imperceptible neuropathic disorder. However, I also had a nerve conduction study performed on the facial nerve and it appeared to be in perfect working order. I have had a V2 nerve block done which produced no ameliorative effects. I have also had a local lidocaine injection performed in the left sphenopalatine ganglion region as well as botox injections, both to no avail. I just recently had a systemic lidocaine infusion that also appears to be ineffectual so far.Throughout the years I have worked with cranio-sacral specialists, chiropractors, neurologists, migraine headache centers, acupuncturists, ENTs, dental specialists, etc., and no one has been able to provide a definitive answer as to what the cause of the pain might be. As far as medications are concerned, I have tried most of the industry standards including Neurontin, Amitriptyline, Lyrica, Tegretol, Cymbalta, Baclofen, Skelaxin, Flexeril, Celexa, Effexor, etc., and none of them have provided any substantial relief. I am at a loss with what to do and would appreciate any suggestions. I've thought about various nerve blocks that may be efficacious (trigeminal, mandibular, sphenopalatine, and stellate in particular), but owing to the fact that the origin of the pain hasn't been definitively found, doctors are apprehensive about administering these blocks. I would appreciate any suggestions as well as any input about the detriments and benefits of these procedures or any others that come to mind.
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