Hi XXXXXXX
Thank you for writing in.
I am a medical specialist with a degree in cardiologist. I read your description and about your history of Fibromyalgia with diligence.

In my opinion, your main complaint is facial pain & burning sensation, dizziness which lead to lack of concentration and weakness. The diagnosis comes to my mind is Trigeminal neuralgia which causes facial pain.Trigeminal neuralgia develops in mid to late life. The condition is the most frequently occurring cause all the nerve pain disorders. The pain, which comes and goes, feels like bursts of sharp, stabbing, electric-shocks. This pain can last from a few seconds to a few minutes. My question is which you can mention in follow up query does the description fit you? Added is the fact that Lyrica did not relieve the symptoms.

People with trigeminal neuralgia become plagued by intermittent severe pain that interferes with common daily activities such as eating and sleep. They live in fear of unpredictable painful attacks, which leads to sleep deprivation and undereating. The condition can lead to irritability, severe anticipatory anxiety and depression, and life-threatening malnutrition. Even depression is not uncommon.

◦There are 3 branches of the trigeminal nerve: the ophthalmic, maxillary, and mandibular. The pain of trigeminal neuralgia occurs almost exclusively in the maxillary and mandibular divisions.
◦You most commonly feel pain in the maxillary nerve, which runs along your cheekbone, most of your nose, upper lip, and upper teeth. Next most commonly affected is the mandibular nerve, affecting your lower cheek, lower lip, and jaw.
•Most of the time, doctors cannot identify any disease of the trigeminal nerve or the central nervous system.
Trigeminal neuralgia is extremely painful but not life threatening. Thus, a goal of therapy is minimizing XXXXXXX side effects. No home remedy or OTC drug is effective, you will have see the doctor if possible Neurologist consult.

Medications used to treat trigeminal neuralgia are those used for many other nerve pain syndromes-drugs originally designed to treat seizures.

These antiseizure agents suppress excessive nerve tissue activity, which is the cause of the painful syndrome. As a result, they are useful in conditions such as trigeminal neuralgia.

Pain specialists use invasive therapy, including nerve blocks, nerve destruction, and nerve decompression techniques, as well as drug therapy to treat trigeminal neuralgia.

•In some instances, a single injection, or a series of injections, or perhaps one decompressive procedure, will reduce or eliminate the pain and prevent your need for a long course of drug therapy.


•Injection techniques also can relieve unremitting pain instantly and further confirm the diagnosis.


•Using real-time x-rays, doctors can target the anatomical origin of the nerve XXXXXXX in your skull. Then, with a fine needle, they can do one of the following to halt the painful syndrome:


◦Inject that source with anesthetic and steroid.


◦Inject that nerve with a drug used to destroy faulty cells.


◦This procedure can be performed with surprisingly little discomfort.


Hope your doctor agrees with me and treatment is started. If you have any followup query, I will be most happy to answer.

With Best Wishes,


Dr Anil Grover
MBBS, MD (Internal Medicine) DM (Cardiology)

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Hi Dr XXXXXXX
It is a pleasure knowing you that you are a dentist and it hurts me when I think you deal with same area of body which is troubling you so much off late.
However, that makes communication all the more easy. Now, when you say burning sensation, that is nothing but a characteristic of pain carried by same pain fibres of a sensory nerve. Whereas, Niacin flush is akin to vascular sensation whose nearest expression comes to mind is 'flushes". It is warm, tingling, itching feeling of the skin accompanied by redness of the skin. Wise observation but two points are different one you are not taking Niacin for one, secondly hormonal changes as the cause of flushes you are not in the age group. But it is a thought worth considering and ruling out!
In any case in both cases the XXXXXXX burning pain" is different from that of Fibromyalgia. Would you mind seeing a doc tor, who after talking one to one, makes the differentiation, now between the three? Then get back and we can discuss what next to do if either of the diagnosis needs worth pursuing.
With personal regards.

Best Wishes. Incidentally, among your specialty what is your sub specialty?

Sincerely

Dr Anil Grover

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