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Dear Dr. Roach: I am a 73-year-old female who is in above average health. I have recently been diagnosed with trigeminal neuralgia after many trips to the dentist and finding out that my pain wasn't dental-related. I experienced electrical shock pains in my lower left jaw when I talked, when I ate, and sometimes when I brushed my teeth.
I am on 300 mg of gabapentin, and after a month, I can say that I'm about 95% better. I still feel some sharp sensations for a few seconds when starting to eat. In the previous year, I was on Fosamax for osteoporosis for one year. Since this didn't show an improvement, I was given one infusion of Reclast. I will be due for another in June.
I mentioned this diagnosis to my ophthalmologist recently, and she mentioned that these drugs for osteoporosis could possibly narrow the openings that the trigeminal nerves run through, therefore rubbing on the nerves themselves. Do I need to stop taking the osteoporosis treatment to stop the nerve pain? Your thoughts on this would be appreciated. -- D.K.V.
Answer: Trigeminal neuralgia is a neuropathy (a disease of the nerve) that, in this case, causes face pain. The pain is often described as an electric shock, but it can vary in different people. It is often misdiagnosed as a dental condition. Gabapentin (Neurontin) is often tried, and a 95% reduction is a very good outcome in this disease, which can sometimes be frustrating to treat.
Bisphosphonate drugs like alendronate (Fosamax) or zoledronic acid (Reclast) do not directly cause trigeminal neuralgia. Most cases are thought to be caused by the compression of the nerve root that is deep inside the brain by an artery. Microdecompression of the nerve is sometimes used to treat trigeminal neuralgia, although the success rate is not perfect and the pain relief is not always permanent.
Bisphosphonates can occasionally cause a condition called osteonecrosis of the jaw. This condition can press on the trigeminal nerve, causing a facial pain syndrome. Your endocrinologist or primary care doctor who is prescribing the osteoporosis treatment should be aware of your facial pain and ensure that you do not have this complication.