Expert: Dr Ian Jackson - please note UK based - 5/29/2008

Question
Hi,
For the past 5 1/2 years I have had pain in my lower jaw.  I saw six dentists during this timeframe and the last one told me it was an orthodontic problem.  I saw an orthodontist and he assured me it was NOT an orthodontic problem but there was definitely something going on in the jaw.  He referred me to a dental surgeon.
In Aug 07 I had a myxomatous tumor removed from my mandible.  During the surgery the nerve was severed.  When I woke up from surgery the same pain was there.  In Jan 08 I had surgery to try to reconnect the nerve.  When the surgeon went in there was a large neuroma which he removed.  This didn't leave enough of the the nerve to reconnect.  The surgeon cut back the nerve where it exits the jaw bone to try to prevent further neuromas.  When I woke up from this surgery I had the same pain.  When I saw the surgeon for a followup he referred me to one of his associates.  This surgeon suggested another surgery to cut the nerve further back and sew it into the muscle.  I told him I didn't want another surgery as the last one really took a toll on me.  He understood and suggested I see an anesthesiologist/pain management doctor.  My question to you is:  have you ever shot alcohol into the mandibular nerve to kill it.  If so, could you tell me the pros and cons of this.  The surgeon who tried to reconnect the nerve suggested that this could be an option.  I am so tired of living with this constant pain.  I take lunesta every night to sleep and get no more than 2 hours of sleep as the constant pain wakes me up.  Thank you for any light you can shed on this.

Answer
Hi there
I am really sorry to hear your story. Obviously it was important to cut the nerve as part of your first surgery to remove the tumour. Unfortunately nerves do have a habit of causing problems when they have been cut but it is unpredictable as to who will have problems. I think you were right to refuse further surgery as this seldom cures this problem. You do need to see a specialist in Chronic Pain - these are usually anaesthetists who have specialised in the management of chronic pain syndromes. Now it is important that you see a good one and that you take his advice rather than listen to me - this is an area that I only dabbled with during my training which was many years ago. There are several drugs that can help settle down 'neurological pain' which they can use and they will go through the options open to you. Interestingly these include antiepileptic and antidepressant drugs - they can settle down the local activity in the nerve that is causing your pain.
I have never shot alcohol into a nerve like this - they actually use a very toxic stuff called phenol. My lack of experience means I can't really comment, however nerves usually respond to more positive approaches rather than blasting them with further toxic substances. Surgeons mind sets work around surgical management of problems and so I understand why they want to cut or destroy the nerve - however experience would suggest other approaches are more successful. Go and see an expert as soon as you can and ask around to find someone with a good reputation - not just some anaesthetist who is happy to do as your surgeon has suggested.
Dr Ian Jackson