Alison Myrden, a member of TreatingYourself.com, has MS and TN as well. She’s about 40 and is a member of the Canadian branch of LEAP (Law Enforcement Against Prohibition). She describes the state of pain produced by TN as being epitomized by The Scream, painted by Edvard Munch, saying that the pain is like a “bolt of lightning shooting through my face.” When it occurs, the pain is almost nonstop, completely intense suffering. When she was taking large quantities of opiates to deal with this pain, she would get them for $2 a pop but could sell them on the street if she so chose for $20-$30 per pill. (She never gave into this temptation but nonetheless it was always there). As a result, she says, “I had people offer me to sell my medication to make me rich.” Furthermore, it took heroic doses aof opiates to even touch her pain. Many TN patients find themselves here. For her, smoking high quality therapeutic cannabis is the only thing that will help reliably alleviate the pain of an episode of TN to any significant degree. She says, “nothing else will help, this is the only thing that gives me relief (23).”
Few may know the true horrors of living with TN, but for those who do, escaping that hell at any cost, even death, becomes a strong motivator. The scientific/medical and legal communities should be equally motivating to find and authorize any non-fatal means of helping these patients achieve this end. The currently approved treatments that show the most efficacy and promise so far are also the most risky and involve irreversibly cutting or killing the nerves responsible. Furthermore, current pharmacological options appear to be effective in the long term for only about half those effected. Many will have a positive initial reaction only later to develop tolerance or insensitivity to the drugs.
In both animal tests and anecdotally in humans cannabinoids have proven effective treatments in the management of TN. Modulators of the endocannabinoid system have also shown much promise. The mechanism of action appears to be both mediated by the peripheral and the central nervous system, indicating that, for some cases, peripheral administration may be enough. It is time their efficacy was properly studied in humans. For those unable to last that long, glycerine-based tincture appears to be a good starting place. For those for whom peripheral administration is not enough, vaporized cannabis may be required to get the full combined peripherally and centrally mediated antinociceptive effect. Either way, it is time we address the needs of the other 50 per cent not able to get long term relief from their trigeminal neuralgia from currently approved medications. Allowing the condition to beat them down into the final submission should not be an option.