DEAR DR. DONOHUE: I was diagnosed with trigeminal neuralgia three years ago. I have taken Tegretol, and it thankfully dulls the pain. Although the episodes come closer and last longer, I am coping with the pain. How do I explain this condition to a mother-in-law who thinks she knows everything and sees my pain simply as a headache? She lives with us. – N.R.

The trigeminal nerve is the nerve that transmits sensations from the face to the brain. Trigeminal neuralgia is an irritated trigeminal nerve. The irritation gives rise to one of mankind’s most agonizing pains. The painful episodes are brief, but patients live in constant fear that another spasm is about to happen. Brushing the teeth, washing the face, even the light touch of a gentle breeze on the cheek can spark an explosion of indescribable agony.

There are a number of medicines that can dull the pain and permit a person to cope with this affliction. In addition to your Tegretol are Lioresal, Topamax and Neurontin.

When medicines bring no relief, then an attack on the nerve can often put an end to the problem. Injecting the nerve with glycerol or destroying it with a probe that emits radiofrequency current are two such procedures.

One explanation for the nerve irritation postulates that it comes from the pulsations of an artery that encircles the nerve. A skillful neurosurgeon can interpose a small sponge between the artery and nerve, and that frees the nerve from the irritating artery pulsations.

If you have a computer, visit the Web site of the Trigeminal Neuralgia Association,, or write to the association for information. The address is 2801 SW Archer Road, Suite C, Gainesville, FL 32608. The association can provide you, your mother-in-law and all trigeminal neuralgia victims an up-to-date summary of the illness and its treatments. That ought to make your mother-in-law a believer.

DEAR DR. DONOHUE: I take Pravachol to lower my cholesterol. I heard it can affect your liver. I also have leg pains for which I take Vioxx. I wonder if the leg pain comes from taking Pravachol. Do you think it could be so? – M.G.

ANSWER: Pravachol (pravastatin) is one of the statin drugs, drugs that are very effective in lowering cholesterol. In addition to lowering the total cholesterol level, they increase good cholesterol – HDL cholesterol – the kind that keeps arteries free from obstructing buildup.

Statin drugs can cause liver problems. That’s why users should have their blood checked from time to time to see if any liver damage is occurring. If it is, then stopping the drug stops the assault on the liver.

These drugs can also damage muscles. That is a rare side effect. It too can be detected with a blood test. Should there be evidence that muscles are under siege, discontinuing the drug almost always ends muscle damage.

Ask your doctor to order the lab test that shows if muscle are involved. Don’t stop the drug without the doctor’s go-ahead.

Medicines are only one way to lower blood cholesterol. The new cholesterol pamphlet describes both drug and nondrug treatments that can bring the cholesterol number down. Readers can obtain a copy by writing: Dr. Donohue – No. 201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Since it is proven that alcohol in moderation is beneficial to the heart, could the use of prescription drugs accomplish the same benefit, especially for a person who might be susceptible to alcoholism? – F.L.

No doctor is going to urge a patient to drink alcohol if that patient is at risk of alcohol addiction or if that patient simply does not like alcohol. There are too many other ways to obtain the same benefits.

Simply bringing weight to its desirable range protects the heart. Controlling blood pressure enhances heart health far more significantly than drinking alcohol does. Eating a diet low in saturated fat and cholesterol is an equally beneficial way to keep the heart healthy. Moderate exercise such as walking controls cholesterol. Medicines are called on to lower cholesterol only when nondrug treatments fail.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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