The Most Severe Pain

In another investigation reported last week, the "double-blind" technique proved to be a needless precaution. The superiority of the medicine being tested was so apparent that the researchers soon dropped the placebo.

The patients were victims of an excruciating form of facial neuralgia known as tic douloureux, which often seems doubly painful because the victims know there is no sure relief. Drug after touted drug and a succession of surgical procedures have been tried, only to be found of limited value, or to be discarded entirely. But hope was rekindled when Columbia University's Dr. William Amols told the American Neurological Association that a new drug, carbamazepine--not yet generally available in the U.S.--has given relief to 75% of patients for as long as two years.

The basic cause of tic douloureux, or trigeminal neuralgia,* remains as little understood as the disease's power to set off stabbing, lightninglike pain, as severe as any known to man. It usually involves one side of the face, sometimes affects the forehead and eye region, but more often concentrates its attack on the cheek and jaw. In early stages, the stabs of pain last only a few seconds and may be hours apart. In more severe cases --and most victims get progressively worse--pains may recur several times a minute for hours or days, and leave a continuous "background" ache. During severe bouts, victims cannot shave, or even wash; they cannot brush their teeth or eat solid food.

Fewer Operations. At Columbia's famed Neurological Institute, Dr. Amols gave carbamazepine (already marketed in Europe as Tegretol by Geigy Pharmaceuticals) to 97 patients, aged 29 to 89, whose illnesses had lasted from three weeks to 50 years (average: ten years). Many had already had operations of various kinds. No fewer than 41 patients enjoyed relief of pain within a few hours, and many got along on three or four tablets a day. Others needed increased doses. In all, 73 patients benefited greatly from carbamazepine alone; four more improved when a modest dose of Dilantin was added.

Carbamazepine, to be sure, is not the answer for all tic douloureux victims. Dr. Amols made clear that ten patients had to quit it because of such side effects as severe rashes; four enjoyed only temporary benefit and then required surgery, while six got only the bad side effects. But as evidence of its value, Dr. Amols noted that before he began using it, his institute averaged 28 operations a year for tic douloureux; in one year with the new drug, the number dropped to 18, and last year to six. This year there has not been one.

-- The French name, "painful twitch," is a descriptive understatement; the medicalese refers to the three branches (trigeminal=triplet) of the fifth cranial nerve.

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