Professionals' Area
These pages are for Medical Professionals. (If you are not a medic, then do not be dismayed if you have difficulty in dealing with them.)
Happily TN is not a common condition.
Unhappily, because it is uncommon it is not always recognised quickly by those who could help. Do read the case studies 'The Good, the Bad and the Ugly' that accompany this introduction.
We hope, via the articles posted on this site, to inform healthcare professionals regarding the diagnosis and treatment of trigeminal neuralgia. Sadly, this is necessary and many people suffer needlessly as a result. One of the myths is that only people aged 50+ suffer from TN. This is not the case, you CANNOT BE TOO YOUNG TO HAVE TRIGEMINAL NEURALGIA - we have many members who are in the early twenties and thirties and, tragically, even a few children.
For GPs unsure of drug dosages/titration, please refer to the information within the NHS Clinical Knowledge Summaries (formerly Prodigy) website or contact us on 01883 370214. Please note that, of necessity, this phone number is diverted on a rota basis to the home addresses of a team of volunteer members, all of whom have TN and all of whom have received in-house training. It may be necessary for you to leave a message but you will be called back at the earliest opportunity. (There is a separate, dedicated Telephone Helpline for members.)
You may also be interested in UCH's guidance upon drug use for TN, included in our members' section.
and 'TN - The Condition'
Here's something that might interest...
Toothache or Trigeminal Neuralgia: Treatment Dilemmas
Christopher J. Spencer, John K. Neubert, Henry Gremillion, Joanna M. Zakrzewska and Richard Ohrbach
Case Review
A 61-year-old woman presented to her general dentist with a complaint of pain associated with the maxillary left first premolar. The patient described a sharp, lancinating pain that was triggered by stimulation of the tooth in question. She also reported 2 specific episodes in which she experienced severe, shooting electrical shock-like pain followed by a hot sensation in the same area. One of these episodes was triggered by a cool breeze on her face and the other occurred while washing her face. Examination and radiographic assessment revealed a periapical osseous lesion resulting in a diagnosis of acute apical periodontitis. Nonsurgical endodontics was completed with no undue effects.
Approximately 2 months after the endodontic treatment, the patient began to have a recurrence of the paroxysmal sharp, shooting pain with a marked increase in the frequency of these episodes. The pain was triggered by light touch of the left cheek. Each episode lasted 1 to 2 seconds; however, she occasionally had 5 to 10 repetitive bursts. Clinical evaluation resulted in a diagnosis of trigeminal neuralgia of the left maxillary division.
Initial treatment included 100 mg carbamazepine bid., which was gradually increased to a maximum dose of 600 mg bid. The patient derived modest benefit from the medication; unfortunately, cognitive changes necessitated a reduction in the dose. Gabapentin was introduced in a bedtime dosage regimen of 100 mg. This provided a marked reduction in pain for approximately 1 week. A gradual titration of gabapentin to 300 mg tid was efficacious for approximately 1 month. Neurosurgical consultation and MRI of the brain revealed no intracranial pathology and confirmed a diagnosis of trigeminal neuralgia. Surgical intervention is being considered.
The complete case review is available on our website www.endthepain.org
With acknowledgements to the American TNA ‘Headline News' (added 28/05/2009)
This page was updated on 13 January 2010
