Importance of specific orofacial pain diagnosis in a classic trigeminal neuralgia non-responsive to pharmacologic treatment. A case report

Abstract

Classical Trigeminal Neuralgia (CTN) is a clinical condition characterized by a sudden, usually unilateral, brief, and recurrent excruciating pain paroxysms, with distribution in one or more division of the trigeminal nerve. Carbamazepine and Oxcarbamazepine are often recommended as the first-line of medical treatment in many clinical guidelines, providing an adequate pain relief in about 90% of the patients; of which those who are refractory to medical treatment should be considered for surgical treatment. Case Description: The authors will present a clinical case of a 70-year-old female patient, who consulted to the Hospital del Salvador's Orofacial Pain Service for presenting a severe facial pain in her left side. The patient had a history of being diagnosed with CTN confirmed with a neuroimaging, not responsive at the time of consultation to pharmacological treatment with carbamazepine. The main complaint was a severe and diffuse facial pain with null response to CTN pharmacologic treatment, so consequently, the patient was put on a waiting list for a neurosurgical procedure. At examination, several sources of musculoskeletal orofacial pain were identified, which were consistent with the chief complaint of the patient and not correlative to the CTN paroxysms. The authors will present a clinical case, illustrating how comorbid regional orofacial pain syndromes can complicate management of a CTN, and most importantly how a well addressed orofacial pain treatment could be decisive in a CTN refractory to medical treatment.