8. Facial pain Flashcards
How can you control trigeminal neuralgia in primary care setting?
Control quickly by treatment with carbamazepine.
A positive response control diagnosis.
Make an urgent referral to a specialist or the patient’s general medical practitioner for a full blood count and liver function tests.
What do you need to check before treating facial pain??
Ensure the pain is not odontogenic in nature. Non-odontogenic facial pain can be organic or neurogenic in nature. Most non-odontogenic facial pain requires specialist care.
What is an appropriate prescription of carbamazepine for trigeminal neuralgia?
Carbamazepine tablets, 100mg.
1 tablet, 2x/day for 10-days.
(20 tablets total)
Advise pt to space out doses as much as possible throughout the day.
Why do you need to be careful prescribing carbamazepine?
Carbamazepine has the potential to react with multiple other medicines. Check BNF for interactions.
What side effects could occur from carbamazepine?
Reversible blurring
Dizziness
Unsteadiness (dose-related).
What local therapies can help with temporomandibular dysfunction?
- Advise pt to have a soft diet - Avoid chewing gum
- Consider making an occlusal splint for the patient.
Acute TMJD might respond to analgesics such as ibuprofen or a short course of diazepam as a muscle relaxant. However, benzodiazepines are addictive and susceptible to abuse so only the minimum number of tablets required should be prescribed.
What prescription of diazepam can be given to pts with TMJD?
Diazepam tablets 2mg.
1 tablets, 3x/day for 5 days.
(total 15 tablets)
The dose can be increased if necessary to 15mg daily.
Halve the adult dose for elderly or debilitated patients.
Advise all patients that they should not drive!!
What might chronic neuropathic facial pain and oral dysaesthesia require?
Chronic neuropathic facial pain and oral dysaesthesia might require to be managed with neuropathic pain killers.
Refer to specialist or GP.
