My mom was treated for trigeminal neuralgia, with no relief. What to do?

Q. My mom was treated for trigeminal neuralgia, with no relief. What to do?

Answered by
Dr. Anshul Varshney
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Oct 20, 2017 and last reviewed on: Aug 07, 2023

Hello doctor,

My 58 year old mother has a history of trigeminal neuralgia from the past four years. She was initially treated with Carbamazepine, but she had a severe allergic reaction, due to which it was stopped. Oxcarbazepine was tried, and it caused allergy too. Pregabalin, phenytoin, and sodium valproate were tried in combination with Baclofen, but the pain persisted. Last year we started her on Gabapentin 400 mg per day and then changed to 300 mg twice a day, and she was pain-free for a long time. Then last year, the pain resurfaced. We increased the dose to 800 mg per day but still, there was pain. So, she underwent a radiofrequency ablation of Gasserian ganglion early this year. She was fine for two days, and then suddenly from the third day the pain resurfaced. The pain is unbearable. The doctor stopped Gabapentin and gave Lyrica 75 along with Baclofen twice a day. A week after the procedure, he increased Lyrica 75 to twice a day, but there was no relief. Three days ago, I stopped Lyrica and started Gabapentin 200 mg twice daily and today increased it 200 mg in the morning and 400 mg in the evening. During the day, I give her a combination of Tramadol and Paracetamol two to three times a day. Please advice on how she can get some relief.



Welcome to You seem to have tried all the possible treatments. I would suggest trying a medicine known as Tapentadol at doses of 50 mg twice daily, along with Gabapentin 600 mg per day. Consider radiofrequency ablation or alcohol injection into the nerve again, if no relief is obtained by these drugs. I hope it helps you. If you have any further queries, please ask me.

Thank you doctor,

She underwent radiofrequency ablation two weeks ago, and the pain has increased a lot since then.



Welcome back to In my opinion, Tapentadol should give her relief. She can also be put on a selective serotonin reuptake inhibitor (SSRI) like Duloxetine, but they will help only in the long term. Discuss with your specialist doctor about my opinion of adding up Tapentadol andDuloxetine. I hope it helps you. If you have any further query, please ask me.

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