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

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.

Thank you doctor,

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