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How Can Pain Be Managed When Scheduled For Trigeminal Neuralgia Surgery?
Question: hi, As of today, I am scheduled for trigeminal neuralgia surgery with first visit in January at Shands Hospital in XXXXXXX with Dr. Friedman. He does not have any clinics to see patients until January. My appointment with him is January 5.
My GP had been treating me with Gabapentin 300 mg cap 3 times daily and hydrocodone-acetaminophen for breakthrough pain since August 16. My GP said she is not qualified to keep treating me because I need a neurologist.
The neurologist she referred me to finally saw me on November 22. She added Carbamazepine ER 200 mg one tablet every 12 hours. She could not see me again until January 9, when she returns from vacation. Her medical assistant said my pain should not be going to my eye and I should see a Ophthalmologist. I did almost immediately. He said my eyes are excellent and I do need the surgery. He referred me to Dr. Friedman
As of today, I am scheduled for trigeminal neuralgia surgery with first visit in January at Shands Hospital in XXXXXXX with Dr. Friedman. He does not have any clinics to see patients until January. My first appointment with him is January 5.
My problem is the pain I am having is more than the pain pills are able to handle. I read the instructions and am not suppose to take more than prescribed which is 1/2 to 3 tablets daily. I cannot get through the day without very deep breathing and /or holding water or Boost in my mouth. Please help me. What should I do until January 5 that is about 17 days away. Please help me. I am 73 and have a college degree. Was a medical record director for 30 years so know how important it is to follow medical instructions. I have been taking my meds as prescribed since August 16. I cannot sleep at night and barely making it through the day with this severe pain. I hope someone can respond to this question asap. Thank you so very much for your advice. This is the first time I have ever gone online for medical help. Please help me know what to do.
My GP had been treating me with Gabapentin 300 mg cap 3 times daily and hydrocodone-acetaminophen for breakthrough pain since August 16. My GP said she is not qualified to keep treating me because I need a neurologist.
The neurologist she referred me to finally saw me on November 22. She added Carbamazepine ER 200 mg one tablet every 12 hours. She could not see me again until January 9, when she returns from vacation. Her medical assistant said my pain should not be going to my eye and I should see a Ophthalmologist. I did almost immediately. He said my eyes are excellent and I do need the surgery. He referred me to Dr. Friedman
As of today, I am scheduled for trigeminal neuralgia surgery with first visit in January at Shands Hospital in XXXXXXX with Dr. Friedman. He does not have any clinics to see patients until January. My first appointment with him is January 5.
My problem is the pain I am having is more than the pain pills are able to handle. I read the instructions and am not suppose to take more than prescribed which is 1/2 to 3 tablets daily. I cannot get through the day without very deep breathing and /or holding water or Boost in my mouth. Please help me. What should I do until January 5 that is about 17 days away. Please help me. I am 73 and have a college degree. Was a medical record director for 30 years so know how important it is to follow medical instructions. I have been taking my meds as prescribed since August 16. I cannot sleep at night and barely making it through the day with this severe pain. I hope someone can respond to this question asap. Thank you so very much for your advice. This is the first time I have ever gone online for medical help. Please help me know what to do.
Brief Answer:
Can raise dosage
Detailed Answer:
I read your question carefully and I understand your situation, trigeminal neuralgia is one of the most excruciating pains possible.
Trouble with it is that medication is not always enough, in fact you have been recommended surgery precisely for that reason.
The drugs you are taking are both valid options. They both can go at much higher dosages though (up to 2400 mg/d for gabapentin and up to 1200 mg for carbamazepine) so can't pronounce them ineffective yet without trying a dose increase. There is the risk of side effects however so that should be done carefully, gradually.
Between the two I would try raising carbamazepine as it is the most proven medication for trigeminal neuralgia (if you're wondering why you were given gabapentine by your GP then it is because it has fewer side effects). So given the severe resistant pain I would raise it, initially by one more tablet (which would get us to 600 mg), afterwards if it doesn't work and there are no added side effects it can be raised again by an additional tablet.
I remain at your disposal for other questions.
Can raise dosage
Detailed Answer:
I read your question carefully and I understand your situation, trigeminal neuralgia is one of the most excruciating pains possible.
Trouble with it is that medication is not always enough, in fact you have been recommended surgery precisely for that reason.
The drugs you are taking are both valid options. They both can go at much higher dosages though (up to 2400 mg/d for gabapentin and up to 1200 mg for carbamazepine) so can't pronounce them ineffective yet without trying a dose increase. There is the risk of side effects however so that should be done carefully, gradually.
Between the two I would try raising carbamazepine as it is the most proven medication for trigeminal neuralgia (if you're wondering why you were given gabapentine by your GP then it is because it has fewer side effects). So given the severe resistant pain I would raise it, initially by one more tablet (which would get us to 600 mg), afterwards if it doesn't work and there are no added side effects it can be raised again by an additional tablet.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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