Craig R. DuBois, M.D.
The Pain Evaluation & Treatment Center
7307 Creekbluff Drive
Austin, TX 78750
512-346-6969
http://www.paineval.net/our_physicians.nxg
Transcript: When trigeminal neuralgia returns
One thing that we see with patients is they may have a course of disease presentation, treatment, and then remission. A lot of people it goes away for a bit or it gets much better. But unfortunately one of the things with trigeminal neuralgia, is it is unpredictable and it can have really fairly aggressive or precipitous worsening of your symptom.
Well the worse thing is the patient’s now been off of their medicine or a low dose and what do they do? And if they go to the ER, oftentimes the emergency room isn’t very well prepared to know what to do with these. So I think the best thing for patients to do is to recognize that if you have trigeminal neuralgia, the important thing to realize it may flare up again. If you’re the one patient who goes away and never comes back, Hallelujah! That’s great! But it is something tends to kind of come and go.
And when I see patients and they’ve gone into remission or a lower level, I like to have them know what to do when there’s a flare. And it’s often a fast and dramatic flare.
First thing, if they’ve tolerated Lyrica or Neurontin, it’s a medicine as I said you can get going very fast on and yeah, you’ll get dizzy and you’ll get a little nausea or stomach upset sometimes but its tolerable compared to the pain. And we’ll tell them when your pain kicks up; push the dose of the Lyrica up. The usual dose is often 50-100 milligrams; three times a day for people and so you can go right into that pretty quickly. And it doesn’t seem to be a medicine that’s easily gets you toxic and it’s not going to put you into a coma. And the biggest problem is that when you hit the high doses, you get kind of dopy. You know, you just don’t think as clearly because of the effect of the medicine.
So a treatment plan that says when this thing kicks up if it does, you do this. You double up your dose or if you’re not taking it, you immediately start taking it again. That’s the medicine we tend to go with. It’s quick to get in.