I need to optimize my pain therapy?

Question

Trigeminal nerve pain following a tooth extraction (tooth 46) Appointment at Laval University for root canal treatment on tooth 47 The pain is still present, following this intervention I am referred to an oral surgeon The whole thing ends with another extraction of tooth 47. The pain persists I am referred to a neurologist on September 17, 2021, I take tegretol 200mg 11/2 tablet twice a day (carbamazepine) and an anti nausea (domperidone 10 mg 1 tablet morning and noon since June 21.The side effects are violent headaches. I have an MRI on October 7, 2021. There is nothing in my head. I consulted a periodontist who extracted the 45 and made a curettage between teeth 45 and 47, there was bad quality tissue which was lodged at this place (granulation tissue) an intervention of one hour and a half. For 4 days no more pain following this surgery. And then, the pain reappeared even more intense...... I take tramadol/acet 37,5 and 325mg 2 tablets every 6 hours. This is not very effective for pain management. I also take not zolpidem ODT 10mg to sleep. Activan 1mg also helps with relaxation. I have an MRI on February 27 for the jaw and mandible on the right side. The pains continue permanently and are intense, no rest period. (Pain in the form of pressure which is between 7 and 10.) Nausea also persists. Hello, i tolerated tegretol well before the periodontist's surgery but I still had nausea, apart from that all that has been tried is what I just wrote to you, I don't eat much I lose my appetite and I sleep a lot....... the sublinox (zolpidem) seems to be the only medication that takes away my pain thank you I was not confirmed that it was a trigeminal neuralgia but that it was surely the trigeminal nerve (V3) that caused this pain the neurologist told me that the neuralgia is more like electric shocks but for me it is permanent. After the periodontist's surgery i took a medication called dexamethasone for a few days that helped me

Naji-tom Samaha · Accepted Answer

Hello sir, sorry to read about your troubles! The acetaminophen in Tramacet is rather ineffective for trigeminal neuralgia. Other than Tegretol, are there any other options that have been tried before? Has an increase in the dose of Tegretol been tried? Thank you for the information! Usually the most effective treatments for trigeminal neuralgia are the drugs of the Tegretol big class, other anti-seizure drugs. If Tegretol is only partially effective, or increasing its dose is limited by side effects, adding another anti-seizure medication is considered, there are several possibilities. This would definitely be discussed with your doctor, but your pharmacist can also contact your doctor to suggest possible alternatives! Tom Samaha, pharmacist