1. Trigeminal neuralgia.
Trigeminal neuralgia is a common cause of facial pain. It has a significant impact on the quality of life and the socioeconomic functioning of the patient. The aim of this review is to provide recommendations for medical management of trigeminal neuralgia based on current evidence. Based upon the analyses of the literature combined with experience in pain management, symptoms, assessment, differential diagnosis, and treatment possibilities of trigeminal neuralgia are described and discussed. Recommendations for pain management are given and are displayed in a clinical practice algorithm. Treatment should be multidisciplinary. Various treatment options and their risks should be discussed with the patient. The first treatment of choice is carbamazepine or oxcarbazepine. In younger patients, the first choice of invasive treatment is probably microvascular decompression. For elderly patients, radiofrequency treatment of Gasserian ganglion is recommended and the technique is described in detail.
van Kleef
Maarten
M
Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands. maarten.van.kleef@mumc.nl
van Genderen
Wilco E
WE
Narouze
Sem
S
Nurmikko
Turo J
TJ
van Zundert
Jan
J
Geurts
José W
JW
Mekhail
Nagy
N
D000465:Algorithms; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D002220:Carbamazepine / Q000627:therapeutic use; D017115:Catheter Ablation / Q000379:methods / Q000592:standards; D002985:Clinical Protocols / Q000592:standards*; D019299:Decompression, Surgical / Q000379:methods / Q000592:standards; D003937:Diagnosis, Differential; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods / Q000592:standards; D016634:Radiosurgery / Q000379:methods / Q000592:standards; D018570:Risk Assessment; D012668:Trigeminal Ganglion / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D014276:Trigeminal Nerve / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D014277:Trigeminal Neuralgia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*
D018712:Analgesics, Non-Narcotic; D002220:Carbamazepine