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Trigeminal neuralgia — FRCA Final MCQ

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EasyPain MedicineTrigeminal neuralgiaFRCA Final

A 72-year-old woman is referred with brief electric-shock pains in the right cheek triggered by brushing her teeth. Neurological examination and MRI brain are normal. Paracetamol and ibuprofen have not helped. What is the most appropriate pain management?

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Correct answer: E — Start carbamazepine with counselling and monitoring

The triggerable electric facial pain with normal examination is typical of trigeminal neuralgia, for which carbamazepine is first-line. Amitriptyline is used for many neuropathic pain syndromes, but trigeminal neuralgia is a specific exception. Long-term opioid therapy is poor practice for classical trigeminal neuralgia. Monitoring for adverse effects and drug interactions is essential.

Reference: NICE CG173 neuropathic pain; Faculty of Pain Medicine Core Standards