Tag: Emergency Department

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Emergency Department – Break-through Trigeminal Neuralgia Pain

This week the Association launched our Emergency Department plastic wallet cards – to assist sufferers with communicating when attending a hospital emergency department with break-through trigeminal neuralgia pain

The following study highlights why this is such an important issue – and very relevant to all of our sufferers

Treatment of acute exacerbations of trigeminal neuralgia in the emergency department: A retrospective case series

Affiliations

  • 1Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal.
  • 2Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.

Abstract

Objective: To evaluate the response to treatment of acute trigeminal neuralgia (TN) exacerbations in the emergency department (ED).

Background: TN is characterized by recurrent and intense pain paroxysms. Some patients experience severe acute exacerbations requiring ED presentation. The optimal management of these episodes is not well established.

Methods: We present a case series of TN exacerbations in adults who presented to the ED of a tertiary centre from January 2008 to December 2020. We analysed demographic and clinical data, including pharmacological management in the ED. The primary outcome was pain relief, classified into “no relief,” “partial relief,” and “satisfactory relief” based on the qualitative description in the ED’s records.

Results: Ultimately 197 crisis episodes corresponding to 140 patients were included. Most were women (61%, 121/197) with a median age of 63 years (interquartile range: 52-73). Acute TN exacerbations were treated with opioids in 78% (108/139) of crisis episodes, nonsteroidal anti-inflammatory drugs in 42% (58/139), corticosteroids in 21% (29/139), intravenous phenytoin in 18% (25/139), and intravenous lidocaine in 6% (8/139). Of the 108 cases treated with opioids, 78 (72%) required additional drugs for pain management. Intravenous phenytoin allowed satisfactory pain relief in 64% of cases.

Conclusion: In our sample, opioids were the most used therapeutic approach in acute TN exacerbations despite their low efficacy and subsequent need for further drug treatment in most cases. Most crisis episodes managed with intravenous phenytoin reached total pain relief. Prospective studies are needed to guide the treatment of acute exacerbations of TN.

Keywords: emergency department; exacerbation; lidocaine; opioids; phenytoin; trigeminal neuralgia.

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References

REFERENCES

    1. Melek LN, Devine M, Renton T. The psychosocial impact of orofacial pain in trigeminal neuralgia patients: a systematic review. Int J Oral Maxillofac Surg. 2018;47(7):869-878.
    1. van Hecke O, Austin SK, Khan RA, Smith BH, Torrance N. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014;155(4):654-662.
    1. Zakrzewska JM, Wu J, Mon-Williams M, Phillips N, Pavitt SH. Evaluating the impact of trigeminal neuralgia. Pain. 2017;158(6):1166-1174.
    1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. 2018;38(1):1-211.
    1. Lambru G, Zakrzewska J, Matharu M. Trigeminal neuralgia: a practical guide. Pract Neurol. 2021;21(5):392-402.
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Emergency Department Plastic Wallet Cards

Following the webinar presented by A/Prof Arun Aggarwal in July, we brainstormed the possibility of providing a plastic wallet card for our sufferers to present to the Emergency Department of their hospital, when Trigeminal Neuralgia break through pain becomes too much to cope with. We worked with PR Design and produced a fantastic card which […]
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Webinar – Prof Arun Aggarwal

Webinar News – Save the Date

We are delighted to announce the details for our next webinar – Presentation by Prof Arun Aggarwal – When Trigeminal Neuralgia Pain is too much : Presenting at the Emergency Department for Pain Management

Professor Arun Aggarwal is a highly experienced neurologist with expertise in chronic pain management, sport related head injuries and rebab.

Professor Aggarwal graduated from the University of Adelaide in 1987 and went on to specialise in neurology, rehabilitation medicine and pain medicine and is a Fellow of the Royal Australasian College of Physicians, the Australasian Faculty of Rehabilitation Medicine, and the Australasian Faculty of Pain Medicine.

Arun completed his PhD at the University of Sydney on motor neuron disease with his primary paper ‘Detection of pre-clinical motor neurone loss in SOD1 mutation carriers using motor unit number estimation’ earning him the Australian Association of Neurologists Young Investigator Award.

He is a Clinical Associate Professor at the University of Sydney’s Medical School and currently oversees a number of research trials examining Parkinson’s disease, trigeminal neuralgia and chronic neuropathic pain. Arun’s exceptional levels of experience and ongoing involvement in research and investigation continue to be widely recognised with over 50 manuscripts in peer-reviewed journals.

Today, Arun sits on the editorial board of the Journal of Clinical Trials and Clinical Case Reports. He is the current Chairman of the ANZ Association of Neurologists Neuro-Rehabilitation Sub-Committee and on the Medical Advisory Board of Trigeminal Neuralgia Association.

Prof Arun’s contact details are below

A/Prof Arun Aggarwal |Neurologist, Rehabilitation & Pain Specialist| The Mater Hospital, North Sydney (svph.org.au)

The webinar can be accessed clicking – Zoom Link to Webinar