Challenging Pain Management in a Patient with Trigeminal Neuralgia Secondary to Multiple Sclerosis

Patients suffering from multiple sclerosis (MS) often develop neuropathic pain. Trigeminal neuralgia (TN) is the most common type in these patients. The pain is characterised by recurrent, unilateral, brief, electric shock-like episodes, abrupt in onset and termination, and limited to the distribution of one or more divisions of the trigeminal nerve, which is difficult to treat when compared to classical TN. The recommended first line of therapy includes medications like carbamazepine, lamotrigine, baclofen, and gabapentinoids to which most of the patients respond well with mild to moderate side effects. Some patients do not respond to conventional pharmacological therapy and may require a combination of other pain medications. A 30-year female patient presented in the pain clinic with TN due to MS and was treated with carbamazepine. However, due to severe side effects she had to quit its use. The patient was then successfully treated with an intravenous infusion of lidocaine and remained pain-free without any other pain medications. Key Words: Trigeminal neuralgia, Multiple sclerosis, Lidocaine.