Facial Trauma and Trigeminal Nerve Complications: A Personal Account
A 38-year-old male is currently dealing with a new trigeminal nerve injury. His medical history includes neuropathy, ADHD, bipolar disorder, combat-related PTSD, rotator cuff surgery, and herniated discs in the cervical spine (C4-C6), alongside myofascial pain syndrome in the shoulder region. Recently, he experienced an additional injury involving facial trauma which raises some questions regarding treatment. The individual suspects that he may have developed maxillary trigeminal neuropathy after accidentally twisting a screw, leading to a slip that caused him to strike his cheekbone. After visiting the emergency room, he was relieved to find out there were no fractures or bleeding. He has previously endured neuropathic pain due to severe TMJ issues and previous disc herniations. Currently, he is on a regimen of pregabalin, taking 200 mg three times a day. However, he is feeling an increase in burning pain and twitching sensations in his facial region compared to his arm discomfort. In efforts to manage the discomfort, he has been taking an additional pregabalin dose—one extra daily over the past three days—along with lidocaine cream, ice, and Aleve for relief. This extra dose of 200 mg in the morning has somewhat alleviated his symptoms, allowing him to cope better at work. He mentioned his medication adjustments to the ER doctor, who documented this change in her notes that are accessible through the patient portal. The patient is particularly anxious about the implications of medication adjustments and how this may be perceived by his healthcare provider. The emergency room physician did not address his concerns directly, leaving him uncertain. He finds himself worried about running out of medication towards the end of the month, especially because his primary care physician (PCP) has access to the same medical records and notes. He describes experiencing withdrawal symptoms if he misses an evening dosage, which can lead to increased heart rate, sweating, and significant insomnia. The thought of potentially being short on medication for two to three days looms over him. He is contemplating whether to share these concerns with his doctor. He believes they have developed a positive rapport over the years since she took over her practice from his former physician. Importantly, he reports no adverse side effects from the pregabalin medication at all.
Answers (1)
3/19/2025, 1:10:42 PM
OpenHealth AI
It's understandable that you're feeling anxious about your medication management following your recent facial trauma and the increase in your symptoms. Here’s a structured response to help address your concerns and provide some guidance.
Main Points:
- Increased pain and twitching sensations may be related to the trigeminal nerve injury.
- Adjusting your pregabalin dosage without your doctor’s oversight can cause concern.
- It is crucial to discuss your symptoms and medication adjustments with your healthcare provider.
Explanation:
You are experiencing heightened symptoms, likely exacerbated by your recent injury and ongoing neuropathy. The trigeminal nerve, which controls sensations in your face, may be affected by the trauma, leading to burning pain and twitching. It’s positive that you were assessed in the ER and found to have no fractures, but the discomfort you're feeling warrants careful management.
While taking an extra dose of pregabalin has offered you temporary relief, adjusting medications should ideally be done in consultation with your healthcare provider to avoid dependency issues and potential withdrawal effects. Your feelings of anxiety about running out of medication are valid and it’s important to communicate these concerns.
Next Steps:
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Consult Your PCP: Schedule an appointment with your primary care physician to discuss the increase in your symptoms and the extra dose of pregabalin you've been taking. Transparency about your situation will help your physician understand and better manage your care.
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Medication Management: Ask your doctor about strategies to ensure you have an adequate supply of medication for the month and discuss any concerns about withdrawal symptoms. They can offer advice or prescribe a slightly modified regimen that might help.
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Pain Management Strategies: In addition to pregabalin, consider non-medication strategies for pain relief, such as gentle facial massage (if tolerable), relaxation techniques, or mindfulness exercises to help manage stress related to your medication concerns.
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Keep a Symptom Diary: Document your pain levels, medication usage, and any withdrawal symptoms you experience. This will provide valuable insight for your doctor when discussing your management plan.
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Communicate Openly: Remember that your healthcare providers are there to support you. Discuss your anxieties head-on—they’re likely to appreciate your honesty and can adjust your treatment effectively.
Taking these steps can help alleviate your anxiety, provide clarity on your current treatment, and guide you toward better management of your symptoms. If you have further questions or need more tailored advice, feel free to ask.
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