Update on atypical facial neuralgia
W. CHAN, MD, of Markham, ON, asks, "Please comment on atypical facial neuralgia. A patient with discomfort in the gum and lip area was diagnosed with atypical facial neuralgia. Treatment by a psychiatrist with various antipsychotics and antidepressants produced no improvement. The dental pathologist suggested amitriptyline therapy. Could you please give me the latest update?"
Amitriptyline has been used successfully for a variety of neurogenic pain conditions. This medication appears to have a specific pain-relieving function, in that the doses usually administered (25-50 mg) aren't antidepressant quantities. Supportive or cognitive-behavioural psychotherapy may also be required to help the patient deal with the consequences of living with chronic pain. GR (see our neurologist's response to this question in the neurology category)