Emergency Room Management of Episodes of Severe TN

When to Go

When pain is too severe to eat or sleep 

Change in the normal pattern of TN pain

Severe side effects

Sudden loss of effectiveness of medication

A severe attack that may occur when a patient has gone into remission and has come off their medication

What you can do

To avoid emergencies, comply with your prescribed medication regimen .

Have a plan ready in case pain begins worsening, and avoid factors that you’ve found exacerbate the pain.

If possible, patients should ask their doctor to call and advise the ER physician about their TN.

Keep a brief record of your TN medical history, including medications taken, allergies and your doctor’s name and phone number.

The patient may be in too much pain to speak, therefore it is important for the ER staff to know the history of the patient.

Whether written or spoken, the ER staff will be more receptive to a short history that only includes pertinent and current information.

The ER staff may be unfamiliar with TN.

ER physicians may perform unnecessary tests, which can delay treatment.

If possible, take someone with you who knows your history, and who can be your spokesperson.

What the ER can do

ER treatments may include morphine administered by IV or injection, which can provide rapid pain relief lasting several hours.  Opiods may be useful in controlling acute pain.

Dilantin may be administered by IV or in a newer form called Cerebyx (fosphenytoin).  The latter can provide rapid if temporary relief, but requires heart and blood pressure monitoring, so the patient may have to stay overnight.

The ER physician may also order Depacon intravenously or an injection of local anesthetic applied to the trigger zone.

When you leave the ER

ER staff should review current medications with the patient, including non-prescription medications that may be causing drug interactions, and possible overuse and toxicity.

Patient’s doctor should be informed about the ER visit and how it was resolved.

The patient should also be given a maintenance plan when being discharged from the Emergency Room.

While none of these are long-term answers, they can help acute pain, buy time to build up new doses of oral medication in the blood stream or decide upon and schedule surgery.