When should I consider referring a patient with trigeminal neuralgia for surgical evaluation?

Consider referring a patient with trigeminal neuralgia for surgical evaluation if their unilateral facial pain is refractory to treatment, particularly when initial pharmacological management with carbamazepine is not effective, not tolerated, or contraindicated. This referral should be made in line with the NICE guideline on neuropathic pain in adults and may involve seeking expert advice from a specialist pain service or a condition-specific service.

Additionally, adults presenting with unilateral facial pain triggered by touching the affected part of the face (typical of trigeminal neuralgia) and who do not respond adequately to medical treatment should be referred for further specialist assessment, which may include surgical options.