Effective management of breakthrough pain in patients with trigeminal neuralgia who are already receiving medication involves ensuring optimal baseline treatment and considering specialist referral for additional management. Carbamazepine is the first-line pharmacological treatment for trigeminal neuralgia and should be optimally dosed and regularly reviewed for efficacy and tolerability. Breakthrough pain episodes should prompt a clinical review to assess pain control, impact on daily activities, and adverse effects, with adjustments made accordingly. If carbamazepine is not effective, not tolerated, or contraindicated, early referral to a specialist pain service or condition-specific service is recommended for further assessment and management options, which may include alternative medications or interventional procedures.
Short-term use of acute rescue therapies such as tramadol may be considered cautiously, but long-term use is not recommended in non-specialist settings. Regular clinical reviews should include assessment of pain severity, impact on lifestyle, and psychological wellbeing to guide treatment adjustments. Non-pharmacological approaches and coping strategies should also be discussed as part of a comprehensive management plan.