QUESTION:
- What clinical practice guidelines or evidence would guide your decision-making in prescribing analgesics or referring to specialists?
- Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
Differential Diagnoses
Based on the symptoms presented by Marva, there is the potential for differential diagnosis that can be considered causing the facial pain. One of the diagnoses could be Trigeminal Neuralgia, which is mainly featured by the sudden-onset, stabbing pain and the trigeminal distribution of the nerve (Silva & Ouanounou, 2020). The sensation of electric shock-like at a like of touch is aligned with the description of Marva. The second diagnosis could be the temporomandibular joint complication, which mainly causes different symptoms such as facial pains at the time of eating or even brushing (Valesan et al., 2021). This is aligned with the symptoms presented by Marva since she presented pains that are aggravated through touch and influence her mouth ADL signifying the TMJ disorder. The third diagnosis is Post-Herpetic Neuralgia which is mainly consistent with the presented description of Marva on wave pains and feeling some electric-like shocks (Aggarwal et al., 2020).
Therapeutic Plan
The first step is performing a comprehensive diagnosis examination for Marva with the main diagnosis focus on the three differential diagnoses, in regard to the presented symptoms.
After the diagnosis, the plan will involve the management through medication based on the differential diagnoses that are presented after the comprehensive examination. Trigeminal Neuralgia can be managed with the use of oxcarbazepine as the first line to manage the nerve pains and pregabalin as the second line. The management of TMJ disorder will involve the use of anti-inflammatory drugs and muscle relaxants (Valesan et al., 2021). Lastly, PHN will be managed with antiviral agents and analgesics.
Aside from then pharmacological interventions, non-pharmacological management will be involved such as physical therapy and muscle relaxation methods, heat and cold therapies, and counseling for the management of stress.
Regular monitoring appointments will be scheduled that will help in assessing the treatment and educating the patient for continued management strategies. Referral of the patient to a neurologist expert for continuous examination.
References
Aggarwal, A., Suresh, V., Gupta, B., & Sonthalia, S. (2020). Post-herpetic neuralgia: A systematic review of current interventional pain management strategies. Journal of Cutaneous and Aesthetic Surgery, 13(4), 265. https://doi.org/10.4103/jcas.jcas_45_20
Silva, M., & Ouanounou, A. (2020). Trigeminal neuralgia: etiology, diagnosis, and treatment. SN Comprehensive Clinical Medicine, 2(9), 1585–1592. https://doi.org/10.1007/s42399-020-00415-9
Valesan, L. F., Da-Cas, C. D., Réus, J. C., Denardin, A. C. S., Garanhani, R. R., Bonotto, D., Januzzi, E., & De Souza, B. D. M. (2021). Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clinical Oral Investigations, 25(2), 441–453. https://doi.org/10.1007/s00784-020-03710-w
