Case report of a patient with neuropathic pain over the right supraorbital nerve following bilateral translid brow lid
This lady has neuropathic pain over the right supraorbital nerve territory following a bilateral translid brow lift in November of last year.
She is felt itchiness intermittently as well as electric shocks in the area. She also complains of paraesthesias. Since the surgery, things have been improving, but very slowly. She had no medical problems, no allergies and takes no medication. The underlying diagnosis was given as a neuropraxia to the supraorbital nerve, a form of nerve damage giving her the symptoms of neuropathic pain. She was started on Gabapentin but unfortunately had multiple adverse effects with this.
On examination she was found to have pain on light touch (allodynia) and an increase in pin prick sensation (hyperalgesia) in the territory of the right supraorbital nerve.
Medication for neuropathic pain in the supraorbital region
The patient was titrated up to 300 mg per day of pregabalin with buprenorphine sublingual tablets for breakthrough pain.
Six weeks after starting the medication she found a noticeable improvement in her pain.
The long term aim is to keep her stable on the medication for 4-5 months then gradually wean and discontinue them