to the editor: The article on trigeminal neuralgia came at a perfect time as I had just been discussing a refractory case with some family medicine and neurology colleagues. This particular patient's pain is made more intolerable by underlying anxiety, as is common with pain syndromes. I would like to add a suggestion from my recent experience. The author of the article briefly discussed “a variety of other medications and modalities” but omitted pregabalin (Lyrica). Although the evidence is scant, this is a potentially useful drug for some patients because it may be beneficial for both the neuropathic pain and comorbid anxiety.1–4
In Reply: I appreciate the comments from Dr. Viel about trigeminal neuralgia. Many medications and modalities have been tried for the treatment of trigeminal neuralgia, but the evidence is very limited regarding the effectiveness of most, with the exception of carbamazepine (Tegretol). The article Dr. Viel references regarding the use of pregabalin (Lyrica)1 was published after the preparation of my manuscript, but it offers another option for patients intolerant or refractory to carbamazepine. Unfortunately, the open-label format and lack of a control group make it difficult to fully evaluate the efficacy of pregabalin for this condition and relegate it to a position with other potentially effective treatments. An argument can be made that the choice of one of these treatments might be properly influenced by coexisting conditions, as was the case in Dr. Viel's patient with anxiety disorder.