Treatment

After assessment, patients should at least initially be treated conservatively with oral medication. Depending on the patient's age, fitness and the underlying cause of the neuralgia, information should be given on, and a discussion undertaken about, the more invasive treatments available.

Carbamazepine is the first-line treatment for TN. The patient should be started on a small dose at night, which is then gradually increased until relief occurs. Relief normally occurs quite quickly, typically at doses below 1000 mg/day. Once relief is obtained, the patient is maintained on that dose, although occasional increases may be necessary to treat breakthrough pain. It may be possible in time to reduce the maintenance dose. If carbamazepine treatment fails or the drug is not tolerated due to side effects or drug reaction, other anticon-vulsants should be tried. Phenytoin is long established as a second-line therapy but the introduction of gabapentin has provided alternatives. Lamotrigine is also used and there are reports of pain relief with baclofen. The drugs may be used in combination, if required.

In the event of failure with conservative therapies, there is a wide range of reported treatments of varying degrees of invasiveness. There

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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