A 56 year old lady was seen in the Pain Clinic. She had a long history; initially she had a tonsillectomy approximately 40 years ago. Following this, intermittently over the years she has had problems in the right tonsillar bed; initially she had a neuroma there which was operated on. Unfortunately, following this she got persistent infection with Candida and for many years she has had problems with heavy burning pain emanating from the area of the right oropharynx, radiating towards the maxilla. This was aggravated by white wine and toothpaste. She described the pain as continuous 24/7, least pain being 5/10 and worse pain is 10/10 and could be very variable.
Clinically, the impression was of neuropathic pain emanating from the right tonsillar bed. She was given a full and frank explanation of the nature of neuropathic pain, being damage and/or dysfunction of nervous tissue causing dysaesthetic pain including burning and shooting pains which she described.
She had some improvement with Amitriptyline 20 mg nocte. The balance between pain relief and the adverse effects of antineuropathic medication was explained in detail. She was started on Pregabalin 75 mg twice per day, titrated slowly to 150mg twice per day. At 3 months he remained stable with significant improvement in her pain and tolerable adverse effects from the medication. The plan is continue the current regimen for another month, then slowly wean down the dosage.
