Nerve block and pharmacotherapy for pain management in refractory trigeminal neuralgia with multiple surgical failures: a case report

To explore the value of foundational, stepwise strategies for treating refractory trigeminal neuralgia (TN), particularly the significance of a “step-back” approach when advanced techniques fail, in a patient who experienced significant relief with basic nerve block therapy after multiple minimally invasive surgical interventions were ineffective. A retrospective analysis was conducted on the diagnosis and treatment process of a patient with refractory TN who experienced recurrent pain after undergoing two microvascular decompression (MVD) procedures and one percutaneous balloon compression (PBC) procedure. The patient ultimately experienced marked relief after receiving mandibular nerve block therapy at our hospital. After two MVD procedures and one PBC procedure, the patient’s pain relief was either short-lived or unsatisfactory. However, upon reverting to foundational nerve block therapy, the pain was significantly and relatively persistently alleviated. This case suggests that for patients with refractory TN, when advanced minimally invasive surgical treatments (e.g., MVD and PBC) are ineffective or fail, foundational and repeatable interventional therapies such as nerve blocks should not be entirely dismissed. In personalized treatment strategies, basic therapeutic methods retain critical “safety net” value and clinical significance, embodying the pragmatic principle of “stepwise treatment with flexible advancement and retreat.”