thyroid hormones (hypothyroidism), the woman had received no further medication. Zolpidem had been prescribed by several physicians and obtained from other sources until the intake was abruptly discontinued by the patient due to supply problems. Within 24 hours, 2 epileptic seizures were observed by relatives. A further generalized convulsion of about 6 minutes occurred in the emergency department and was terminated by administration of intravenous diazepam 10 mg. Her substance use history was significant for intermittent use of barbiturates and diazepam during adolescence due to an anxiety disorder (not further specified). Experiences of illegal drugs/alcohol or previous detoxification treatments were not reported (actual toxicology without abnormal findings).Six years previously, the patient had developed severe facial pain after excessive treatment of the skin with various external cleansing lotions of unknown composition. Presently, a symmetrical burning pain, including all sensory branches of the trigeminal nerve, with an intensity of 8 out of 10 on a visual analog rating scale (VAS) and persistence during the most part of the day was described. Trigger points were not mentioned, but there was increased sensitivity to cold and touch. Extensive examinations, including electrophysiologic and imaging techniques, were within the normal range. The symptomatology was considered painful polyneuropathy of neurotoxic genesis on the basis of excessive dermal treatment.Various treatment efforts in the past, including tricylic and other antidepressants, non-opioidergic and opioidergic analgesics, memantine, glucocorticoids, anticonvulsive agents, α-lipoic acid, lidocaine, benzodiazepines, and blockade of the superior cervical ganglion, were ineffective. However, the patient noted substantial pain relief (VAS score 1) with zolpidem therapy, which had been prescribed as temporary sleep medication starting with 10 mg/day. Over the past 2 years, the dose of zolpidem was gradually escalated by the patient to reach optimal pain relief.Detoxification was accomplished using a standardized 10-day tapering protocol of oxazepam (starting with 20 mg for 4 days) in combination with carbamazepine (starting with 200 mg for 3 days), which was successfully completed. 1,2 However, the pain reappeared and did not respond to any further treatment efforts.
