Gabapentin Supplemented With Ropivacain Block of Trigger Points Improves Pain Control and Quality of Life in Trigeminal Neuralgia Patients When Compared With Gabapentin Alone (original) (raw)
Related papers
Journal of Pain Research, 2010
Treatment of trigeminal neuralgia (TN) is achieved by using adjuvant analgesics like antiepileptics, with carbamazepine (CBZ) being the first-line approach for TN patients, although side effects may be present. Other approaches using gabapentin, namely when associated with peripheral analgesic block of TN trigger points with the local anesthetic ropivacaine (ROP), resulted in decreased pain and daily drug intake (reduced side effects). This study evaluates if the association between CBZ and the peripheral block with ROP reinforces the clinical value of CBZ. In this parallel, double-blinded study, idiopathic TN patients were randomized to receive during 4 weeks either CBZ (CBZ; n = 21) or CBZ associated with the peripheral analgesic block using ROP (CBZ + ROP; n = 24). The primary outcome measures were the following: i) pain intensity, evaluated by the numerical rating scale; ii) number of pain crises; and iii) number needed to treat. Evaluation points were at the beginning (day 1) and end (day 29) of treatment and after a follow-up of 5 months (month 6). Both protocols resulted in a decrease of pain intensity and number of pain crises, but only the association CBZ + ROP showed i) a significant stronger reduction in pain intensity at month 6 and ii) a significant decrease in the daily dose of CBZ given to patients (both at day 29 and month 6). In contrast, the daily dose in CBZ-only patients remained constant or even increased. The number needed to treat for the association CBZ + ROP over the CBZ protocol reduced from 5 at the end of the 4-week treatment to 3 after the 5-month follow-up. Data reinforce the use of CBZ as a primary tool to control pain in TN patients, as the association CBZ + ROP i) improves the clinical qualities of CBZ, ii) strongly reduces the daily dose of CBZ, and iii) reduces the potential side effects attributed to high doses of CBZ.
Efficacy Of Gabapentin In Trigeminal Neuralgia: A Non-randomized Trial
Journal of Bahria University Medical and Dental College, 2018
Objective: To compare the efficacy of Gabapentin with carbamazepine in Trigeminal Neuralgia. Material/Method: The study was conducted in Agha Khan University Hospital and Abbasi Shaheed Hospital for four months. 19 patients of TN were collected through purposive convenience sampling. DN4 questionnaire was used to differentiate between Somatic and Neuropathic pain. Numeric Pain Rating Scale was used to assess the severity of pain. Results: Nine patients of Trigeminal Neuralgia refractory to carbamazepine were put on Gabapentin with male to female ratio of 4:5. All showed favorable response on 800-1600 mg Gabapentin on Numeric Pain Rating Scale. All patients were pain free in three weeks with no side effects. There was significant difference between pain response to carbamazepine and Gabapentin at P< .05. Four patients (44%) had pain relief on 900 mg Gabapentin, three (33%) on 1200 mg, one responded on 800 mg and one on 1600 mg. Conclusion: Gabapentin is effective as first line tre...
& Abstract: To evaluate the safety and efficacy of gaba-pentin in comparison with carbamazepine in the treatment of trigeminal neuralgia, a meta-analysis of randomized controlled trials was performed. Two reviewers independently selected studies, assessed study quality, and extracted data. Sixteen randomized controlled trials that included 1,331 patients were assessed. The meta-analysis showed that the total effective rate of gabapentin therapy group was similar with carbamazepine therapy group (OR = 1.600, 95% CI 1.185, 2.161, P = 0.002). While the effective rate of gabapen-tin therapy for 4 weeks was higher than that of carba-mazepine therapy (OR = 1.495, 95% CI 1.061, 2.107, P = 0.022, heterogeneity: x 2 = 7.12, P = 0.625, I 2 = 0.0%), the life satisfaction improvement is also better in the gabapentin therapy group after a 4-week treatment (SMD = 0.966, 95% CI 0.583, 1.348, P < 0.001). Furthermore, our meta-analysis suggested that the adverse reaction rate of gabapentin therapy group was significantly lower than that of carbamazepine therapy group (OR = 0.312, 95% CI 0.240, 0.407, P < 0.001). In conclusion, present trials comparing gabapentin with carbamazepine are all poor in terms of methodological quality. Based on the available evidence, it is not possible to draw conclusions regarding the efficacy and side effects of gabapentin being superior to carba-mazepine. &
Lamotrigine for trigeminal neuralgia: Efficacy and safety in comparison with carbamazepine
Journal of The Chinese Medical Association, 2011
Background: Anticonvulsants are regarded as useful for the treatment of neuropathic pain. In this study, we evaluated the efficacy and occurrence of side effects of lamotrigine (LTG) in comparison with carbamazepine (CBZ), in trigeminal neuralgia (TN) patients. Methods: The study was an interventional and crossover comparison. Twenty-one patients with TN were administered with LTG in comparison to CBZ. The clinical trials comprised two phases of 40 days each, with an intervening three-day washout period. The final titration in dose for LTG was 400 mg and 1,200 mg for CBZ. Efficacy of the medications involved was determined by visual analog scale (VAS) and verbal rating scale (VRS). Side effects were recorded through marking of the profiles of side effects encountered on administration of LTG and CBZ, together with baseline haematological, hepatic and renal investigations. Results: Both on VAS and VRS assessments, in terms of proportion of patients, CBZ benefitted 90.5% (19/21) of the patients with pain relief ( p < 0.05), in contrast to 62% (13/21) from LTG. On VAS assessment, of the 13 patients who gained pain relief from LTG and 19 from CBZ, 77% (10/13) obtained a "complete" degree of pain relief from LTG, as compared with 21% (4/19) from CBZ. On VRS assessment, with LTG, 84% (11/13) of the patients accomplished "much better" degree of pain relief, as compared with 26% (5/19) with CBZ. On LTG, 67% (14/21) of patients endured general pharmacological side effects, as compared with 57% (12/21) of patients on CBZ ( p > 0.05). Meanwhile, LTG inflicted 14% (3/21) of the patients with haematological, hepatic and renal derangements, as compared with 48% (10/21) on CBZ. Conclusion: LTG is generally an effective and safe treatment for management of TN, compared to CBZ.
Journal of Investigative and Clinical Dentistry, 2019
The aim of this systematic review was to determine the efficacy of gabapentin (GBP) in the treatment of pain of idiopathic trigeminal neuralgia (TN). A comprehensive literature search was conducted using the Cumulative Index of Nursing and Allied Health Literature (EBSCO Industries), Emcare (Ovid), Medline (Ovid), Medline (PubMed), Scopus (Elsevier) and Web of Science (Clarivate Analytics). The inclusion criteria comprised randomized controlled trials of GBP as a monotherapy in the treatment of idiopathic TN in adult participants and publications in English. All other study methodologies were excluded. The search yielded 1472 articles, and after exclusion, 11 full-text articles were eligible for full-text analysis. Only two studies met the inclusion criteria. There is insufficient evidence either to support or refute the efficacy of GBP in the management of idiopathic TN. Therefore, further well-designed placebocontrolled trials are required to confirm the efficacy of GBP in managing TN pain as a single therapy.
Defining the role for gabapentin in the treatment of trigeminal neuralgia: A retrospective study
The Journal of Pain, 2002
The preferred treatment for trigeminal neuralgia consists of antiepileptic drugs. Among them, gabapentin has shown promise in relieving some forms of neuropathic pain. This retrospective review examined 194 consecutive cases of trigeminal neuralgia, many of whom had paroxysmal facial pain resistant to previous surgical interventions or treatment with multiple medications. Of the 92 who had received a trial of gabapentin, 43 reported reduction in facial pain. This benefit was complete in 16, nearly complete in 9, moderate in 12, and partial in 6. Onset of pain relief occurred generally within 1 to 3 weeks, depending on the rate and end point of dose titration. The effective range of stable daily dosing varied from 100 to 2400 mg divided 3 times a day, with a mean of 930 mg. Pain relief was sustained in two thirds during a mean follow-up time of 8 months. The fact that gabapentin was well-tolerated and without serious side effects is an important advantage when prescribing for elderly patients. The present study suggests that gabapentin can be effective as first or second line treatment of trigeminal neuralgia, even in cases resistant to traditional treatment modalities.
2021
Background: Trigeminal neuralgia (TN) is a debilitating unilateral, stabbing facial painful, condition originating from the trigeminal nerve. It is presented as burning, electric shock, or Tingling sensation. Pain in the trigeminal neuralgia significantly affects both the sensory as well as the motor activities of the body, thus affects the quality of life. Carbamazepine remains the gold standard drug in terms of efficacy for treatment for trigeminal neuralgia. The study aimed to evaluate the efficacy of tablet Carbamazepine in improving quality of life by using BPI Facial questionnaire. Materials and Methods: A total of 20 patients with a mean age of 50.80 years included in the study were randomly selected from the outpatients having complaint of facial pain. All the patients were given a Brief pain inventory Questionnaire before and after tablet carbamazepine intervention (400mg OD) divided into two doses. After 1-month patients were again given BPI Facial questionnaire to evaluat...
Journal of Dental Anesthesia and Pain Medicine, 2021
Background: Trigeminal neuralgia (TN) is characterized by brief, unilateral, sharp, stabbing, and shooting pain of the fifth cranial nerve. The objective of this systematic review with meta-analysis was to determine the effect of medications compared to placebo in adult patients with TN. Methods: Review authors identified randomized placebo-controlled trials (RCTs) from PubMed, Web of Science, Cochrane, and EMBASE up to February 2021. We assessed the inclusion and exclusion criteria as well as the risk of bias of the studies based on the Cochrane Handbook. A total of 324 unduplicated references were scanned independently and reduced to eight relevant RCTs, with 89 patients included. Medications investigated included oral carbamazepine, subcutaneous sumatriptan, lidocaine (intranasal, 8% spray on the oral mucosa or intravenous), buprenorphine (ganglionic local opioid analgesia), and oral Nav1.7, a selective sodium channel blocker. Results: Meta-analyses showed that overall patients receiving lidocaine reported a significantly lower post-treatment intensity of pain −3.8 points on a 0-10 scale (95% Cl = −4.653 to −2.873; P < 0.001). Patients who received lidocaine were 8.62 times more likely to have pain improvement than patients on placebo (P < 0.001). In one RCT, patients receiving oral carbamazepine showed a significant improvement in pain intensity of −32% compared to the placebo (P < 0.001). In one trial, patients receiving 3 mg subcutaneous sumatriptan had a significantly lower intensity of pain on average −6.1 points on a scale of 0-10 compared to placebo (P < 0.001) and a significant improvement in pain intensity of −75% compared to the improvement in the placebo group (P < 0.001). Patients who received subcutaneous sumatriptan were 10 times more likely to have pain improvement than those who received placebo (P = 0.001) in one study. Due to the unclear/high risk of bias and small sample size, the quality of the evidence for lidocaine in the treatment of TN was low. Conclusion: Further studies are needed for carbamazepine, sumatriptan, buprenorphine, and oral Nav1.7 sodium channel blockers, as only one study reported outcomes.
https://www.ijhsr.org/IJHSR\_Vol.8\_Issue.3\_March2018/IJHSR\_Abstract.011.html, 2018
Introduction: Pain and fear of pain continue to be the commonest and strongest motivation for the people to seek facial pain treatment. Pain is a personal experience of the sufferer that cannot be shared and wholly belongs to the sufferer. Trigeminal neuralgia (TN) is a notable facial pain disorder resulting in periodic severe pain that produces one of the most severe kinds of pain known to mankind. Treatment of this debilitating condition may be varied, ranging from medical to surgical interventions. However antiepileptic drugs are commonly used for its treatment. This study was done with an aim to evaluate the efficacy and safety of pregabalin as an add on therapy to carbamazepine in patients of trigeminal neuralgia. Materials and Methods: This was a prospective, open label, randomized, comparative clinical study conducted on 50 patients. The patients were randomly divided in two groups of 25 patients to receive following two treatments. Group I (n=25) received tablet carbamazepine as a monotherapy initially 200 mg daily per orally in divided doses and gradually built up as per clinical response with maximum titrated dose upto 1000mg/day. Group II (n=25) received capsule pregabalin 75 mg OD and tablet carbamazepine 200 mg daily per orally in divided doses and dose gradually built up as per clinical response with maximum titrated dose upto 300mg/day for pregabalin for a period of 12 weeks. Efficacy assessment was done by Visual analogue scale (VAS), Verbal rating scale (VRS) and safety was assessed by monitoring of adverse drug reactions. The patients were assessed at the end of 4 th , 8 th and 12 th weeks. Results: There was statistically significant reduction in mean pain score at 4 th , 8 th and 12 week, in both the groups when compared to the baseline i.e both carbamazepine and pregabalin as an add on therapy to carbamazepine were effective in reducing the pain. However on intergroup comparison, pregabalin as an add on drug to carbamazepine(Group II) produced better response with earlier onset of pain relief with statistically significant reduction in mean pain score at 8 th and 12 th weeks when compared to carbamazepine alone (Group I). There were no serious adverse effects in either of treatment group. Common adverse effects in group I were drowsiness, nausea and vomiting while in group II, drowsiness and dry mouth were commonly noticed Conclusion: The present study suggested that pregabalin as an add on therapy to carbamazepine was found to cause significant reduction in pain scoring at 8 th & 12 weeks and could be a promising drug in patients of trigeminal neuralgia when therapeutic options are limited.
Health Notions
Trigeminal neuralgia is a condition that affects the trigeminal nerve, that manifests in a series of stabbing like pain, and often described like electricity. Its treatment guideline is to prioritize pharmacotherapy until patient is well. The gold standard treatment for trigeminal neuralgia is pharmacotherapy of Carbamazepine. However, carbamazepine is proven to cause allergic reaction to some patients. This research aims to describe the pharmacotherapy that is given to patients. The regiments of pharmacotherapy in trigeminal neuralgia shows that CBZ is the main pharmacotherapy given, as it is the gold standard treatment. GBP is the is the second most pharmacotherapy given and a concoction medication of Paracetamol, Diazepam and Amitriptyline being the third most favored therapy. Neurotropic B Vitamins plays a big role, as a support in the therapy to maintain the health of the overall nervous system. The pain scale data shows that almost all patients have significant pain relieve. T...