Topical Gabapentin as Add-on Therapy for Trigeminal Neuralgia. A Case Report

Brid, Teresa; Lama, Maria Paz Sacristán de; González, Nieves; Baamonde, Ana

doi:10.1093/pm/pnx013

Cited by 8 publications

(12 citation statements)

References 10 publications

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“…Considering the usual side effects of such treatments (fatigue, dizziness, vertigo, etc) mostly related to central nervous system depression, their prescription can be cumbersome, especially in patients with severe systemic conditions, as in the present case. Topical applications of aforementioned drugs, although not yet validated, can offer a safe and efficient alternative for such cases, as scarce evidence would start to suggest 9 28 29. As such, this case illustrates the efficacy of topical pregabalin mouthwashes for glossodynia over a period of more than 2 years (as confirmed by the patient’s son).…”

Section: Discussionmentioning

confidence: 85%

“…Nevertheless, considering her underlying severe bronchomalacia (that puts her at risk of acute respiratory distress) and the increased risk of falls, both related to systemic administration of pregabalin, we opted for topical pregabalin administration as a mouthwash to manage her pain. This choice was justified by the previously evidenced local effect of gabapentinoids,9 preclinical data showing lack of local toxicity10 and potential indirect benefit related to the soothing effect of the cold liquid on the patient’s tongue. Both the patient and her son consented to this treatment option.…”

Section: Treatmentmentioning

confidence: 99%

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Unilateral glossodynia as a harbinger of an occult cerebellopontine angle tumour

Gibeili

Sulukdjian²,

Chanlon³

et al. 2022

BMJ Case Rep

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A woman in her late 80s with severe bronchomalacia was referred to a tertiary orofacial pain clinic for unexplained right unilateral glossodynia of progressive and continuous evolution for the past 8 months, spreading to the ipsilateral labiomental region, associated with ipsilateral hypoacusia. Local and general clinical examinations were unremarkable and routine blood work could not reveal any underlying systemic disease explaining the glossodynia and burning/pricking labiomental pain. Suspecting a painful trigeminal neuropathy secondary to a space-occupying lesion, a cerebral MRI was prescribed, revealing an ipsilateral cerebellopontine angle lesion, compatible with either a schwannoma or meningioma. This lesion invaded the root entry zones of cranial nerves V and VIII explaining the patient’s oral pain and hypoacusia. Following a neurosurgical consultation where surgical treatment was rejected, her pain was successfully managed by topical pregabalin mouthwashes, to prevent any risk of respiratory depression related to her underlying severe bronchomalacia.

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Section: Discussionmentioning

confidence: 85%

Section: Treatmentmentioning

confidence: 99%

Unilateral glossodynia as a harbinger of an occult cerebellopontine angle tumour

Gibeili

Sulukdjian²,

Chanlon³

et al. 2022

BMJ Case Rep

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“…As primary afferent neurons express voltage-gated calcium channels [51], a local effect of gabapentinoids is pathophysiologically plausible and in adherence with what is observed in clinical practice. Indeed, topical gabapentin has been used successfully as an add-on treatment for the management of trigeminal neuralgia [52]. In our tertiary clinic, we have proposed mouthwashes with pregabalin as the sole (efficient) treatment option for management of inflammatory anemia-related glossitis [6] or for management of trigeminal neuropathy in a patient with severe bronchomalacia, who was deemed unfit for systemic administration (unpublished case report).…”

Section: Discussionmentioning

confidence: 99%

Gabapentinoid prescription in Oral Medicine and Oral Surgery practice. Part II − a systematic scoping review of the literature

Sulukdjian

L'Homme

Chanlon

et al. 2020

J Oral Med Oral Surg

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Introduction: Gabapentinoids, pregabalin and gabapentin, neuronal voltage-gated calcium channel inhibitors are first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions). Nevertheless, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. A previous article, the first of a two-part series, presented the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in orofacial conditions. This second article aimed to explore the scientific literature on the subject. Material and methods: A systematic scoping review was conducted on multiple relevant databases (MEDLINE®, Cochrane®, Agence Nationale de Sécurité du Médicament et des produits de santé, Haute Autorité de Santé) and journal archives (JOMOS, JSOMFS) to assess the indications, non-indications and contraindications of gabapentinoids in an Oral Medicine/Oral Surgery context. Results: Out of 131 records selected during the initial screening, 34 matched the inclusion criteria and were used for subsequent analyses. Gabapentinoids were prescribed in three clinical contexts: orofacial pain management (32 studies), anxiolysis (1 study) and prevention of postoperative nausea/vomiting (1 study), with variable quality of evidence: high (6 studies), moderate (3 studies), low (5 studies) and very low (20 studies) quality studies (GRADE scale). Untoward effects of gabapentinoids were reported in 16 studies, mainly neurological (vertigo, drowsiness, sedation) and gastro-intestinal (nausea, vomiting, diarrhea, constipation). Gabapentinoids were ineffective in preemptive and postoperative analgesia and for the management of mucositis-related pain. Discussion: There is some evidence supporting the use of gabapentinoids in Oral Medicine/Oral Surgery in adherence with current practices observed in France and other countries (practices often extrapolated from their use in other non-orofacial painful conditions). The methodological quality of the studies included in this scoping review is often poor and publication bias is most probable in this field. Therefore, any conclusion drawn from such studies must be subject to circumspection. Conclusion: Data obtained from the present scoping review suggests the potential use of gabapentinoids as second-line treatments for anxiolysis, prevention of postoperative nausea/vomiting and the management of trigeminal neuralgia and masticatory myalgia. Other potential indications of gabapentinoids in Oral Medicine/Oral Surgery practice include cranial neuralgias, post-traumatic trigeminal neuropathies, first bite syndrome, burning mouth syndrome and migraine prophylaxis, when other treatment options are inefficient or unavailable.

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“…Gabapentin is effective in treating neuropathic pain in randomized controlled trials [5,12]. Additionally, gabapentin is a therapeutic agent for the management of TN, with a favorable side-effect profile, mild somnolence, and dizziness [13,14]. Hyperlipidemia is an important side effect of gabapentin [15].…”

Section: Discussionmentioning

confidence: 99%

Trigeminal neuralgia management after microvascular decompression surgery: two case reports

Hwang

Gomez-Marroquin

Enciso

et al. 2020

J Dent Anesth Pain Med

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Trigeminal neuralgia (TN) involves chronic neuropathic pain, characterized by attacks of repeating short episodes of unilateral shock-like pain, which are abrupt in onset and termination. Anticonvulsants, such as carbamazepine, are the gold standard first-line drugs for pharmacological treatment. Microvascular decompression (MVD) surgery is often the course of action if pharmacological management with anticonvulsants is unsuccessful. MVD surgery is an effective therapy in approximately 83% of cases. However, persistent neuropathic pain after MVD surgery may require reintroduction of pharmacotherapy. This case report presents two patients with persistent pain after MVD requiring reintroduction of pharmacological therapy. Although MVD is successful for patients with failed pharmacological management, it is an invasive procedure and requires hospitalization of the patient. About one-third of patients suffer from recurrent TN after MVD. Often, alternative treatment protocols, including the reintroduction of medications, may be necessary to achieve improvement. This case report presents two cases of post-MVD recurrent pain. Further research is lacking on the success rates of subsequent medication therapy after MVD has proven less effective in managing TN.

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Topical Gabapentin as Add-on Therapy for Trigeminal Neuralgia. A Case Report

Cited by 8 publications

References 10 publications

Unilateral glossodynia as a harbinger of an occult cerebellopontine angle tumour

Unilateral glossodynia as a harbinger of an occult cerebellopontine angle tumour

Gabapentinoid prescription in Oral Medicine and Oral Surgery practice. Part II − a systematic scoping review of the literature

Trigeminal neuralgia management after microvascular decompression surgery: two case reports

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