Neuromodulators for Atypical Facial Pain and Neuralgias: A Systematic Review and <scp>Meta‐Analysis</scp>

Triet, M.; Unis, Graham D.; Kattar, Nrusheel; Ananth, Ashwin; McCoul, Edward D.

doi:10.1002/lary.29162

Cited by 13 publications

(16 citation statements)

References 67 publications

(346 reference statements)

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“…Although BoNT has been suggested as an effective treatment to counter neuropathic pain [ 29 , 30 , 31 , 32 , 33 , 34 , 35 ], evidence in the literature is mainly focused on the unidimensional evaluation of pain, with different systematic reviews assessing the Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS). Conversely, given the psychosocial and functional burden of neuropathic pain, a multidimensional assessment of this condition is needed, in order to promote a patient-centered approach.…”

Section: Introductionmentioning

confidence: 99%

Multidimensional Effectiveness of Botulinum Toxin in Neuropathic Pain: A Systematic Review of Randomized Clinical Trials

Lippi

Sire

Folli

et al. 2022

Toxins

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Although botulinum toxin (BoNT) has been suggested as a treatment to counter neuropathic pain, no previous systematic reviews investigated the multidimensional effects of BoNT on pain relief and Health-Related Quality of Life (HR-QoL). The aim of this systematic review is to summarize the current evidence on the effectiveness of BoNT treatment for neuropathic pain, and to characterize its multidimensional effectiveness in order to guide physicians in clinical practice. Five databases were systematically searched up to 4 April 2022, to identify randomized controlled trials satisfying the following criteria: adults suffering from neuropathic pain, BoNT administration, any comparator, multidimensional assessment of pain as primary outcome, HR-QoL, physical function, anxiety and depression, and sleep quality as secondary outcomes. Twelve studies were included. The multidimensional pain scales used were short-form McGill Pain Questionnaire, Neuropathic pain scale, Neuropathic Pain Symptom Inventory, International SCI Pain Basic Data Set, West Haven-Yale Multidimensional Pain Inventory, Brief Pain Inventory, and Douleur Neuropathique 4. These scales highlighted the positive effects of BoNT administration. According to the Jadad scale, all the RCTs included were high-quality studies. BoNT administration might be effectively introduced in the comprehensive management of neuropathic pain. Further research should focus on optimal and cost-effective therapeutic protocols.

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Section: Introductionmentioning

confidence: 99%

Multidimensional Effectiveness of Botulinum Toxin in Neuropathic Pain: A Systematic Review of Randomized Clinical Trials

Lippi

Sire

Folli

et al. 2022

Toxins

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“…In 2011, Martin et al [ 38 ] reviewed the results of the study by Campbell et al [ 7 ] and found that pain intensity was reduced by 58% in the carbamazepine group compared with 26% in the placebo group. In their meta-analyses, Do et al [ 22 ] found that carbamazepine had a clinically significant pain reduction in patients with TN; however, they also found that patients had hematologic side effects and recommended further studies on new anticonvulsants such as oxcarbazepine. Six reviews of the literature agree that carbamazepine should be a first-line drug therapy for TN, but should be used with caution due to side effects [ 39 40 41 42 43 44 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Botulinum toxin has also been systematically reviewed for its effectiveness in the treatment of TN [ 21 22 ]. Although not within the scope of this review, it is currently under consideration as a treatment modality[ 22 ]. The mechanism of action includes extracellular binding of the medication to glycoprotein structures that are found on terminals of cholinergic nerves, which causes a blockade of intracellular acetylcholine secretion[ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of medications in adult patients with trigeminal neuralgia compared to placebo intervention: a systematic review with meta-analyses

Peterson-Houle

AbdelFattah

Padilla

et al. 2021

J Dent Anesth Pain Med

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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.

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“…Other anticonvulsants, including gabapentin, pregabalin, lamotrigine, and topiramate, have also been used as a monotherapy or in combination with carbamazepine or oxcarbazepine, although there is only low quality evidence supporting their use [20]. In addition, botulinum toxin A, an inhibitor of acetylcholine release at the neuromuscular junction, has been reported to reduce pain symptoms [124]. Despite the variety of available treatment options, relieving pain in patients with PTN has been unsatisfactory, with large inter-patient variability [61].…”

Section: Efficacy Of Clinically Used Drugsmentioning

confidence: 99%

Potential Molecular Targets for Treating Neuropathic Orofacial Pain Based on Current Findings in Animal Models

Nagakura

Nagaoka

Kurose

2021

IJMS

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This review highlights potential molecular targets for treating neuropathic orofacial pain based on current findings in animal models. Preclinical research is currently elucidating the pathophysiology of the disease and identifying the molecular targets for better therapies using animal models that mimic this category of orofacial pain, especially post-traumatic trigeminal neuropathic pain (PTNP) and primary trigeminal neuralgia (PTN). Animal models of PTNP and PTN simulate their etiologies, that is, trauma to the trigeminal nerve branch and compression of the trigeminal root entry zone, respectively. Investigations in these animal models have suggested that biological processes, including inflammation, enhanced neuropeptide-mediated pain signal transmission, axonal ectopic discharges, and enhancement of interactions between neurons and glial cells in the trigeminal pathway, are underlying orofacial pain phenotypes. The molecules associated with biological processes, whose expressions are substantially altered following trigeminal nerve damage or compression of the trigeminal nerve root, are potentially involved in the generation and/or exacerbation of neuropathic orofacial pain and can be potential molecular targets for the discovery of better therapies. Application of therapeutic candidates, which act on the molecular targets and modulate biological processes, attenuates pain-associated behaviors in animal models. Such therapeutic candidates including calcitonin gene-related peptide receptor antagonists that have a reasonable mechanism for ameliorating neuropathic orofacial pain and meet the requirements for safe administration to humans seem worth to be evaluated in clinical trials. Such prospective translation of the efficacy of therapeutic candidates from animal models to human patients would help develop better therapies for neuropathic orofacial pain.

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Neuromodulators for Atypical Facial Pain and Neuralgias: A Systematic Review and Meta‐Analysis

Cited by 13 publications

References 67 publications

Multidimensional Effectiveness of Botulinum Toxin in Neuropathic Pain: A Systematic Review of Randomized Clinical Trials

Multidimensional Effectiveness of Botulinum Toxin in Neuropathic Pain: A Systematic Review of Randomized Clinical Trials

Efficacy of medications in adult patients with trigeminal neuralgia compared to placebo intervention: a systematic review with meta-analyses

Potential Molecular Targets for Treating Neuropathic Orofacial Pain Based on Current Findings in Animal Models

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