Painful Traumatic Trigeminal Neuropathy: An Open Study on the Pharmacotherapeutic Response to Stepped Treatment

Haviv, Yaron; Zadik, Yehuda; Sharav, Yair; Benoliel, Rafael

doi:10.11607/jop.1154

Cited by 75 publications

(76 citation statements)

References 44 publications

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“…Efficacy of current therapies for chronic low back and trigeminal neuropathic pain, in particular, remains low (Baron et al, ). For example, only 11% of patients with painful traumatic trigeminal neuropathy responded to pharmacotherapy with a greater than 50% reduction in pain intensity (Haviv et al, ). Opiates are the most highly efficacious analgesic drugs available, but their use for neuropathic pain in particular remains controversial because they lack efficacy at the doses usually used for other pain syndromes.…”

Section: Introductionmentioning

confidence: 99%

The noradrenergic locus coeruleus as a chronic pain generator

Taylor

Westlund

2016

J of Neuroscience Research

101

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Central noradrenergic centers such as the locus coeruleus are traditionally viewed as pain inhibitory; however, complex interactions among brainstem pathways and their receptors modulate both inhibition and facilitation of pain. In addition to the well-described role of descending pontospinal pathways that inhibit spinal nociceptive transmission, an emerging body of research now indicates that noradrenergic neurons in the locus coeruleus (LC) and their terminals in the dorsal reticular nucleus (DRt), medial prefrontal cortex (mPFC), spinal dorsal horn and trigeminal spinal nucleus caudalis (spVc) participate in the development and maintenance of allodynia and hyperalgesia after nerve injury. With time after injury, we argue that the balance of LC function shifts from pain inhibition to pain facilitation. Thus, the pain inhibitory actions of antidepressant drugs achieved with elevated noradrenaline concentrations in the dorsal horn may be countered or even superseded by simultaneous activation of supraspinal facilitating systems dependent on α1-adrenoreceptor in the DRt and mPFC as well as α2-adrenoreceptors in the LC. Indeed, these opposing actions may account in part for the limited treatment efficacy of tricyclic antidepressants and noradrenaline reuptake inhibitors such as duloxetine for the treatment of chronic pain. We propose that the traditional view of the LC as a pain inhibitory structure be modified to account for its capacity as a pain facilitator. Future studies are needed to determine the neurobiology of ascending and descending pathways and the pharmacology of receptors underlying LC-mediated pain inhibition and facilitation.

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Section: Introductionmentioning

confidence: 99%

The noradrenergic locus coeruleus as a chronic pain generator

Taylor

Westlund

2016

J of Neuroscience Research

101

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“…The treatment of PPNT is based solely on the use of antiepileptics (GBP, carbamazepine (CBZ), pregabalin) as well as tricyclic antidepressants (amitriptyline). The response to the majority of these medications is unpredictable because it varies among patients [5]. In the case presented, there was no observable improvement under GBP and duloxetine.…”

Section: Discussionmentioning

confidence: 77%

“…Therefore, the use of first-line oral treatments such as antidepressants, antiepileptics, and other topical treatments like capsaicin at 0.025% is recommended [4]. However, their frequent side effects sometimes preclude their usage with certain patients, and there is only a moderate, observable effect in only 30% patients [5]. Thus, other therapeutic alternatives are required.…”

Section: Introductionmentioning

confidence: 99%

Injection of ropivacaine combined with pregabalin in a patient with post-traumatic trigeminal neuropathic pain

Tisné-Versailles

Fénelon

Marteau

et al. 2018

J Oral Med Oral Surg

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Introduction: Post-traumatic painful trigeminal neuropathy is a chronic facial pain secondary to trigeminal nerve injury. The treatment of this pain is a therapeutic issue due to the alteration of quality of life that it generates. Observation: A 58-year-old man whose main history of facial trauma has been consulted in the Odontology Department for bilateral trigeminal neuropathic pain that has been evolving for several months. The interrogation revealed continuous pain like electric shocks in the canine areas and daily painful exacerbations. Hyperesthesia and allodynia were found on clinical examination. The patient had received several treatments, oral and local, without significant improvement. As a last resort, injections of ropivacaine every 2 weeks associated with pregabalin (200 mg/day) were performed. At 6 months, there was a clear decrease in the burning sensation and a complete disappearance of painful exacerbations. Discussion: Two studies have recently shown the benefit of the combination of an antiepileptic and a local analgesic in the treatment of classical trigeminal neuralgia, justifying their use in a context of post-traumatic neuropathic pain. Conclusion: Further studies with higher levels of evidence are needed to confirm these preliminary results.

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“…Unfortunately, even with this stepped approach only 25% of patients experience 30% or greater improvement in symptoms. 46 Of note, these drugs can be used in the management of patients where surgery is indicated to help reduce further central and peripheral sensitization.…”

Section: When Injury Occursmentioning

confidence: 99%