Use of topical medication in orofacial neuropathic pain: a retrospective study

Heir, Gary M.; Karolchek, Scott; Kalladka, Mythili; Vishwanath, Archana; Gomes, Julyana; Khatri, R; Nasri, Cibele; Eliav, Eli; Ananthan, Sowmya

doi:10.1016/j.tripleo.2007.09.030

Cited by 48 publications

(32 citation statements)

References 21 publications

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“…10,14 Such systemic medication can cause a multitude of side effects that the patients would find hard to cope with in addition to their other symptoms. Owing to this, only a small group of patients in this study were prescribed medication, which included pregabalin, lorazepam and amitriptyline.…”

Section: Systemic Analgesiamentioning

confidence: 99%

Managing iatrogenic trigeminal nerve injury: a case series and review of the literature

Renton

Yılmaz

2012

International Journal of Oral and Maxillofacial Surgery

104

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Section: Systemic Analgesiamentioning

confidence: 99%

Managing iatrogenic trigeminal nerve injury: a case series and review of the literature

Renton

Yılmaz

2012

International Journal of Oral and Maxillofacial Surgery

104

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“…De conclusie was dat op beschikbaar bewijs van andere neuropathische aandoeningen, centraal werkende medicijnen, zoals tricyclische antidepressiva (TCA's) en anticonvulsiva (bijvoorbeeld gabapentine), de eerste keus lijken bij de behandeling van PDAP (Lewis et al, 2007). Casusbeschrijvingen suggereren verder dat sommige patiënten gunstig reageren op het plaatselijk toedienen van pijnmedicatie (bijvoorbeeld stoffen als capsaicine of een combinatie van carbamazepine 4%, lidocaïne 1% en ketoprofen 4%, of ketamine 4% met gabapentine 4%), al dan niet in combinatie met de centraal werkende pijnmedicatie (Vickers et al, 1998;Heir et al, 2008).…”

Section: Behandelingunclassified

Persisterende dentoalveolaire pijn (PDAP)

Warnsinck¹,

Koutris²,

Lobbezoo³

2015

NTvT

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Pijn in het dentoalveolaire gebied is een veelvoorkomend verschijnsel. Meestal betreft het acute pijn, waarvoor snel de juiste behandeling kan worden toegepast. Bij bepaalde vormen van persisterende pijn in dit gebied is de etiologie echter moeilijk te achterhalen. In het verleden bestond er verwarring over de diagnose en classificatie van deze vorm van persisterende pijn, die veelal met verschillende benamingen werd aangeduid, zoals atypische odontalgie, fantoompijn of deafferentiatiepijn. Enkele jaren geleden is er daarom gestart met de ontwikkeling van een classificatiesysteem van dergelijke aandoeningen en is er de volgende naam aan gegeven: persisterende dentoalveolaire pijn. Met deze nieuwe benaming is de eerste stap gezet om tot verbetering te komen van de taxonomie en zijn 3 diagnostische criteria opgesteld die leiden tot vorderingen op het gebied van klinisch onderzoek en behandeling.

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“…87 Each of the retrospective analyses recognized inherent limitations to the approach; however, each noted a high response rate in conditions that are challenging to treat and encouraged further clinical exploration. 90 A retrospective survey of ketamine in combination with several other drugs indicates a response rate of 41% for orofacial pain, 91 and when combined with lidocaine, 73% in cases of neuropathic pain. Thus, amitriptyline 5%, ketamine 10%, and dimethyl sulfoxide 50% (given sequentially in that order) produced stepwise improvements in CRPS; 88 ketamine 10% along with oral palmitoylethanolamide relieved CRPS, 89 and ketamine 10% along with lidocaine 8%, clonidine 0.2%, and ketoprofen 5% provided pain relief in postherpetic neuralgia.…”

Section: Topical Ketamine In Combination With Other Drugs For Neuropamentioning

confidence: 99%

Topical and Peripheral Ketamine as an Analgesic

Sawynok

2014

Anesthesia &Amp; Analgesia

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Ketamine, in subanesthetic doses, produces systemic analgesia in chronic pain settings, an action largely attributed to block of N-methyl-D-aspartate receptors in the spinal cord and inhibition of central sensitization processes. N-methyl-D-aspartate receptors also are located peripherally on sensory afferent nerve endings, and this provided the initial impetus for exploring peripheral applications of ketamine. Ketamine also produces several other pharmacological actions (block of ion channels and receptors, modulation of transporters, anti-inflammatory effects), and while these may require higher concentrations, after topical (e.g., as gels, creams) and peripheral application (e.g., localized injections), local tissue concentrations are higher than those after systemic administration and can engage lower affinity mechanisms. Peripheral administration of ketamine by localized injection produced some alterations in sensory thresholds in experimental trials in volunteers and in complex regional pain syndrome subjects in experimental settings, but many variables were unaltered. There are several case reports of analgesia after topical application of ketamine given alone in neuropathic pain, but controlled trials have not confirmed such effects. A combination of topical ketamine with several other agents produced pain relief in case, and case series, reports with response rates of 40% to 75% in retrospective analyses. In controlled trials of neuropathic pain with topical ketamine combinations, there were improvements in some outcomes, but optimal dosing and drug combinations were not clear. Given orally (as a gargle, throat swab, localized peritonsillar injections), ketamine produced significant oral/throat analgesia in controlled trials in postoperative settings. Topical analgesics are likely more effective in particular conditions (patient factors, disease factors), and future trials of topical ketamine should include a consideration of factors that could predispose to favorable outcomes.

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Use of topical medication in orofacial neuropathic pain: a retrospective study

Cited by 48 publications

References 21 publications

Managing iatrogenic trigeminal nerve injury: a case series and review of the literature

Managing iatrogenic trigeminal nerve injury: a case series and review of the literature

Persisterende dentoalveolaire pijn (PDAP)

Topical and Peripheral Ketamine as an Analgesic

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