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Gabapentin supplemented with ropivacain block of trigger points improves pain control and quality of life in trigeminal neuralgia patients when compared with gabapentin alone.

Abstract

OBJECTIVE

Pain control in trigeminal neuralgia (TN) is achieved using anticonvulsivants, mainly carbamazepine. When this drug cannot be used, other drugs like gabapentin (GBP) have been used to provide adequate pain control. To improve the therapeutic effect of GBP, we evaluated the clinical efficacy of associating GBP with ropivacain (ROP) analgesic block of facial trigger points in TN patients.

DESIGN

Thirty-six TN patients were randomly assigned during 4 weeks to 1 of the following protocols: Protocol I-daily oral GBP administered in a titrated dose; Protocol II-ROP applied as analgesic block to TN trigger points once a week; Protocol III-daily oral GBP plus ROP once a week. Protocol II had to be discontinued in 7/12 patients owing to insufficient pain control. Pain intensity was evaluated by the Visual Analog Scale (VAS) and disability was assessed by Sickness Impact Profile.

RESULTS

When compared with Protocol I, Protocol III (GBP+ROP) patients showed (1) a reduction of VAS score after 7 and 28 days of treatment, an effect that was still present 6 and 12 months later; (2) a faster reduction of VAS score using a significantly lower dose of GBP; (3) a smaller total and daily GBP dose at the end of the treatment, which resulted in a total absence of adverse side effects; and (4) an improvement of the functional well-being measured by the Sickness Impact Profile. The number needed to treat (NNT) (GBP+ROP vs. GBP protocols) to obtain 1 GBP+ROP-treated patient with at least 50% pain relief was 1.71 (day 7) and 2.40 (day 28).

CONCLUSIONS

The association of GBP and ROP is safe, without side effects and results in an important clinical benefit associated to an improvement of the functional health status of TN patients when compared with GBP alone. This may constitute a therapeutic alternative for pain control in TN patients who cannot be treated with carbamazepine.

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  • Authors+Show Affiliations

    ,

    Health and Life Sciences Research Institute (ICVS), School of Health Sciences, Braga, Portugal.

    , ,

    Source

    The Clinical journal of pain 24:1 2008 Jan pg 64-75

    MeSH

    Acetaminophen
    Amides
    Amines
    Analgesics
    Analgesics, Non-Narcotic
    Anesthetics, Local
    Cyclohexanecarboxylic Acids
    Dose-Response Relationship, Drug
    Drug Therapy, Combination
    Female
    Follow-Up Studies
    Gabapentin
    Humans
    Male
    Middle Aged
    Pain Measurement
    Quality of Life
    Ropivacaine
    Treatment Outcome
    Trigeminal Neuralgia
    gamma-Aminobutyric Acid

    Pub Type(s)

    Comparative Study
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    18180639

    Citation

    Lemos, Laurinda, et al. "Gabapentin Supplemented With Ropivacain Block of Trigger Points Improves Pain Control and Quality of Life in Trigeminal Neuralgia Patients when Compared With Gabapentin Alone." The Clinical Journal of Pain, vol. 24, no. 1, 2008, pp. 64-75.
    Lemos L, Flores S, Oliveira P, et al. Gabapentin supplemented with ropivacain block of trigger points improves pain control and quality of life in trigeminal neuralgia patients when compared with gabapentin alone. Clin J Pain. 2008;24(1):64-75.
    Lemos, L., Flores, S., Oliveira, P., & Almeida, A. (2008). Gabapentin supplemented with ropivacain block of trigger points improves pain control and quality of life in trigeminal neuralgia patients when compared with gabapentin alone. The Clinical Journal of Pain, 24(1), pp. 64-75. doi:10.1097/AJP.0b013e318158011a.
    Lemos L, et al. Gabapentin Supplemented With Ropivacain Block of Trigger Points Improves Pain Control and Quality of Life in Trigeminal Neuralgia Patients when Compared With Gabapentin Alone. Clin J Pain. 2008;24(1):64-75. PubMed PMID: 18180639.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Gabapentin supplemented with ropivacain block of trigger points improves pain control and quality of life in trigeminal neuralgia patients when compared with gabapentin alone. AU - Lemos,Laurinda, AU - Flores,Sara, AU - Oliveira,Pedro, AU - Almeida,Armando, PY - 2008/1/9/pubmed PY - 2008/2/21/medline PY - 2008/1/9/entrez SP - 64 EP - 75 JF - The Clinical journal of pain JO - Clin J Pain VL - 24 IS - 1 N2 - OBJECTIVE: Pain control in trigeminal neuralgia (TN) is achieved using anticonvulsivants, mainly carbamazepine. When this drug cannot be used, other drugs like gabapentin (GBP) have been used to provide adequate pain control. To improve the therapeutic effect of GBP, we evaluated the clinical efficacy of associating GBP with ropivacain (ROP) analgesic block of facial trigger points in TN patients. DESIGN: Thirty-six TN patients were randomly assigned during 4 weeks to 1 of the following protocols: Protocol I-daily oral GBP administered in a titrated dose; Protocol II-ROP applied as analgesic block to TN trigger points once a week; Protocol III-daily oral GBP plus ROP once a week. Protocol II had to be discontinued in 7/12 patients owing to insufficient pain control. Pain intensity was evaluated by the Visual Analog Scale (VAS) and disability was assessed by Sickness Impact Profile. RESULTS: When compared with Protocol I, Protocol III (GBP+ROP) patients showed (1) a reduction of VAS score after 7 and 28 days of treatment, an effect that was still present 6 and 12 months later; (2) a faster reduction of VAS score using a significantly lower dose of GBP; (3) a smaller total and daily GBP dose at the end of the treatment, which resulted in a total absence of adverse side effects; and (4) an improvement of the functional well-being measured by the Sickness Impact Profile. The number needed to treat (NNT) (GBP+ROP vs. GBP protocols) to obtain 1 GBP+ROP-treated patient with at least 50% pain relief was 1.71 (day 7) and 2.40 (day 28). CONCLUSIONS: The association of GBP and ROP is safe, without side effects and results in an important clinical benefit associated to an improvement of the functional health status of TN patients when compared with GBP alone. This may constitute a therapeutic alternative for pain control in TN patients who cannot be treated with carbamazepine. SN - 0749-8047 UR - https://www.unboundmedicine.com/medline/citation/18180639/Gabapentin_supplemented_with_ropivacain_block_of_trigger_points_improves_pain_control_and_quality_of_life_in_trigeminal_neuralgia_patients_when_compared_with_gabapentin_alone_ L2 - http://Insights.ovid.com/pubmed?pmid=18180639 DB - PRIME DP - Unbound Medicine ER -