The course of pain in Bell's palsy: treatment with prednisolone and valacyclovir.

Abstract

OBJECTIVE:

To evaluate the effect of prednisolone and valacyclovir on ipsilateral pain around the ear and in the face or neck in Bell's palsy. The incidence and intensity of pain during the first 2 months of palsy and its prognostic value were also assessed.

STUDY DESIGN:

Prospective, randomized, double-blind, placebo-controlled, multicenter trial.

SETTING:

Sixteen tertiary referral centers in Sweden and 1 in Finland.

PATIENTS:

Data are part of the Scandinavian Bell's palsy study; 829 patients aged 18 to 75 years with onset of palsy within 72 hours were included. Follow-up time was 12 months.

INTERVENTION:

Patients were assigned to 1 of 4 treatment arms in a factorial fashion: placebo plus placebo; prednisolone 60 mg daily for 5 days, then tapering for 5 days, plus placebo; valacyclovir 1,000 mg 3 times daily for 7 days plus placebo; or prednisolone plus valacyclovir.

MAIN OUTCOME MEASURES:

Pain was registered on a visual analog scale within 72 hours, at Days 11 to 17, 1 month, and 2 months. Facial function was assessed with the Sunnybrook and House-Brackmann systems.

RESULTS:

Prednisolone and/or valacyclovir did not significantly affect the incidence or intensity of pain during the first 2 months. Pain was registered in 542 (65%) of 829 patients. At 2 months, 53 (8%) of 637 patients still reported pain. Subjects with pain at Days 11 to 17 had lower facial recovery rates at 12 months than those with no pain (p < 0.0001).

CONCLUSION:

Prednisolone and/or valacyclovir did not affect the incidence or intensity of ipsilateral pain in Bell's palsy. The incidence of pain was similar during the first 2 weeks and then decreased. Presence of pain at Days 11 to 17 indicated a worse prognosis for facial recovery.

• Authors: Thomas Berg, Sara Axelsson, Mats Engström, Anna Stjernquist-Desatnik, Anne Pitkäranta, Mervi Kanerva, Lars Jonsson
• Journal: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (Otol Neurotol) Vol. 30 Issue 6 Pg. 842-6 (Sep 2009) ISSN: 1537-4505 [Electronic] United States
• PMID: 19503012 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Inflammatory Agents
• Antiviral Agents
• Prednisolone
• Valine
• Valacyclovir
• Acyclovir

Topics

• Acyclovir (analogs & derivatives, therapeutic use)
• Adult
• Anti-Inflammatory Agents (therapeutic use)
• Antiviral Agents (therapeutic use)
• Bell Palsy (complications, drug therapy)
• Double-Blind Method
• Earache (drug therapy, etiology)
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Neck Pain (drug therapy, etiology)
• Pain (drug therapy, etiology)
• Pain Measurement
• Prednisolone (therapeutic use)
• Prognosis
• Prospective Studies
• Treatment Outcome
• Valacyclovir
• Valine (analogs & derivatives, therapeutic use)