Pharmacotherapeutic management of trigeminal neuropathic pain: an update.

Abstract

INTRODUCTION:

Guidelines recommend a number of pharmacotherapeutic options used as monotherapy or in combination with others for treating the pain of trigeminal neuropathy.

AREAS COVERED:

The authors examine the pharmacotherapeutic options for treating trigeminal neuralgia and supporting evidence in the literature. Guidelines reported the most effective treatment for trigeminal neuropathy, in particular trigeminal neuralgia, appears to be carbamazepine or oxcabazepine, but side effects can be treatment limiting. Lamotrigine and gabapentin are also recommended in guidance. In real-world clinical practice, baclofen, cannabinoids, eslicarbazepine, levetiracetam, brivaracetam, lidocaine, misoprostol, opioids, phenytoin, fosphenytoin, pimozide, sodium valproate, sumatriptan, tizanidine, tocainide, tricyclic antidepressants, and vixotrigine are sometimes used, either as monotherapy or in combination. The relatively small patient population has limited the number of large-scale studies and there is limited evidence on which to base prescribing choices.

EXPERT OPINION:

While there is no optimal pharmacotherapy for treating trigeminal neuropathy, advancements in our understanding of the underlying mechanisms of this condition and drug development indicate promise for NaV inhibitors, despite the fact that not all patients respond to them and they may have potentially treatment-limiting side effects. Nevertheless, better understanding of NaV channels may be important avenues for future drug development for trigeminal neuropathy.

• Authors: Joseph V Pergolizzi Jr, Christopher Gharibo, Peter Magnusson, Frank Breve, Jo Ann LeQuang, Giustino Varrassi
• Journal: Expert opinion on pharmacotherapy (Expert Opin Pharmacother) Vol. 23 Issue 10 Pg. 1155-1164 (Jul 2022) ISSN: 1744-7666 [Electronic] England
• PMID: 35695796 (Publication Type: Journal Article)

Chemical References

• Anticonvulsants
• Carbamazepine
• Lamotrigine

Topics

• Anticonvulsants (therapeutic use)
• Carbamazepine (therapeutic use)
• Humans
• Lamotrigine (therapeutic use)
• Neuralgia (drug therapy)
• Trigeminal Neuralgia (drug therapy)