title: Analgesic efficacy and safety of medical therapy alone vs combined medical therapy and extraoral glossopharyngeal nerve block in glossopharyngeal neuralgia.
abstract: OBJECTIVE
  The aim of this study is to compare medical therapy alone and medical therapy with add on extraoral glossopharyngeal nerve block in terms of analgesic efficacy and hemodynamic safety in patients with glossopharyngeal neuralgia (GPN). As GPN is a rare disease, our secondary targets were to review the demographic profile of the disease, clinical profile, and any associations with the disease.
  
  
  METHODS
  This was a randomized, prospective, active-controlled, parallel group study conducted from 2007 to 2009 to determine the safety and efficacy of extraoral glossopharyngeal nerve block in GPN and compare it with pharmacological intervention. After institutional ethics committee approval and patient's consent, GPN patients were randomly allocated into two groups. Group A (N = 15) received standard medical therapy (gabapentin 300 mg, tramadol 50 mg TDS, methylcobalamin 500 μgm PO) and group B (N = 15) patients received extraoral glossopharyngeal nerve block together with standard medical therapy. Patients were analyzed for analgesic outcome using numerical pain scale (NPS) and brief pain inventory (BPI) assessing both analgesic effect and degree of interference in quality of life (QOL) during 3-month follow-up. They were also evaluated for any significant hemodynamic alterations.
  
  
  RESULTS
  Over the follow-up of 90 days, the mean NPS in group A decreased from 6 ± 2 to 3 ± 2 and in group B from 5 ± 1 to 2 ± 2. From the mean NPS scores, it can be interpreted that both the modalities were effective clinically in treating GPN. However, NPS scores were statistically similar by the end of 90 days. Improvement from baseline in BPI measurement of QOL (mood, interpersonal relationship, and emotion) was earlier in group B (1, 2, and 1 months, respectively) compared with group A (2, 3, and 2 months, respectively). However, there were no significant hemodynamic adverse outcomes after administration of the block.
  
  
  CONCLUSIONS
  This study found that patients in both the groups had significantly lower pain intensities, improved pain relief, and reduced pain interference with QOL, which was especially evident on fourth visit (2 months) after the initiation of treatment regimen. Both were safe and well tolerated. The study advocates rational polypharmacy approach (oral and block) in difficult to treat painful conditions. Further controlled trials are warranted to further define the impact of such a combination therapy.
authors.affiliation: Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India. preetrajpal@gmail.com
authors.forename: Preet M
authors.initials: PM
authors.lastname: Singh
authors.forename: Maya
authors.initials: M
authors.lastname: Dehran
authors.forename: Virender K
authors.initials: VK
authors.lastname: Mohan
authors.forename: Anjan
authors.initials: A
authors.lastname: Trikha
authors.forename: Manpreet
authors.initials: M
authors.lastname: Kaur
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D020435:Glossopharyngeal Nerve Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D009407:Nerve Block / Q000706:statistics & numerical data*; D010147:Pain Measurement / Q000187:drug effects / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics