Painful traumatic trigeminal neuropathy: an open study on the pharmacotherapeutic response to stepped treatment.
OBJECTIVE
To evaluate pharmacotherapeutic success in patients with painful traumatic trigeminal neuropathy (PTTN) and to identify patient or pain characteristics that may predict treatment outcome.


METHODS
Pharmacotherapy was instituted for PTTN patients and was based on widely accepted protocols for neuropathic pain and conducted in an open fashion. Outcome was assessed by employing prospective diaries recording pain intensity measured with an 11-point (0 to 10) verbal pain score (VPS). Individual characteristics in the patients and their influence on outcome were analyzed. Treatment results in the PTTN patients were compared with those in classical trigeminal neuralgia (CTN) patients, who were used as a comparative cohort. Data were analyzed with a Pearson chi-square test for nominal variables and with an independent samples t test or analysis of variance for continuous variables.


RESULTS
A total of 145 patients were included: 91 with PTTN and 54 with CTN. In PTTN patients, 11% had a ≥ 50% reduction in pain intensity. Higher VPS scores in the PTTN patients were associated with a significantly reduced response to therapy (P = .03). No other pain-related or demographic parameters were associated with treatment outcome in the PTTN patients. Also the response rate of PTTN patients was significantly inferior to that of CTN patients, 74.1% of whom attained a significant reduction in pain intensity (P < .001).


CONCLUSIONS
This study underpins the poor pharmacotherapeutic prognosis of PTTN. The results support findings on neuropathic pain in other sites and point to the need for further research and reexamination of current PTTN treatment protocols.
Yaron
Y
Haviv
Yehuda
Y
Zadik
Yair
Y
Sharav
Rafael
R
Benoliel
D000588:Amines / Q000627:therapeutic use; D000639:Amitriptyline / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D001418:Baclofen / Q000627:therapeutic use; D002220:Carbamazepine / Q000627:therapeutic use; D002985:Clinical Protocols; D015331:Cohort Studies; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D004338:Drug Combinations; D000068736:Duloxetine Hydrochloride; D005260:Female; D005500:Follow-Up Studies; D058786:GABA-B Receptor Agonists / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009661:Nortriptyline / Q000627:therapeutic use; D010146:Pain / Q000145:classification; D010147:Pain Measurement / Q000379:methods; D000069583:Pregabalin; D011379:Prognosis; D011446:Prospective Studies; D013876:Thiophenes / Q000627:therapeutic use; D016896:Treatment Outcome; D061221:Trigeminal Nerve Injuries / Q000188:drug therapy*; D014277:Trigeminal Neuralgia / Q000188:drug therapy; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives / Q000627:therapeutic use
D000588:Amines; D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D003509:Cyclohexanecarboxylic Acids; D004338:Drug Combinations; D058786:GABA-B Receptor Agonists; D013876:Thiophenes; D000639:Amitriptyline; D002220:Carbamazepine; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D000068736:Duloxetine Hydrochloride; D009661:Nortriptyline; D001418:Baclofen