Evaluation of topical versus systemic medications in the treatment of neuropathic orofacial pain : a prospective study

Abstract EN

Background : neuropathic or facial pain is a multifactorial condition and mainly treated by systemic anticonvulsant and antidepressant medications which result in unpleasant side effects and may contradict or interact with other medications especially in elderly.

This study demonstrates preparation of alternative topical treatment and evaluation of its efficacy versus systemic treatment in respect to period taken for pain reduction and side effects.

Sample and Method : A prospective study was conducted on systemically healthy 41 patients treated for neuropathic or facial pain attended the Oral Medicine Clinic / Dentistry College / Mustansiria University and private clinic.

Patients were divided into 2 groups of almost similar ages, genders and pain severities.

Microemulsive gel was prepared to carry specific concentrations of active agents by transdermal permeative vehicle to the affected sites.

The first group received topical medications only (n = 21), while the second group was treated with systemic medications only (n = 20).

The intensity of pain was recorded for each on a Visual Analog Scale (from 0 = no pain to 10 = intolerable pain) at diagnosis, and at 4 successive weeks after initiation of treatment.

Reduction in pain severity was considered only if it equals 30 % or more.

The two methods of treatment were evaluated according to the period required for 30% pain reduction and side effect(s) caused by each type of treatment.

Results : after initiation of treatment, 81% of patients (no = 17) on topical treatment showed 30 % reduction in neuropathic or facial pain levels (which is considered a good response) within 2 weeks, the rest 4 patients (19%) reached 30 % pain reduction within the third week.

In systemic group, 50% of patients (no = 10) showed 30 % pain reduction within 2 weeks, 4 patients (20 %) showed 30 % reduction in the third week and 6 patients (30 %) of the same group did not experienced 30 % pain reduction until the fourth week.

Ten patients of systemic group experienced side effects, while patients on topical treatment did not complain of any side effect along term of treatment.

Conclusion : topical medication as a single treatment is more efficient in reduction of neuropathic or facial pain within shorter period and no side effects than systemic medications.

Younger patients (≤ 40 years) responded to treatment better than elderly in both groups.