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


Background: Neuropathic orofacial pain is a multifactorial condition and mainly treated by systemic anticonvulsantand antidepressant medications which result in unpleasant side effects and may contradict or interact with othermedications especially in elderly. This study demonstrates preparation of alternative topical treatment andevaluation 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 forneuropathic orofacial pain attended the Oral Medicine Clinic/ Dentistry College/ Mustansiria University and privateclinic. Patients were divided into 2 groups of almost similar ages, genders and pain severities. Microemulsive gel wasprepared 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 systemicmedications only (n = 20). The intensity of pain was recorded for each on a Visual Analog Scale (from 0= no pain to10= intolerable pain) at diagnosis, and at 4 successive weeks after initiation of treatment. Reduction in pain severitywas considered only if it equals 30% or more. The two methods of treatment were evaluated according to the periodrequired 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 inneuropathic orofacial 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% painreduction within 2 weeks, 4 patients (20%) showed 30% reduction in the third week and 6 patients (30%) of the samegroup did not experienced 30% pain reduction until the fourth week. Ten patients of systemic group experiencedside 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 orofacial painwithin shorter period and no side effects than systemic medications. Younger patients (≤ 40 years) responded totreatment better than elderly in both groups