Khawaja Nadine, Yilmaz Zehra, Renton Tara
Department of Oral Surgery, King's College London, London, UK.
Br J Pain. 2013 May;7(2):107-13. doi: 10.1177/2049463713483459.
Chronic trigeminal pain, with its severe related functional problems, is difficult to treat. Treatment is often empirically based on medications used for other chronic pain conditions. Systemic sodium channel and calcium channel blocking agents may cause a multitude of complications that are often poorly tolerated by the patient.
The aim of this case report was to assess the efficacy of topical 5% lidocaine plasters in reducing pain and reducing adjuvant medication in patients with orofacial neuropathic pain.
Fourteen patients with chronic orofacial pain conditions referred to the oral surgery department were instructed to wear 5% lidocaine plasters for 12 hours each day over the painful area. The conditions included post-surgical neuropathy (n = 10), multiple sclerosis-related pain (n = 1), persistent idiopathic facial pain (n = 1), Ramsay Hunt syndrome (post-herpetic neuralgia, n = 1) and trigeminal neuralgia (n = 1). Data were collected on patient demographics, pain levels and medication.
Pain levels improved in 12 out of 14 patients. Nine patients had a reduction in adjuvant medication, two of whom completely stopped adjuvant treatment.
This case series demonstrates that of the use of 5% lidocaine plasters may play a useful role in the management of chronic trigeminal pain. A suggested novel approach for the management of orofacial pain, for clinicians, is presented.
Management of chronic orofacial pain continues to be a major challenge to the clinician.Patients are often placed on a multitude of medications in an attempt to alleviate pain without success.Topical 5% lidocaine plasters, currently used for the management of post-herpetic neuralgia, offer the option of locally targeting trigeminal pain without the multiple side-effects of systemic medication.This case series demonstrates that lidocaine plasters decrease verbal pain scores in extraoral, trigeminal and neuropathic pain, and reduce the use of other neuromodulatory agents in some, but not all, patients.The plasters should be considered as a useful adjuvant in the management of pain in these patients.
慢性三叉神经痛伴有严重的相关功能问题，难以治疗。治疗通常基于用于其他慢性疼痛病症的药物进行经验性治疗。全身性钠通道和钙通道阻滞剂可能会引发多种并发症，患者往往难以耐受。
本病例报告旨在评估局部使用5%利多卡因贴剂对减轻口面部神经性疼痛患者的疼痛及减少辅助用药的疗效。
14例转诊至口腔外科的慢性口面部疼痛患者被指导每天在疼痛区域佩戴5%利多卡因贴剂12小时。这些病症包括术后神经病变（n = 10）、多发性硬化相关疼痛（n = 1）、持续性特发性面部疼痛（n = 1）、拉姆齐·亨特综合征（疱疹后神经痛，n = 1）和三叉神经痛（n = 1）。收集了患者的人口统计学数据、疼痛程度和用药情况。
14例患者中有12例疼痛程度改善。9例患者的辅助用药减少，其中2例完全停止辅助治疗。
本病例系列表明，使用5%利多卡因贴剂可能在慢性三叉神经痛的管理中发挥有益作用。为临床医生提出了一种建议的口面部疼痛管理新方法。
慢性口面部疼痛的管理仍然是临床医生面临的重大挑战。患者常常使用多种药物试图缓解疼痛但未成功。局部使用的5%利多卡因贴剂目前用于治疗疱疹后神经痛，可选择局部靶向三叉神经痛，而无全身性药物的多种副作用。本病例系列表明，利多卡因贴剂可降低口外、三叉神经和神经性疼痛的言语疼痛评分，并在部分（但非全部）患者中减少其他神经调节药物的使用。应将这些贴剂视为这些患者疼痛管理中的有用辅助手段。
