Garcia Roxana, Chen QiLiang, Posadas Edmund, Tran Johnathan, Kwon Albert, Qian Xiang
Department of Orthopedic Surgery, Physical Medicine, and Rehabilitation, Stanford Health Care, Palo Alto, USA.
Department of Anesthesiology, Stanford Health Care, Palo Alto, USA.
Cureus. 2023 Mar 1;15(3):e35638. doi: 10.7759/cureus.35638. eCollection 2023 Mar.
Complex orofacial pain disorders, such as trigeminal neuralgia (TN) and atypical facial pain (AFP), can be excruciating and debilitating during attacks. Ketamine, an N-methyl-D-aspartate (NMDA) antagonist, is a powerful analgesic that has been used to treat various chronic pain conditions, but its role in treating complex facial pain has only been recently explored. In this retrospective case series, we reviewed the efficacy of continuous ketamine infusion for 12 patients with facial pain refractory to medical treatment. Patients who presented with a diagnosis of TN were more likely to have significant and sustained pain relief after receiving ketamine infusion. By contrast, those who did not respond to the treatment were more likely to have a diagnosis of AFP. The current report suggests a fundamental difference between these two facial pain disorders in their respective underlying pathophysiology and supports the use of continuous ketamine infusion for refractory TN, but not AFP.
复杂的口面部疼痛障碍，如三叉神经痛（TN）和非典型面部疼痛（AFP），在发作期间可能会极其痛苦且使人衰弱。氯胺酮是一种N-甲基-D-天冬氨酸（NMDA）拮抗剂，是一种强效镇痛药，已被用于治疗各种慢性疼痛病症，但其在治疗复杂面部疼痛中的作用直到最近才被探索。在这个回顾性病例系列中，我们评估了连续输注氯胺酮对12例药物治疗无效的面部疼痛患者的疗效。诊断为TN的患者在接受氯胺酮输注后更有可能获得显著且持续的疼痛缓解。相比之下，那些对治疗无反应的患者更有可能被诊断为AFP。本报告表明，这两种面部疼痛障碍在各自潜在的病理生理学方面存在根本差异，并支持对难治性TN使用连续氯胺酮输注治疗，但不支持用于AFP。
