Sharav Yair, Shalit Yuva, Czerninski Rakefet, Leibowiz Shirley, Aframian Doron J, Haviv Yaron
Department of Oral Medicine, Sedation and Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, 9112001 Jerusalem, Israel.
Hebrew University-Hadassah School of Dental Medicine, 9112001 Jerusalem, Israel.
J Oral Facial Pain Headache. 2024 Sep;38(3):38-45. doi: 10.22514/jofph.2024.025. Epub 2024 Sep 12.
Chronic intraoral neuropathic pain (NP), often developing post-dental procedures, poses significant management challenges. The prevalent use of systemic treatments, with their frequent substantial side effects, emphasizes the need for alternative therapeutic strategies. Our aim is to explore the efficacy and adherence with a topical drug regimen delivered through a neurosensory stent (NS) for treating chronic neuropathic pain (NP) within the oral cavity. A retrospective analysis in addition to a telephone structured questionnaire conducted on patients with chronic intraoral NP treated at the Orofacial Pain Clinic, Hadassah Medical Center, between 2017 and 2020. A standard combination of lidocaine 2%, pregabalin 5%, ibuprofen 5% and optionally amitriptyline 2% was administered using a custom-made NS. Out of 12 participants, 6 reported more than 50% pain relief, indicating high effectiveness. Notably, females showed a more favorable response than males. 75% of patients used the NS consistently. No significant difference in pain relief was observed between the standard formula and the one with supplementary amitriptyline. The results highlight the potential of NS as an alternative, or adjunct treatment that may reduce the dosage of systemic medications for chronic NP. Additionally, the NS device can be used as an "escape drug", or add-on, method if pain exacerbates under systemic therapy or if higher dose of systemic therapy causes serious side effects. Large scale prospective double-blind studies are required to substantiate the findings of this pilot study.
慢性口腔内神经性疼痛（NP）通常在牙科手术后出现，给治疗带来了重大挑战。全身治疗方法普遍使用，但常常伴有严重的副作用，这凸显了寻求替代治疗策略的必要性。我们的目的是探索通过神经感觉支架（NS）递送局部用药方案治疗口腔内慢性神经性疼痛（NP）的疗效和依从性。对2017年至2020年期间在哈达萨医疗中心口腔面部疼痛诊所接受治疗的慢性口腔内NP患者进行回顾性分析，并开展电话结构化问卷调查。使用定制的NS给予2%利多卡因、5%普瑞巴林、5%布洛芬以及（可选的）2%阿米替林的标准组合。在12名参与者中，6人报告疼痛缓解超过50%，表明疗效显著。值得注意的是，女性的反应比男性更良好。75%的患者持续使用NS。在标准配方和添加阿米替林的配方之间，未观察到疼痛缓解方面的显著差异。结果突出了NS作为一种替代或辅助治疗手段的潜力，它可能减少慢性NP全身用药的剂量。此外，如果全身治疗期间疼痛加剧，或者更高剂量的全身治疗导致严重副作用，NS装置可作为一种“应急药物”或附加方法使用。需要开展大规模前瞻性双盲研究来证实这项初步研究的结果。
