James Zakery, Patel Biraj, He Jianing, Hargreaves Kenneth M, Ruparel Nikita B
Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Afton Endodontics, Concord, North Carolina.
Private Practice, London, United Kingdom.
J Endod. 2025 May;51(5):627-637. doi: 10.1016/j.joen.2025.01.007. Epub 2025 Jan 17.
Persistent postendodontic pain following endodontic therapy is a rare but substantial clinical challenge. Mechanisms that mediate peripheral neuropathy and/or central sensitization likely play a pivotal role in its development and chronification. The objective of this case series is to describe a management plan for persistent postendodontic pain and provide prescription guidelines using a standardized "Gabapentin Pyramid Protocol" for clinical practice.
Four cases of persistent postendodontic pain are presented. A peripheral etiology for pain was eliminated in all 4 cases. All patients were also refractory to conventional analgesics. Patients received the "Gabapentin Pyramid Protocol."
Three of the 4 cases experienced complete resolution of symptoms within the prescribed treatment period. In 1 case, symptoms were greatly reduced but recurred upon discontinuation of the drug.
The "Gabapentin Pyramid Protocol" represents an effective treatment option for persistent postendodontic pain, demonstrating significant symptom relief and potential for complete resolution.
根管治疗后持续的根管治疗后疼痛是一种罕见但严峻的临床挑战。介导外周神经病变和/或中枢敏化的机制可能在其发生和慢性化过程中起关键作用。本病例系列的目的是描述一种针对持续性根管治疗后疼痛的管理计划，并提供使用标准化“加巴喷丁金字塔方案”的临床实践处方指南。
介绍了4例持续性根管治疗后疼痛的病例。所有4例患者均排除了疼痛的外周病因。所有患者对传统镇痛药也均无反应。患者接受了“加巴喷丁金字塔方案”。
4例患者中有3例在规定的治疗期内症状完全缓解。1例患者症状大幅减轻，但停药后复发。
“加巴喷丁金字塔方案”是治疗持续性根管治疗后疼痛的一种有效选择，显示出显著的症状缓解和完全治愈的可能性。
