Abstract
Introduction: Post-traumatic painful trigeminal neuropathy is a chronic facial pain secondary to trigeminal nerve injury. The treatment of this pain is a therapeutic issue due to the alteration of quality of life that it generates. Observation: A 58-year-old man whose main history of facial trauma has been consulted in the Odontology Department for bilateral trigeminal neuropathic pain that has been evolving for several months. The interrogation revealed continuous pain like electric shocks in the canine areas and daily painful exacerbations. Hyperesthesia and allodynia were found on clinical examination. The patient had received several treatments, oral and local, without significant improvement. As a last resort, injections of ropivacaine every 2 weeks associated with pregabalin (200 mg/day) were performed. At 6 months, there was a clear decrease in the burning sensation and a complete disappearance of painful exacerbations. Discussion: Two studies have recently shown the benefit of the combination of an antiepileptic and a local analgesic in the treatment of classical trigeminal neuralgia, justifying their use in a context of post-traumatic neuropathic pain. Conclusion: Further studies with higher levels of evidence are needed to confirm these preliminary results.
Highlights
The French Pain Society (Société Française D’étude Et De Traitement De La Douleur) has officially defined neuropathy as a “pain associated with an injury or disease affecting the somatosensory system.” Painful post-traumatic neuropathies (PPTN) constitute 12% of all neuropathic pain [1]
Combination therapy with an antiepileptic and local anesthetic injections has been recently shown to result in symptomatic improvement in the management of classical trigeminal neuralgia [3,6], justifying the use of this strategy in PPTN
The pain had been evolving for more than 3 months. His medical history revealed type-I, type-II, type-III LeFort fractures associated with a naso-orbito-ethmoido-frontal disjunction (NOE) following a road accident (Fig. 1)
Summary
The French Pain Society (Société Française D’étude Et De Traitement De La Douleur) has officially defined neuropathy as a “pain associated with an injury or disease affecting the somatosensory system.” Painful post-traumatic neuropathies (PPTN) constitute 12% of all neuropathic pain [1]. Painful post-traumatic neuropathies (PPTN) constitute 12% of all neuropathic pain [1]. The latter are defined as pain associated with nerve deafferentation mediated by peripheral nerves, generally caused by the formation of post-traumatic neuroma [2]. They combine a continuous sensation of burning or electrical shocks with intermittent exacerbations. Combination therapy with an antiepileptic and local anesthetic injections has been recently shown to result in symptomatic improvement in the management of classical trigeminal neuralgia [3,6], justifying the use of this strategy in PPTN. The case being reported here is that of a patient presenting with PPTN who received the above-described combination therapy
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