What is the role of gabapentin in the treatment of trigeminal neuralgia (TN)?

Updated: Jul 11, 2019
  • Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD  more...
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Answer

Gabapentin has demonstrated effectiveness in trigeminal neuralgia (TN), especially in patients with multiple sclerosis (MS). In an early study, Sist et al reported 2 patients with trigeminal neuralgia whose condition had a response to gabapentin, [32] 1 of whom was previously unresponsive to carbamazepine.

In another study, Khan reported complete relief of secondary trigeminal neuralgia in 6 of 7 patients with multiple sclerosis who received gabapentin doses of 900-2400 mg/d. [33] The patients previously had not responded to a variety of drugs. Once on gabapentin, 2 subjects were able to discontinue all other pain medications, and the remaining 5 could stop all but one other pain medication. [33] All patients maintained the response at 1 year of therapy with minimal adverse effects. In a similar, uncontrolled, small study of patients with multiple sclerosis, Solaro et al reported that 5 of 6 individuals found complete and sustained relief with gabapentin. [34]

To date, the efficacy of gabapentin and lamotrigine versus placebo or their efficacy in patients whose pain is refractory to carbamazepine has not been established. In paclitaxel-induced neuropathic pain, lamotrigine appears to be a promising drug. The difference in responses shown by different antiepileptic drugs depends on the etiology of the underlying mechanisms in neuropathic pain. [35] As stated by Carrazana and Schachter, of these 2 agents, gabapentin has advantages, which include faster titration, no known drug interactions, and no known idiosyncratic skin reaction. [36]


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