Treatment for facial pain

Medication for facial pain

The main drug in the treatment of trigeminal neuralgia is carbamazepine (carbasan, finlepsin, tegretol, stazepine, mazetol). Carbamazepine promotes GABA-ergic inhibition in neuronal populations prone to paroxysmal forms of activity. Treatment of facial pain begins with a dose of 0.1x2 times a day. Then the daily dose is gradually increased by 1/2-1 tablet to the minimum effective (0.4 g per day). It is not recommended to exceed a dose of more than 1200 mg / day. After 6-8 weeks after the onset of the effect, the dose is gradually reduced to the minimum maintenance (0.2-0.1 g per day) or completely discontinued. In patients using the drug for a long time, its effectiveness gradually decreases. In addition, with prolonged use, the drug causes toxic damage to the liver, kidneys, bronchospasm, aplastic pancytopenia. Mental disorders, memory loss, ataxia, dizziness, drowsiness, and dyspeptic disorders may occur. The drug is known to have a teratogenic effect. Contraindications to the use of carbamazepine: atrioventricular block, glaucoma, prostatitis, blood diseases, and individual intolerance. When using it, it is necessary to periodically (once every 2-3 months) monitor a complete blood count and biochemical parameters of liver function. Other anticonvulsants that can be used to treat trigeminal neuralgia include morsuximide (morpholep), ethosuximide (suxilep), diphenin (phenytoin), and valproic acid preparations (depakine, convulex).

In acute, severely expressed muscle-tonic pain syndromes, the muscle relaxant tolperisone hydrochloride (Mydocalm) is prescribed intramuscularly at 100 mg (1 ml) 2 times a day - 3-7 days. After parenteral administration, 150 mg of Mydocalm is prescribed orally 3 times a day. The duration of treatment is individual, on average two weeks.

Sodium oxybutyrate is used to stop crises - 5 ml of a 20% solution is slowly administered intravenously in a 5% glucose solution. However, the effect of one administration is short-lived (several hours). The drug is contraindicated in myasthenia. Parallel monitoring of potassium in the blood serum is necessary (causes hypokalemia). In case of significant pain syndrome, a single administration of 2-3 ml of a 0.25% solution of droperidol in combination with 2 ml of a 0.005% solution of fentanyl is indicated.

In the complex therapy of trigeminal neuralgia, non-narcotic analgesics, NSAIDs, antihistamines, and B vitamins are widely used.

The amino acid glycine, which is an inhibitory mediator in the central nervous system, can be used as an additional agent. In the form of myeglinol glycine, the drug is dissolved in 50 ml of water at a dose of 110 mg/kg.

The course of treatment lasts for 4-5 weeks.

Antidepressants are of no small importance in the treatment of trigeminal neuralgia. They soften the perception of pain, eliminate depression, and change the functional state of the brain. Amitriptyline at a dose of 50-150 mg/day is considered the most effective. Neuroleptics (pimozide) and tranquilizers (diazepam) are quite effective. Vasoactive drugs (trental, nicerium, cavinton, etc.) are included in the treatment regimen for patients with vascular diseases of the brain. Local anesthetics are used to reduce the activity of "trigger" zones in the acute stage of the disease - lidocaine, trimecaine, chloroethyl. In autoimmune and allergic processes, it is advisable to use glucocorticoids.

Physiotherapy Treatment for Facial Pain

Some effect in the treatment of trigeminal neuralgia is provided by acupuncture, laser puncture, low-voltage and low-frequency pulsed currents, magnetic and electromagnetic fields (including infrared and ultraviolet radiation), ultrasound, electrophoresis of medicinal substances (xydiphone solution, novocaine, calcium chloride, etc.), biostimulants, ozokerite, paraffin, mud therapy.

A number of authors recommend the use of efferent therapy methods (plasmapheresis, hemosorption).

Surgical methods. They are used when conservative methods are completely ineffective, since there is a high risk of relapses with aggravation of the clinical picture.

Nasociliary and sulro-orbital neuralgia

Pain in nasociliary and supraorbital neuralgia is usually relieved by blockades or applications with local anesthetics or by transection of the corresponding nerve.

Glossopharyngeal neuralgia

Treatment is similar to that for trigeminal neuralgia.

Postherpetic trigeminal neuralgia

First-line drugs include gabapentin, pregabalin, tricyclic antidepressants (amitriptyline). Local anesthetic applications (lidocaine patch) are used. There is evidence of high efficiency of the glutamate antagonist amantadine. If the effect is insufficient, second-line drugs are used - opioids (tramadol), anticonvulsants (lamotrigine), serotonin and norepinephrine reuptake inhibitors, NSAIDs (dexketoprofen), local agents (capsaicin).

Hunt syndrome

Blockades with lidocaine, amitriptyline, dexketoprofen, neurontin, and peripheral magnetic stimulation are used.

Myofascial pain dysfunction syndrome of the face

Injections of anesthetics (lidocaine), antidepressants (usually amitriptyline), muscle relaxants (tolperisone, tizanidine, baclofen) into the muscle trigger areas are used. In recent years, data have appeared in the literature on favorable results from the introduction of botulinum toxin into muscle trigger areas. In addition, manual therapy (post-isometric relaxation) is used.

Cervicoprosocranialgia

Blockades with local anesthetics, muscle relaxants, antidepressants, physiotherapy, and NSAIDs are used.

Psychogenic prosocranialgia

Treatment of psychogenic pain syndromes can be effective provided that the “pain matrix” is modified, which is possible with the use of psychotropic drugs and the use of TMS.