Treatment of pain in the face

Medicamental treatment of pain in the face

The main drug in the treatment of neuralgia of the trigeminal nerve is carbamazepine (carbasan, finlepsin, tegretol, stazepine, mazetol). Carbamazepine promotes GABA-ergic inhibition in neuronal populations prone to paroxysmal forms of activity. Treatment of pain in the face begins with a dose of 0.1x2 times a day. Then the daily dose gradually increases by 1 / 2-1 tab. To minimally effective (0.4 g per day). Do not exceed the 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 abolished. Patients who use the drug for a long time gradually decrease its effectiveness. In addition, with prolonged use, the drug causes toxic damage to the liver, kidneys, bronchospasm, and aplastic pancytopenia. There may be mental disorders, memory loss, ataxia, dizziness, drowsiness, dyspeptic disorders. It is known that the drug has a teratogenic effect. Contraindications to the use of carbamazepine: atrioventricular blockade, glaucoma, prostatitis, blood diseases, individual intolerance. When it is used, it is necessary periodically (once in 2-3 months) to monitor the general blood test, the biochemical parameters of liver function. Of the other anticonvulsants for the treatment of trigeminal neuralgia, there may be used morsuximide (morpholip), ethosuximide (sulex), diphenin (phenytoin), valproic acid preparations (depakin, convulux).

In acute, pronounced musculo-tonic pain syndromes, muscle relaxant muscle relaxant (midol) is prescribed in 100 mg (1 ml) 2 times / day for 3-7 days. After parenteral administration, 150 mg of midocular 3 times a day are administered per day. The duration of treatment is individual, on average, two weeks.

To stop the crises, sodium oxybutyrate is used - 5 ml of a 20% solution is injected slowly intravenously on a 5% solution of glucose. However, the effect of one administration is short-lived (several hours). The drug is contraindicated in cases of myasthenia gravis. Parallel control of potassium in the blood serum is required (causes hypokalemia). With a significant pain syndrome, a single injection of 2-3 ml of 0.25% solution of droperidol in combination with 2 ml of 0.005% solution of fentanyl is shown.

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

As an additional tool, amino acid glycine, which is a brake mediator in the central nervous system, can be used. In the form of myceloline, glycine, a drug in a dose of 110 mg / kg is dissolved in 50 ml of water.

The course of treatment lasts for 4-5 weeks.

Important in the therapy of neuralgia of the trigeminal nerve are antidepressants, which soften the perception of pain, eliminate depression, change the functional state of the brain. The most effective is amitriptyline in a dose of 50-150 mg / day. Neuroleptics (pimozide), tranquilizers (diazepam) are quite effective. In patients with cerebral vascular diseases, vasoactive drugs (trental, nitricium, cavinton, etc.) are included in the treatment regimen. To reduce the activity of "homing" zones in the acute stage of the disease, local anesthetics - lidocaine, trimecaine, chloroethyl - are used. With autoimmune and allergic processes, it is advisable to use glucocorticoids.

Physiotherapeutic treatment of pain in the face

Some effect in the treatment of neuralgia of the trigeminal nerve 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 (xydiphon, novocaine, calcium chloride and etc.), biostimulants, ozocerite, paraffin, mud therapy.

A number of authors recommend carrying out efferent methods of therapy (plasmapheresis, hemosorption).

Surgical methods. Are applied at full inefficiency of conservative methods, tk. The risk of relapse is high with the weighting of the clinical picture.

Nasociliary and sulraorbital neuralgia

Pain in nasociliary and supraorbital neuralgias is usually stopped by blockades or applications with local anesthetics or by the intersection of the corresponding nerve.

Neuralgia of the glossopharyngeal nerve

Treatment is similar to that in trigeminal neuralgia.

Postherpetic neuralgia of the trigeminal nerve

Preparations of the first line include gabapentin, pregabalin, tricyclic antidepressants (amitriptyline). Applied local anesthetics (patch with lidocaine). There are data on the high efficacy of antagonist glutamate amantadine. If the effect is insufficient, second-line drugs are used - opioids (tramadol), anticonvulsants (lamotrigine), serotonin and noradrenaline reuptake inhibitors, NSAIDs (dexketoprofen), local remedies (capsaicin).

Hunt's syndrome

Apply blockades with lidocaine, amitriptyline, dexketoprofen, neurontin, peripheral magnetic stimulation.

Myofascial painful dysfunctional face syndrome

Apply injection to the area of muscle triggers of anesthetics (lidocaine), antidepressants (usually amitriptyline), muscle relaxants (tol-perison, tizanidine, baclofen). In recent years, the literature has published data on favorable results when injected into muscle trigger regions of botulinum toxin. In addition, manual therapy (post-isometric relaxation) is used.

Cervical-prosocarcinialgia

Apply blockades with local anesthetics, muscle relaxants, antidepressants, physiotherapy, NSAIDs.

Psychogenic prosocranialgia

Treatment of psychogenic pain syndromes can be effective under the condition of modification of the "pain matrix", which is possible with the appointment of psychotropic drugs, the effect of TKMS.