%0 Journal Article
%T The Effect of Intravenous Lidocaine on Trigeminal Neuralgia: A Randomized Double Blind Placebo Controlled Trial
%A Evmorfia Stavropoulou
%A Erifili Argyra
%A Panagiotis Zis
%A Athina Vadalouca
%A Ioanna Siafaka
%J ISRN Pain
%D 2014
%R 10.1155/2014/853826
%X Trigeminal neuralgia is the most common neuralgia. Its therapeutic approach is challenging as the first line treatment often does not help, or even causes intolerable side effects. The aim of our randomized double blind, placebo controlled, crossover study was to investigate in a prospective way the effect of lidocaine in patients with trigeminal neuralgia. Twenty patients met our inclusion criteria and completed the study. Each patient underwent four weekly sessions, two of which were with lidocaine (5£¿mgs/kg) and two with placebo infusions administered over 60 minutes. Intravenous lidocaine was superior regarding the reduction of the intensity of pain, the allodynia, and the hyperalgesia compared to placebo. Moreover, contrary to placebo, lidocaine managed to maintain its therapeutic results for the first 24 hours after intravenous infusion. Although, intravenous lidocaine is not a first line treatment, when first line medications fail to help, pain specialists may try it as an add-on treatment. This trial is registered with NCT01955967. 1. Introduction Trigeminal neuralgia (TN) is the most common neuralgia, with an annual incidence of 5/100000 [1]. The International Association for the Study of Pain (IASP) defines TN as sudden, usually unilateral, severe, brief, stabbing, and recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve. Treatment guidelines, published from the American Academy of Neurology (AAN) and the European Federation of Neurologic Societies (EFNS), recommend carbamazepine or oxcarbazepine as the first choice pharmacological treatment of TN and baclofen or lamotrigine as the second choice [2]. However, some patients may experience intractable pain despite adequate treatment with these medications or their combination. On the other hand, some patients may experience intolerable side effects that lead to discontinuation, although recommended treatments have achieved sufficient reduction of their pain. Lidocaine is a common amino amide-type local anesthetic and antiarrhythmic drug [3]. It is mainly used to relieve cancer or postoperative pain [4, 5], however, it has also been used to relieve several kinds of neuropathic pain, including postherpetic neuralgia [6] and intractable TN [7, 8]. This therapeutic potential lies in the fact that systemic lidocaine and its oral congeners can block sodium channels in a dose dependent fashion [9, 10] in both the peripheral and the central nervous system [11]. In the literature, only few retrospective studies of the effect of intravenous lidocaine on TN exist.
%U http://www.hindawi.com/journals/isrn.pain/2014/853826/