Considerations When Using Gabapentinoids to Treat Trigeminal Neuralgia: A Review

Abstract

Despite the exemplary efficacy of voltage-gated sodium channel blockers as a first-line treatment of trigeminal neuralgia, the pharmacological management of this excruciating facial pain condition remains a major issue, as these first-line drugs produce intolerable side effects in a significant portion of patients. In addition, in patients with concomitant continuous pain, the efficacy of these drugs may drop, thus suggesting the opportunity to test the efficacy of different drug categories. The aim of this review is to provide current, evidence-based, knowledge about the use of gabapentin and other α2δ ligands in patients with trigeminal neuralgia. We searched for relevant papers within PubMed, EMBASE, the Cochrane Database of Systematic Reviews and the Clinical Trials database (ClinicalTrials.gov), considering publications up to April 2023. Two authors independently selected studies for inclusion and data extraction. The efficacy of α2δ ligands, gabapentin and pregabalin, has been assessed in seven controlled or open-label studies. Despite the low quality of evidence, the favorable tolerability profile and the possible action on concomitant continuous pain make this drug category of interest for future trials in trigeminal neuralgia. Plain Language Summary: Trigeminal neuralgia is a really excruciating neuropathic pain condition. Although sodium channel blockers are efficacious in most of the patients, the poor tolerability profile and the limited efficacy in patients with concomitant continuous pain represent a major issue over the long-term treatment. Gabapentin and other α2δ ligands, which have been shown to be effective in the treatment of other neuropathic conditions characterized by continuous pain, may be tried as additional agents along with sodium channel blockers. In this review, based on a systematic search of relevant literature, we aim to provide current, evidence-based, knowledge about the use of gabapentin and other α2δ ligands in patients with trigeminal neuralgia. The favourable tolerability profile and the possible action on concomitant continuous pain make this drug category of interest for future trials in trigeminal neuralgia.