Radiofrequency thermocoagulation effective for dental trigeminal neuralgia
medwireNews: Conventional radiofrequency thermocoagulation (RFTC) is more effective than pulsed radiofrequency (PRF) for the treatment of dental procedure-related trigeminal neuralgia, a retrospective study indicates.
Symptomatic trigeminal neuralgias arise due to nerve damage during procedures such as wisdom tooth extraction, root canal treatment, implantation, and apicoectomy. In this study published in Pain Medicine, Yong Chul Kim (Seoul National University Hospital, Korea) and team compared two minimally invasive approaches that are used to manage the condition in patients who have failed to respond to drugs.
The researchers identified 54 patients from medical records, who were referred to a pain clinic with dental procedure-related trigeminal nerve pain and were subsequently treated with PRF on the maxillary or mandibular nerves or RFTC on trigeminal rootlets.
Two-thirds of the patients were women, all had been symptomatic for at least 3 months, and all had pain scores of at least 6 out of 10 despite taking multiple medications including carbamazepine, pregabalin, and gabapentin.
Twenty-six patients were treated by PRF and 28 by RFTC; the two patient groups did not differ with regard to demographic or clinical features at baseline.
Nevertheless, the RFTC group had significantly better treatment outcomes, with the differences becoming apparent as early as 1 week after treatment. Mean pain scores were 6.4 in the PRF group versus 3.0 in the RFTC group at 1 week; 5.9 versus 2.5 at 1 month; 5.5 versus 2.6 at 3 months; 7.1 versus 3.1 at 6 months; and 7.2 versus 4.8 at 1 year.
At 1 month after treatment, three-quarters of patients in the RFTC group reported that their pain levels had been reduced by at least 50% without medication, whereas no patient in the PRF group was able to stop their medication. Also, the median duration of pain relief was 10.8 months following RFTC versus 0 months following PRF.
The efficacy of RFTC appeared durable, with 11 (39.3%) patients at 1 year and five (17.9%) patients at 2 years reporting successful pain control without medication.
While RFTC was clearly superior to PRF with regard to efficacy, it was associated with a much higher rate of complications, at 46.4% versus 3.8%. All complications in the RFTC group were classified as postoperative hypesthesia, with all instances being minor, transient, and not requiring treatment.
In the PRF group, the only complication was a single case of difficulty opening the mouth and chewing, which was transient.
Interestingly, despite the higher rate of complications, RFTC had a significantly higher patient satisfaction rating than PRF, at 3.86 versus 2.19. "The patients who had only hypesthesia did not complain, and their satisfaction was not lower than the other patients," note Kim et al.
The researchers conclude: "RFTC for the treatment of dental treatment-related symptomatic trigeminal neuralgia can be effective, resulting in high satisfaction and relatively long-term relief of pain without medication and the need for other treatments."
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By Joanna Lyford, Senior medwireNews Reporter