Evidence of the medical and surgical treatment options
Citation, study design, patients, study arms of the various clinical trials, results
Wiffen PJ, et al. Carbamazepine for acute and chronic pain. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD005451. PMID: 16034977. Systematic review that includes 2 RCTs. Total of 47 receiving carbamazepine and 34 receiving placebo for the treatment of TN. 1. Carbamazepine 400 mg-1 g /day v. placebo; 2. carbamazepine 100 mg-2.4 g /day v. placebo – For full description of studies, see Killian 1968 and Nicol 1969 on p. 11 of pdf. Combined Relative Risk (95% CI) for both trials: 5.57 — See analysis table 01.01 on p. 16 of the pdf
He L, Wu B, Zhou M. Non-antiepileptic drugs for trigeminal neuralgia. Cochrane Database Syst Rev. 2008 Jul 19;3:CD004029. Review. PMID: 16856027
Systematic review of 9 RCTs. Total of 223 participants w/TN. 1. Baclofen v. placebo; 2. baclofen v. carbamazepine; 3. L-baclofen v. racemic baclofen; 4. tizanidine v. placebo; 5. tizanidine v. carbamazepine; 6. tocainide v. carbamazepine; 7. proparacaine hydrochloride 0.5% v. placebo; 8. pimozide v. carbamazepine; 9. clomipramine v. amitriptyline – For full desc. of studies, see p. 12. Various outcomes measured. See analysis tables starting on p. 20 of the pdf.
There are no relevant RCTs in Pubmed or EMBASE.
Per Schwartz’s Principles of Surgery, microvascular decompression (MVD) is the current intervention of choice (when TN does not respond to drugs) because sterotactic radiosurgery (SRS) is associated with a high incidence of facial numbness. Other options for medically refractory cases include percutaneous injection of glycerol into the path of the nerve and peripheral transection of the nerve branches.
DynaMed Plus includes an entry for trigeminal neuralgia that includes a summary of the available studies (mostly follow up studies and case series) regarding various surgical interventions.