Various topical drug combination assessed using a neurosensory stent for chronic intraoral neuropathic pain: a pilot...

Chronic intraoral neuropathic pain (NP), often developing post-dental procedures, poses significant management challenges. The prevalent use of systemic treatments, with their frequent substantial side effects, emphasizes the need for alternative therapeutic strategies. Our aim is to explore the efficacy and adherence with a topical drug regimen delivered through a neurosensory stent (NS) for treating chronic neuropathic pain (NP) within the oral cavity. A retrospective analysis in addition to a telephone structured questionnaire conducted on patients with chronic intraoral NP treated at the Orofacial Pain Clinic, Hadassah Medical Center, between 2017 and 2020. A standard combination of lidocaine 2%, pregabalin 5%, ibuprofen 5% and optionally amitriptyline 2% was administered using a custom-made NS. Out of 12 participants, 6 reported more than 50% pain relief, indicating high effectiveness. Notably, females showed a more favorable response than males. 75% of patients used the NS consistently. No significant difference in pain relief was observed between the standard formula and the one with supplementary amitriptyline. The results highlight the potential of NS as an alternative, or adjunct treatment that may reduce the dosage of systemic medications for chronic NP. Additionally, the NS device can be used as an "escape drug", or add-on, method if pain exacerbates under systemic therapy or if higher dose of systemic therapy causes serious side effects. Large scale prospective double-blind studies are required to substantiate the findings of this pilot study.