Baclofen in the treatment of a trigeminal neuralgia and a glossopharyngeal neuralgia

Trigeminal neuralgia and glossopharygeal neuralgia include severe paroxysmal pains. Carbamazepine is used for treatment of these disorders, but has many side effects and the efficacy may decline over time.A 65-year-old male with severe pain of trigeminal neuralgia (VAS=100mm) experienced a general e...

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Published inJournal of Japan Society of Pain Clinicians Vol. 12; no. 2; pp. 105 - 108
Main Authors 中谷 俊彦, 蛭田 博行, SHIGEYAMA Taiki, LEE Shinhae, DOI Katsushi, SAKURA Shinichi, SAITO Yoji
Format Journal Article
LanguageEnglish
Japanese
Published Japan Society of Pain Clinicians 2005
一般社団法人 日本ペインクリニック学会
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ISSN1340-4903
1884-1791
DOI10.11321/jjspc1994.12.105

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Summary:Trigeminal neuralgia and glossopharygeal neuralgia include severe paroxysmal pains. Carbamazepine is used for treatment of these disorders, but has many side effects and the efficacy may decline over time.A 65-year-old male with severe pain of trigeminal neuralgia (VAS=100mm) experienced a general eruption due to a side effect of carbamazepine. We prescribed baclofen (10mg/day) for the pain. After increasing baclofen to 15mg/day, the pain disappeared completely.A 76-year-old male was diagnosed as having glossopharyngeal neuralgia from left pharyngeal pain on swallowing and the efficacy of nerve block by topical application of local anesthetic. The combined treatment with carbamazepine and repetitive nerve block using local anesthetics was not effective for pain relief (VAS=96mm). Baclofen was started from 15mg/day in addition to carbamazepine and herbal medicine. After increasing baclofen to 20mg/day, the pain was reduced to VAS 36mm.Baclofen was effective to treat pain caused by trigeminal neuralgia and glossopharyngeal neuralgia. 三叉神経痛, および舌咽神経痛は発作性の強い痛みを生じ, ときに日常生活も妨げられる. 治療薬の第一選択は抗けいれん薬であるカルバマゼピンであるが, 発疹, 汎血球減少症, ふらつきなどの副作用や, 長期使用時における効果の減弱などにより, ほかの侵襲的な治療法の適用を余儀なくされることも多い. 今回, バクロフェンが有効と考えられた三叉神経痛と舌咽神経痛の症例をそれぞれ経験したので報告する. カルバマゼピンによる発疹の既往歴を有する左三叉神経痛の65歳男性は, visual analogue scale (VAS) で100mmの強い疼痛発作症状を訴えた. 局所麻酔薬による神経ブロックの効果が不十分であったためバクロフェン10～15mg/dayを投与したところ, 疼痛発作の消失を認めた. 左舌咽神経痛の76歳男性は, カルバマゼピンと漢方薬内服および局所麻酔薬による舌咽神経ブロックで治療を行っていた. しかし, 嚥下時の痛みが増強したため (VAS=96mm), バクロフェン15～20mg/dayの投与を開始した. バクロフェンの併用開始後に疼痛コントロールが可能となった (VAS=36mm). カルバマゼピンが使用できない場合や, 効果が減弱した場合にはバクロフェンの使用は有用であると考えられた.
ISSN:1340-4903
1884-1791
DOI:10.11321/jjspc1994.12.105