A clinical study on comparative evaluation of the effectiveness of carbamazepine and combination of carbamazepine with baclofen or capsaicin in the management of Trigeminal Neuralgia

Abstract

Background: Trigeminal neuralgia (TN) is characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution. Various medicinal and surgical procedures have been utilized for the treatment of TN. Over the time, several drugs other than carbamazepine have been used but none of them have shown satisfying results.

Objective: The objective of the study is to evaluate the effectiveness of carbamazepine and combination of carbamazepine with baclofen or capsaicin in the management of TN.

Materials and Methods: A total of 45 patients diagnosed with TN were randomly divided into three groups. The patients were prescribed carbamazepine in Group 1, carbamazepine and baclofen in Group 2, and carbamazepine and capsaicin in Group 3. All the patients were followed on the 7^th day, 15^th day, and 1‑month period to evaluate the response to the drugs. Data were subjected to statistics.

Results: The results are composed of a total of 45 patients (15 in each group). The mean visual analogue scale scores were calculated for each group at day 0, 7^th day, 15^th day, and 30 days, and it was found that there was statistically significant reduction of pain (P < 0.001) in all the three groups at different intervals. At day 7, comparative percentage reduction of pain in both groups was not statistically significant. At 15-days and 30 days, percentage change in pain reduction in Group 1 was 42.3% and 48.0% respectively and in Group 2 it was found to be 60.3% and 83.4%, respectively. The reduction in pain percentage was found to be statistically significant. Similarly, Group 1 was compared to Group 3, significant reduction of pain was found for carbamazepine‑capsaicin combination at 30‑day interval but the comparative reduction of pain at 7^th day and 15^th day was not statistically significant.

Conclusion: Carbamazepine in combination with baclofen is more efficient and effective in reducing pain in TN patients, followed by carbamazepine‑capsaicin combination compared to carbamazepine alone.

Keywords: Baclofen, capsaicin, carbamazepine, therapeutic effectiveness, trigeminal neuralgia