The efficacy and safety of gabapentin vs. carbamazepine in patients with primary trigeminal neuralgia: A systematic review and meta-analysis

Abstract

BackgroundDrug therapy is the most commonly used treatment for primary trigeminal neuralgia (PTN), in which carbamazepine is the first-line drug. Recently, the anti-epileptic drug gabapentin has also been widely used in patients with PTN, but whether it can be used as a substitute for carbamazepine still needs to be verified. Our study aimed to assess the safety and efficacy of gabapentin vs. carbamazepine as a treatment for PTN.MethodsWe searched seven electronic databases for studies published as of 31 July 2022. All randomized controlled trials (RCTs) of gabapentin vs. carbamazepine on patients with PTN that met the inclusion criteria were included. Meta-analysis was conducted using Revman 5.4 and Stata 14.0, in which forest plots, funnel plots, and sensitivity analysis were performed. Mean difference (MD) and odds ratio (OR) with 95% confidence intervals (CIs) were used for the measurement indicators of continuous and categorical variables, respectively.ResultsA total of 18 RCTs with 1,604 patients were eventually identified. The meta-analysis showed that compared with the carbamazepine group, the gabapentin group significantly improved the effective rate (OR = 2.02, 95% CI 1.56 to 2.62, P < 0.001), reduced the adverse event rate (OR = 0.28, 95% CI 0.21 to 0.37, P < 0.001), and improved the visual analog scale (VAS) score (MD = −0.46, 95% CI −0.86 to −0.06, P = 0.03). Although the funnel plot showed evidence of publication bias, the sensitivity analysis revealed the stability of the results.ConclusionThe current evidence showed that gabapentin may be superior to carbamazepine in relation to efficacy and safety in patients with PTN. It is crucial that more RCTs are conducted to confirm the conclusion in the future.

Considerations When Using Gabapentinoids to Treat Trigeminal Neuralgia: A Review

“…However, the quality of the study was globally poor. 18 In the study of Lemos et al, 7 the authors assessed the efficacy of gabapentin associated with ropivacain analgesic block of facial trigger points in 36 patients with TN. The association of gabapentin and ropivacain improved the functional health status of patients when compared with gabapentin alone, without side effects.…”

Mental Nerve Neurectomy: A Comparison of Titanium Screw Versus Gutta-Percha Oburation of the Mental Foramen

“…In their meta-analysis, Zhao and Ge compared the efficacy of carbamazepine and gabapentine. They found carbamazepine to be superior in the treatment of trigeminal neuralgia [ 17 ]. However, they stated that like other medications, carbamazepine has adverse effects like ataxia and dizziness or drowsiness; therefore, proper monitoring is required.…”

Non-Surgical Treatments of Trigeminal Neuralgia from the Perspective of a Pain Physician: A Narrative Review

“…Gabapentin is widely used for TN treatment. It can act on peripheral nerve nociceptors, the spinal conduction pain pathway, and the cerebral cortex [ 4 ]. During the occurrence and progression of TN, nerve demyelination damages intraneural mast cells, macrophages, and vascular endothelial cells, leading to inflammatory responses [ 4 ].…”

“…It can act on peripheral nerve nociceptors, the spinal conduction pain pathway, and the cerebral cortex [ 4 ]. During the occurrence and progression of TN, nerve demyelination damages intraneural mast cells, macrophages, and vascular endothelial cells, leading to inflammatory responses [ 4 ]. Gabapentin reduces tumor necrosis factor-α and interleukin-6 levels, which promote inflammation and produce acute response proteins [ 4 ].…”

“…The subtypes of TN are defined by the International Headache Society with the International Classification of Headache Disorders Edition 3 (ICHD-3) as classical (75%), idiopathic (10%), and secondary (15%) [ 2 , 3 ]. Classical TN is caused by the compression of abnormally twisted blood vessels, such as the superior cerebellar and basilar arteries [ 2 , 4 ]. Vascular compression of the trigeminal root in the entry zone of the pons causes demyelination and neuronal loss.…”