Rev. Soc. Esp. Dolor. 2023; 30(4): 217-226 / DOI: 10.20986/resed.2023.4043/2022
Juan Carlos Acevedo, Jose Bello
ABSTRACT
Introduction: Facial pain comprehends a cluster of entities which are difficult to diagnose and treat. Its response to medical treatment can be limited and it becomes a refractory chronic pain. New invasive techniques for intervention with continuous electric stimulation (CES) are being reviewed for implementation.
Objectives: To evaluate recent evidence focused on the use of continuous electric stimulation of the trigeminal nerve for treatment of chronic facial pain.
Methods and materials: This review was undertaken in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA). A literature search was conducted in 4 databases including evidence from the last 5 years. Original publications based on population analyses were selected for preliminary review by the authors; only articles written in English or Spanish were included. The obtained data was loaded into the online platform Rayyan where each author conducted an independent analysis of each article’s abstract, selecting those that met the inclusion criteria for review.
Results: 162 articles were reviewed for inclusion, 31 were further analyzed to determine eligibility and 131 were excluded. 27 full text articles including systematic reviews, narrative reviews, retrospective case series, cohort studies, meta-analyses, institutional protocols and guidelines were included. From the 27 included publications, 16 studied trigeminal neuralgia or neuropathic pain of the trigeminal nerve as their main diagnosis, 8 did so with refractory facial pain, 1 did with postherpetic facial neuralgia, 1 with facial neuralgia secondary to multiple sclerosis, and 1 with mental nerve pain. Analyzed publications either use small group samples or offer heterogeneous treatment protocols, complication rates and follow-up periods; this allows for individual analysis and formulation of general recommendations.
Conclusions: Continuous electric stimulation is yet to prove its relevance in treatment of idiopathic trigeminal neuralgia. It may be used in some forms of chronic neuropathic trigeminal pain after conventional treatment fails. Use of CES on peripheral branches of the trigeminal nerve is limited, only Gasserian ganglion stimulation may offer a better outlook for select patients.
RESUMEN
Introducción: El dolor facial incluye un grupo de patologías de muy difícil diagnóstico y tratamiento. Su respuesta al manejo médico puede ser limitada y se convierte en un dolor crónico de difícil tratamiento. Nuevas técnicas de tratamiento invasivo con estimulación eléctrica continua (EEC) se están evaluando para su utilización.
Objetivos: Revisar la evidencia actual relacionada con el uso de la estimulación eléctrica continua del nervio trigémino para el tratamiento del dolor facial crónico.
Materiales y métodos: Esta revisión se realizó de acuerdo con las recomendaciones del Preferred Reporting ítems for systematic reviews and Meta-analyses (PRISMA). Se realizó una búsqueda sistemática de la literatura en los últimos 5 años utilizando 4 bases de datos. Se incluyeron para una primera revisión por parte de los autores todos los artículos en inglés y en español que tuvieran análisis poblacional. Los datos obtenidos fueron exportados a la plataforma Rayyan, en donde cada investigador realizó un análisis independiente de los resúmenes y seleccionó los artículos que cumplían con los requisitos de búsqueda.
Resultados: 162 artículos fueron revisados para inclusión, de los cuales 31 fueron analizados a profundidad para determinar su elegibilidad y 131 fueron excluidos. Se incluyeron 27 artículos de texto completo incluyendo revisiones sistemáticas, revisiones narrativas, series de casos retrospectivas, cohortes de casos, metanálisis, protocolos institucionales y guías de práctica clínica. De los 27 artículos incluidos, 16 establecieron su diagnóstico de base como neuralgia trigeminal o dolor neuropático del nervio trigémino, 8 lo hicieron con dolor facial refractario, 1 con neuralgia facial postherpética, 1 con neuralgia facial secundaria a esclerosis múltiple y 1 con dolor del nervio mentoniano. Las publicaciones consultadas ofrecen tamaños de muestra pequeños, parámetros de manejo, tasas de complicaciones y esquemas de seguimiento heterogéneos que permiten hacer un análisis individual y establecer recomendaciones generales.
Conclusiones: La estimulación eléctrica continua no ha demostrado aún su utilidad en el tratamiento de la neuralgia idiopática del trigémino. Puede utilizarse en algunas formas de dolor neuropático trigeminal crónico que no responda a otros tratamientos. La aplicación de EEC sobre ramas periféricas del nervio trigémino tiene un uso muy limitado y solo la estimulación continua del ganglio de Gasser podría tener un mejor futuro en el tratamiento de pacientes seleccionados.
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