Rapid Management of Trigeminal Neuralgia and Comorbid Major Depressive Disorder With Duloxetine

  title={Rapid Management of Trigeminal Neuralgia and Comorbid Major Depressive Disorder With Duloxetine},
  author={Chung-Chih Hsu and Chun-Wei Chang and Chia-Ho Peng and Chih-Sung Liang},
  journal={Annals of Pharmacotherapy},
  pages={1090 - 1092}
Objective: To describe a case of a patient diagnosed with major depressive disorder whose trigeminal neuralgia was unexpectedly but rapidly and efficiently responsive to duloxetine. Case Summary: A 37-year-old woman was diagnosed with trigeminal neuralgia, and the initial treatment with carbamazepine 800 mg/d did not improve her pain. In the following 3 years, she was poorly responsive to the combination therapy with several medications, including carbamazepine, valproate, baclofen, diclofenac… 
Effect of 5% Lidocaine Medicated Plaster on Pain Intensity and Paroxysms in Classical Trigeminal Neuralgia
LMP may be an effective and well-tolerated treatment option for TN in those patients who do not tolerate or who refuse other therapies, and may outlast the pharmacokinetics of the drug by reducing pain amplification mechanisms in the central nervous system.
Medical Management of Trigeminal Neuralgia
This chapter is a guide to the broad selection of medical therapies currently available for the treatment of trigeminal neuralgia which includes oral therapies and other non-surgical methods of treatment such as IV medications, nasal sprays, topical ointments, and injections.
Proteomic Analysis of the Hippocampus in Mouse Models of Trigeminal Neuralgia and Inescapable Shock-Induced Depression
It is demonstrated that the LH and TN models both develop depressive-like behaviors, and the involvement of many psychiatric disorder-related biomolecules/pathways in the pathogenesis of TN and LH is revealed.
Duloxetine Reduces Oxidative Stress, Apoptosis, and Ca2+ Entry Through Modulation of TRPM2 and TRPV1 Channels in the Hippocampus and Dorsal Root Ganglion of Rats
TRPM2 and TRPV1 channels are involved in Ca2+ entry-induced neuronal death and modulation of the activity of these channels by DULOX treatment may account for their neuroprotective activity against apoptosis, excessive ROS production, and Ca2- entry.
Amac: Noropatik Agri (NA) farkli bircok hastaliga bagli olarak ortaya cikan bir semptomdur. Hastalarin yasam kalitesini negatif yonde etkilemesinin yani sira tedavisi zor, uzun ve yuksek
Pharmacologic Management of Neuropathic Pain


Efficacy, safety and tolerability of duloxetine in idiopathic trigeminal neuralgia.
Duloxetine showed statistically significant pain relief in trigeminal neuralgia, and double-blind, placebo-controlled studies are needed to confirm findings at a large scale.
Associations between chronic pain and depressive symptoms in patients with trigeminal neuralgia.
Patients with TN and chronic facial pain had a significantly higher level of pain perception, and they presented the higher level for anxiety and depression than those with atypical facial pain.
AAN‐EFNS guidelines on trigeminal neuralgia management
Carbamazepine or oxcarbazepine should be offered as first‐line treatment for pain control and microvascular decompression may be considered over other surgical techniques to provide the longest duration of pain freedom in patients with TN.
Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia.
Duloxetine at 60 mg daily is effective in treating painful diabetic peripheral neuropathy in the short term, with a risk ratio for ≥ 50% pain reduction at 12 weeks of 1.73, and in fibromyalgia, there is low to moderate quality evidence that pain relief is also achieved in pain associated with depressive symptoms, but the NNTB of 8 in Fibromyalgia and depression is not an indication of substantial efficacy.
Efficacy of duloxetine in painful symptoms: an analgesic or antidepressant effect?
The data strongly suggest that duloxetine also exerts a substantial direct analgesic effect over and above its antidepressant effects, in patients with major depressive disorder, diabetic peripheral neuropathic pain, and fibromyalgia syndrome.
Pathophysiology of trigeminal neuralgia: the ignition hypothesis.
The ignition hypothesis is based on recent advances in the understanding of abnormal electrical behavior in injured sensory neurons, and new histopathologic observations of biopsy specimens from patients with trigeminal neuralgia who are undergoing microvascular decompression surgery.
Antidepressants for the Treatment of Chronic Pain
Evidence supports the use of tricyclic antidepressants in neuropathic pain, headaches, low back pain, fibromyalgia and IBS and the efficacy of the newer serotonin and norepinephrine reuptake inhibitors is less supported by evidence, but can be recommended in neuropathy pain, migraines and Fibromyalgia.
Mechanisms and treatment of neuropathic pain.
  • J. Vranken
  • Medicine, Psychology
    Central nervous system agents in medicinal chemistry
  • 2009
Despite the numerous treatment options available for relieving neuropathic pain, the most appropriate treatment strategy is only able to reduce pain in 70% of patients, and combination therapies using two or more analgesics with different mechanisms of action may also offer adequate pain relief.