The Effectiveness of Transcutaneous Electrical Nerve Stimulation Versus Carbamazepine in Trigeminal Neuralgia: A Randomized Controlled Trial

Authors

  • Rebecca Millan-Guerrero University of Colima, School of Medicine, Colima, Mexico
  • Rebecca Isais-Millan University of Salamanca, Salamanca, Spain
  • Gabriel Castillo-Varela University Clinical Hospital of Salamanca, CAUSA, Salamanca, Spain
  • Gabriel Ceja-Espíritu University of Colima, School of Medicine, Colima, Mexico
  • Martha A. Higareda-Almaraz Medical benefits. IMSS, Colima, Mexico

DOI:

https://doi.org/10.17140/CTPOJ-2-104

Keywords:

Trigeminal neuralgia (TN), Transcutaneous electrical nerve stimulation (TENS), Carbamazepine (CBZ)

Abstract

Objectives
To determine if the treatment of refractory trigeminal neuralgia (TN) with transcutaneous electrical nerve stimulation (TENS)
could lead to improved pain control.
Materials and Methods
We enrolled 20 patients with refractory TN in a double blinded, randomized, placebo-controlled clinical trial. Patients received
either TENS for group 1 (n=10) or carbamazepine (CBZ) for group 2 (n=10). The visual analog pain scale (VAS) and the barrow
neurological institute (BNI) pain scale, the number and duration of pain episodes and daily analgesic intake were analyzed for
each group at 1 month, 2 months, 3 months, 1 year, 3 years and 5 years.
Results
The TENS group achieved better pain control than the CBZ group (p<0.05). Pain-free patients accounted for 60% in the TENS
group and 50% in the CBZ group 1 month after initiating treatment, 100% and 77.77% at 3 months, 100% and 62.5% at 1 year,
100% and 50% at 3 years, respectively. The TENS group remained pain free for 3 years. At the 5-year mark, all members of the
TENS group and the CBZ group presented pain recurrence.
Conclusion
TENS group scored significantly lower in pain scales compared with the CBZ group. TENS group was pain free for a longer
period of time compared with the CBZ group. Significant differences between both groups favored TENS therapy, however the
small sample size remains an important limitation of this study.

References

Headache Classification Committee of the International Head-ache Society (IHS). The International Classification of Headache Disorders, 3rd ed. Cephalalgia. 2018; 38:708-721.

Börü UT, Duman A, Bölük C, Coskun DS, Tasdemir M. Bot-ulinum toxin in the treatment of trigeminal Neuralgia. 6-Month follow-up. Medicine (Baltimore). 2017; 96: e8133. doi: 10.1097/ MD.0000000000008133

Van Hecke O, Austin SK, Khan RA, Smith BH, Torrance N. Neuropathic pain in the general population: A systematic review of epidemiological studies. Pain. 2014; 155: 654-662. doi: 10.1016/j. pain.2013.11.013

Hall GC, Carroll D, Parry D, McQuay HJ. Epidemiology and treatment of neuropathic pain: The UK primary care perspective. Pain. 2006; 122: 156-162. doi: 10.1016/j.pain.2006.01.030

Koopman JS, Dieleman JP, Huygen FJ, et al. Incidence of fa-cial pain in the general population. Pain. 2009; 147: 122-127. doi: 10.1016/j.pain.2009.08.023

Dandy WE. Concerning the cause of trigeminal neuralgia. Am J Surg.1934; 24: 447-455. doi: 10.1016/S0002-9610(34)90403-7

Prasad S, Galetta S. Trigeminal neuralgia: Historical notes and current concepts. The Neurologist. 2009; 15: 87-94. doi: 10.1097/ NRL.0b013e3181775ac3

Yoshino N, Akimoto H, Yamada I, et al. Trigeminal neuralgia: Original Research | Volume 2 | Number 1 | Millan-Guerrero R et al evaluation of neuralgic manifestation and site of neurovascular compression with 3D CISS MR imaging and MR angiography. Ra-diology. 2003; 228: 539-545. doi: 10.1148/radiol.2282020439

McMillan R. Trigeminal neuralgia-a debilitating facial pain. Rev Pain. 2011; 5: 26-34. doi: 10.1177/204946371100500105

Cruccu G, Finnerup NB, Jensen TS, et al. Trigeminal neu-ralgia: New classification and diagnostic grading for prac-tice and research. Neurology. 2016; 87: 220-228 doi: 10.1212/ WNL.0000000000002840

Treede RD, Jensen TS, Campbell JN, et al. Neuropath-ic pain: Redefinition and a grading system for clinical and re-search purposes. Neurology. 2008; 70: 1630-1635. doi: 10.1212/01. wnl.0000282763.29778.59

Antonini G, Di Pasquale A, Cruccu G, et al. Magnetic reso-nance imaging contribution for diagnosing symptomatic neurovas-cular contact in classical trigeminal neuralgia: A blinded case-con-trol study and meta-analysis. Pain. 2014; 155: 1464-1471. doi: 10.1016/j.pain.2014.04.020

Lee A, McCartney S, Burbidge C, Raslan AM, Burchiel KJ. Trigeminal neuralgia occurs and recurs in the absence of neu-rovascular compression. J Neurosurg. 2014; 120: 1048-1054. doi: 10.3171/2014.1.JNS131410

Cruccu G. Trigeminal Neuralgia. Continuum (Minneap Minn). 2017; 23 (2, Selected Topics in Outpatient Neurology): 396-420. doi: 10.1212/CON.0000000000000451

Weber K. Neuromodulation and devices in trigeminal neural-gia. Headache. 2017; 57: 1648-1653. doi: 10.1111/head.13166

Gronseth G, Cruccu G, Alksne J, et al. Practice parameter: The diagnostic evaluation and treatment of trigeminal neuralgia (an ev-idence-based review): Report of the quality standards subcommit-tee of the American academy of neurology and the European fed-eration of neurological societies. Neurology. 2008; 71: 1183-1190. doi: 10.1212/01.wnl.0000326598.83183.04

Cruccu G, Gronseth G, Alksne J, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008; 15: 1013- 1028. doi: 10.1111/j.1468-1331.2008.02185.x

Al-Quliti KW. Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical op-tions. Neurosciences (Riyadh). 2015; 20: 107-114. doi: 10.17712/ nsj.2015.2.20140501

Nurmikko TJ, Eldridge PR. Trigeminal neuralgia—pathophysi-ology, diagnosis and current treatment. Br J Anaesth. 2001; 87: 117- 132. doi: 10.1093/bja/87.1.117

Spatz AL, Zakrzewska JM, Kay EJ. Decision analysis of med-ical and surgical treatments for trigeminal neuralgia: How patient evaluations of benefits and risks affect the utility of treatment de-cisions. Pain. 2007; 131: 302-310. doi: 10.1016/j.pain.2007.02.009

Bennetto L, Patel NK, Fuller G. Trigeminal neuralgia and its management. BMJ. 2007; 334: 201-205. doi: 10.1136/ bmj.39085.614792.BE

Li ST, Pan Q, Liu N, Shen F, Liu Z, Guan Y. Trigeminal neural-gia: What are the important factors for good operative outcomes with microvascular decompression. Surg Neurol. 2004; 62: 400-404. doi: 10.1016/j.surneu.2004.02.028

Bick SKB, Eskandar EN. Surgical treatment of trigeminal neuralgia. Neurosurg Clin N Am. 2017; 28: 429-438. doi: 10.1016/j. nec.2017.02.009

Holsheimer J. Electrical stimulation of the trigeminal tract in chronic, intractable facial neuralgia. Arch Physiol Biochem. 2001; 109: 304-308. doi: 10.1076/apab.109.4.304.4246

Eckerdal A, Bastian L. Can low reactive level laser therapy be used in the treatment of neurogenic facial pain? A double-blind placebo controlled investigation of patients with trigeminal neural-gia. Laser Ther. 1996; 8: 247-252. doi: 10.5978/islsm.8.247

Thompson JW, Filshie J. Transcutaneous electrical nerve stimu-lation (TENS) and acupuncture. In: Doyle D, Hanks G, MacDon-ald N, eds. Oxford Textbook of Palliative Medicine. Oxford, England, UK: Oxford University Press; 1998: 421-437

American physical therapy association. Guide to physical ther-apist practice, 2nd ed. Phys Ther. 2001; 81: 9-746.

Johnson M. Transcutaneous electrical nerve stimulation: Mech-anisms, clinical application and evidence. Rev Pain. 2007; 1: 7-11 doi: 10.1177/204946370700100103

Sluka KA, Deacon M, Stibal A, Strissel S, Terpstra A. Spinal blockade of opioid receptors prevents the analgesia produced by TENS in arthritic rats. J Pharmacol Exp Ther. 1999; 89: 840-846.

Sluka KA, Walsh D. Transcutaneous electrical nerve stimula-tion: Basic science mechanisms and clinical effectiveness. J Pain. 2003; 4: 109-121. doi: 10.1054/jpai.2003.434

Binder A, Baron R. Utility of transcutaneous electrical nerve stimulation in neurologic pain disorders. Neurology. 2010; 74: 104- 105. doi: 10.1212/WNL.0b013e3181cbb8af

Bilgili A, Cakir T, Dogan SK, et al. The effectiveness of trans-cutaneous electrical nerve stimulation in the management of patients with complex regional pain syndrome: A randomized, double-blinded, placebo controlled prospective study. J Back Mus-8 Millan-Guerrero R et al culoskelet Rehabil. 2016; 29: 661-671. doi: 10.3233/BMR-160667

Vance CG, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control: The state of the evidence. Pain Manag. 2014; 4: 197- 209. doi: 10.2217/pmt.14.13

DeSantana JM, Walsh DM, Vance C, Rakel BA, Sluka KA. Effectiveness of transcutaneous electrical nerve stimulation for treatment of hiperalgesia and pain. Curr Rheumatol Rep. 2008; 10: 492-499.

World Medical Association. World medical association decla-ration of helsinki ethical principles for medical research involv-ing human subjects. JAMA. 2013; 310: 2191-2194. doi: 10.1001/ jama.2013.281053

Cruccu G, Truini A. Refractory trigeminal neuralgia. Non-sur-gical treatment options. CNS Drugs. 2013; 27: 91-96. doi: 10.1007/ s40263-012-0023-0

Rennie S. Electrophysical agents-contraindications and pre-cautions: An evidence-based approach to clinical decision making in physical therapy. Physiother Can. 2011; 62: 1-80. doi: 10.3138/ ptc.62.5

Yameen F, Shahbaz NN, Hasan Y, Fauz R, Abdullah M. Effica-cy of transcutaneous electrical nerve stimulation and its different modes in patients with trigeminal neuralgia. J Pak Med Assoc. 2011; 61: 437-439.

Law P, Cheing G. Optimal stimulation frequency of transcutane-ous electrical nerve stimulation on people with knee osteoarthritis. J Rehabil Med. 2004; 36: 220-225. doi: 10.1080/16501970410029834

De Tommaso M, Fiore P, Camporeale A, et al. High and low frequency transcutaneous electrical nerve stimulation inhibits noci-ceptive responses induced by CO laser stimulation in humans. Neu-rosci Lett. 2003; 342: 17-20. doi: 10.1016/S0304-3940(03)00219-2

ObermannM.Treatmentoptionsintrigeminalneuralgia.TherAdv Neurol Disord. 2010; 3: 107-115. doi: 10.1177/1756285609359317

Rogers CL, Shetter AG, Fiedler JA, Smith KA, Han PP, Speiser BL. Gamma knife radiosurgery for trigeminal neuralgia: The initial experience of the barrow neurological institute. Int J Radiat Oncol Biol Phys. 2000; 47: 1013-1019. doi: 10.1016/S0360-3016(00)00513-

Jellish WS, Benedict W, Owen K, Anderson D, Fluder E, Shea JF. Perioperative and long-term operative outcomes after sur-gery for trigeminal neuralgia: microvascular decompression vs percutaneous balloon ablation. Head Face Med. 2008; 4: 11. doi: 10.1186/1746-160X-4-11

Li J, Song Y. Transcutaneous electrical nerve stimulation for Original Research | Volume 2 | Number 1 | postoperative pain control after total knee arthroplasty a meta-anal-ysis of randomized controlled trials. Medicine (Baltimore). 2017; 96: e8036. doi: 10.1097/MD.0000000000008036

Johnson MI, Bjordal JM. Transcutaneous electrical nerve stim-ulation for the management of painful conditions: Focus on neu-ropathic pain. Expert Rev Neurother. 2011;11: 735-753. doi: 10.1586/ ern.11.48

Claydon LS, Chesterton LS, Barlas P, Sim J. Alternating-fre-quency TENS effects on experimental pain in healthy human par-ticipants. A randomized placebo-controlled trial. Clin J Pain. 2013; 29: 533-539 doi: 10.1097/AJP.0b013e318262330f

Thorsen SW, Lumsden SG. Trigeminal neuralgia: Sudden and long-term remission with transcutaneous electrical nerve stimula-tion. J Manipulative Physiol Ther. 1997; 20: 415-419.

Singla S, Prabhakar V, Singla RK. Role of transcutaneous Submit your article to this journal | https://openventio.org/submit-manuscript/ Original Research | Volume 2 | Number 1 | Millan-Guerrero R et al electric nerve stimulation in the management of trigeminal neu-ralgia. J Neurosci Rural Pract. 2011; 2: 150-152 doi: 10.4103/0976- 3147.83580

Sluka KA, Bjordal JM, Marchand S, Rakel BA. What makes transcutaneous electrical nerve stimulation work? Making sense of the mixed results in the clinical literature. Phys Ther. 2013; 93: 1397- 1402. doi: 10.2522/ptj.20120281

Fishbain DA, Chabal C, Abbott A, Heine LW, Cutler R. Transcutaneous electrical nerve stimulation (TENS) treatment outcome in long-term users. Clin J Pain. 1996; 12: 201-214. doi: 10.1097/00002508-199609000-00008

Wu N, Lee J, Zakrzewska J, Werneburg B, Hoffman D, Liu Y. 378 Trigeminal neuralgia: Pharmacotherapy and surgical treatment patterns in the United States. J Pain. 2017; 18: S69. doi: 10.1016/j. jpain.2017.02.352

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Published

2019-01-30

How to Cite

Rebecca Millan-Guerrero, Rebecca Isais-Millan, Gabriel Castillo-Varela, Gabriel Ceja-Espíritu, & Martha A. Higareda-Almaraz. (2019). The Effectiveness of Transcutaneous Electrical Nerve Stimulation Versus Carbamazepine in Trigeminal Neuralgia: A Randomized Controlled Trial. Clinical Trials and Practice – Open Journal, 2(1), 1–9. https://doi.org/10.17140/CTPOJ-2-104