악안면 신경통성 동통의 임상적 특징과 약물 치료

The Clinical Characteristics and Pharmacologic Treatment of Neuralgic Pain in Maxillofacial Region

This study was performed to provide the information on the clinical characteristics of the most common paroxysmal pain disorder in maxillofacial region, trigeminal neuralgia, and the effects and side effects of carbamazepine. The patients who visited Orofacial Pain Clinic, Dept. of Oral Diagnosis, Seoul National University Dental Hospital for treating paroxysmal pain were studied by history taking, clinical examination, and radiography. Sixty-two patients(male 20, female42) without any clinical and radiological abnormalities were Included. The change of pain, blood tests, and side effects were investigated periodically after administration of carbamazepine. The obtained results were as follows : 1. Almost all patient with trigeminal neuralgia were over the age of forties and it was more common in women. 2. Trigeminal neuralgia was more right sided and the involved nerve was in the order of maxillary n., mandibular n., and ophthalmic n. 3. The mean duration of suffering was 20.7 months. Eighty percent of patients had apparent trigger area. 4. The duration of pain attack was in the older of several seconds, 1 min. to 5 min., more than 10 min., and 5 min. to 10 min. The frequency of pain attack was in the order of more than 10 per day, 6-10 per day, and 1-5 per day. 5. The clinic the patients had visited for reducing neuralgic pain was in the order of dental clinic, neurology, oriental medicine, otolaryngology, and pharmacy. 6. Unnecessary dental treatments for reducing neuralgic pain were performed in 41.9% of the patients. Almosit all treatments were irreversible ones such as endodontic treatment and tooth extraction. 7. The initial mean VAS was 8.6, but it was decreased to 3.8 after 1 month, to 2.7 after 2 months. Almost all patients showed decreased pain with 200-600mg/day of carbamazepine to 6 months. 8. WBC counts, especially neutrophil counts, was decreased in 1 week after administration of carbamazepine but reached initial level after 1 month. SGOT, SGPT, and creatinine did not show any significant change. 9. Blood pressure was not changed significantly after administration of carbamazepine. 10. Almost patients did not show any apparent side effects, but drowsiness, dizziness, skin itching, constipation, and gastric irritation were occurred in some patients.