HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) [Data suppl] Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gilron, I. Articles by Max, M. B. Search for Related Content PubMed PubMed Citation Articles by Gilron, I. Articles by Max, M. B.

A randomized, controlled trial of high-dose dextromethorphan in facial neuralgias

From the Pain and Neurosensory Mechanisms Branch, National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD.

Address correspondence and reprint requests to Dr. Mitchell B. Max, National Institutes of Health, Rm. 3C-405, Bethesda, MD 20892-1258; e-mail: mm77k{at}nih.gov

BACKGROUND: NMDA glutamate receptor antagonists such as ketamine and dextromethorphan reduce pain in certain neuropathic pain conditions. However, there have been no controlled trials of NMDA antagonists in facial neuralgias.

METHODS: A randomized, double-blind, crossover trial compared 6 weeks of oral dextromethorphan with active placebo (low-dose lorazepam) in 19 patients, stratified into three groups: 11 with facial pain and possible trigeminal neuropathy, five with anesthesia dolorosa, and three with idiopathic trigeminal neuralgia. Dosage was titrated in each patient to the highest level reached without disrupting normal activities.

RESULTS: Patients completing the trial included 10 with possible trigeminal neuropathy, four with anesthesia dolorosa, and two with trigeminal neuralgia. In patients with possible trigeminal neuropathy and anesthesia dolorosa, dextromethorphan decreased pain by a mean of only 2 to 4%, and these estimates were not significant. Both patients with trigeminal neuralgia had more pain during dextromethorphan treatment than during placebo treatment. Of three patients who demonstrated an analgesic response to dextromethorphan during the main trial, only one repeatedly responded in four subsequent confirmatory drug–placebo crossovers.

CONCLUSIONS: Dextromethorphan shows little or no analgesic efficacy in pain due to possible trigeminal neuropathy and anesthesia dolorosa. Additional trials are necessary to conclusively evaluate the efficacy of NMDA-receptor antagonists in trigeminal neuralgia.

This article has been cited by other articles:

				I. Gilron, J. M. Bailey, D. Tu, R. R. Holden, D. F. Weaver, and R. L. Houlden Morphine, Gabapentin, or Their Combination for Neuropathic Pain N. Engl. J. Med., March 31, 2005; 352(13): 1324 - 1334. [Abstract] [Full Text] [PDF]

				A. Tarral, P. Dostert, Y. Guillevic, L. Fabbri, I. Rondelli, F. Mariotti, and B. P. Imbimbo Safety, Pharmacokinetics, and Pharmacodynamics of CHF 3381, a Novel N-Methyl-D-Aspartate Antagonist, after Single Oral Doses in Healthy Subjects J. Clin. Pharmacol., August 1, 2003; 43(8): 901 - 911. [Abstract] [Full Text] [PDF]

				R. M. Allen, A. L. Granger, and L. A. Dykstra Dextromethorphan Potentiates the Antinociceptive Effects of Morphine and the delta -Opioid Agonist SNC80 in Squirrel Monkeys J. Pharmacol. Exp. Ther., February 1, 2002; 300(2): 435 - 441. [Abstract] [Full Text] [PDF]