Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20200042
Brazilian Journal of Pain
Relato de Caso

Photobiomodulation as an adjuvant in the pharmacological treatment of trigeminal neuralgia. Case report

Fotobiomodulação como adjuvante no tratamento farmacológico da neuralgia trigeminal. Relato de caso

João Paulo Colesanti Tanganeli; Denise Sabbagh Haddad; Sandra Kalil Bussadori

http://dx.doi.org/10.5935/2595-0118.20200042 BrJP, vol.3, n3, p.285-287, 2020
PDF English
PDF Português
SciELO
Downloads: 0
Views: 570

Abstract

BACKGROUND AND OBJECTIVES: Trigeminal Neuralgia causes intense suffering and impaired quality of life. The diagnosis is clinical. Thermography has been proven to be a useful tool, both for confirming and monitoring this neuralgia. Photobiomodulation is being increasingly well documented, specially when associated with the first-choice therapy, which is pharmacotherapy. In this case report, the objective was to investigate the performance of the laser, associated with anticonvulsants, in a patient with trigeminal neuralgia, considering its results from a clinical and thermographic point of view.

CASE REPORT: Male patient, 62 years old, presenting idiopathic trigeminal neuralgia, diagnosed 4 years before, being controlled with oxcarbazepine (600mg), divided in 2 daily doses, being the dose doubled in the last year. In the last 4 months, the symptoms worsened with the increase in the drug dosage, generating side effects not supported by the patient. Photobiomodulation was proposed as a complementary treatment, with infrared thermography being performed before and after treatment. After the low-intensity laser therapy protocol, there was a significant improvement, demonstrated both by the patients report and the thermography, maintaining this result in the 6-month control. The dosage was reduced to 300 mg/day, restoring quality of life.

CONCLUSION: Low-intensity infrared laser photobiomodulation can be extremely useful when associated with an appropriate drug in the control of idiopathic trigeminal neuralgia, both in the immediate and medium-term outcome.

Keywords

Laser therapy, Thermography, Trigeminal Neuralgia

Resumo

JUSTIFICATIVA E OBJETIVOS: A neuralgia trigeminal provoca intenso sofrimento e comprometimento da qualidade de vida. O diagnóstico é clínico. A termografia tem se mostrado uma ferramenta útil tanto para a confirmação quanto para o acompanhamento dessa neuralgia. A fotobiomodulação está cada vez mais bem documentada, em especial quando associada com a terapia de primeira escolha, que é a farmacoterapia. O objetivo deste estudo foi investigar a atuação do laser, associado a anticonvulsivante, em paciente com neuralgia trigeminal, considerando os seus resultados sob o ponto de vista clínico e termográfico.

RELATO DO CASO: Paciente do sexo masculino, 62 anos, portador de neuralgia trigeminal idiopática, diagnosticado há 4 anos, sendo controlado com oxcarbazepina (600mg), dividida em 2 doses diárias, sendo esta dose dobrada no último ano. Nos últimos quatro meses os sintomas se agravaram com o aumento da dose do fármaco, gerando efeitos adversos não suportados pelo paciente. Foi proposta a fotobiomodulação como tratamento complementar, sendo realizada a termografia infravermelha antes e depois do tratamento. Após o protocolo de laserterapia de baixa intensidade, houve melhora significativa, demonstrada tanto pelo relato do paciente quanto observado pela termografia, mantendo-se esse resultado no controle de seis meses. O fármaco foi reduzido para 300mg/dia, o que devolveu ao paciente a qualidade de vida.

CONCLUSÃO: A fotobiomodulação por laser de baixa intensidade infravermelho pode ser extremamente útil quando associada a um adequado fármaco no controle da neuralgia trigeminal idiopática, tanto no resultado imediato quanto a médio prazo.

Palavras-chave

Neuralgia do trigêmeo, Terapia a laser, Termografia

Referências

Graff-Radford SB, Ketelaer MC, Gratt BM, Solberg WK. Thermographic assessment of neurophatic facial pain. J Orofac Pain. 1995;9(2):138-46.

Haddad DS, Brioschi ML, Baladi MG, Arita ES. A new evaluation of the heat distribution on facial skin surface by infrared thermography. Dentomaxillofac Radiol. 2016;45(4):20150264.

Hardy PA, Bowsher DR. Contact thermography in idiopathic trigeminal neuralgia and other facial pains. Br J Neurosurg. 1989;3(3):399-401.

Guidelines for dental-oral and systemic health infrared thermography. Pan Am Journal Med Thermol. 2019;5(1):41-55.

de Pedro M, López-Pintor RM, de la Hoz-Aizpurua JL, Casañas E, Hernández G. Efficacy of low-level laser therapy for the therapeutic management of neurophatic orofacial pain: a systematic review. J Oral Facial Pain Headache. 2018;34(1):13-30.

Falaki F, Nejat AH, Dalirsani Z. The effect of low-level laser therapy on trigeminal neuralgia: a review of literature. J Dent Res Dent Clin Dent Prospects. 2014;8(1):1-5.

Ebrahimi H, Najafi S, Khayamzadeh M, Zahedi A, Mahdavi A. Therapeutic and analgesic efficacy of laser in conjunction with pharmaceutical therapy for trigeminal neuralgia. J Lasers Med Sci. 2018;9(1):63-8.

Amanat D, Ebrahimi H, Lavaee F, Alipour A. The adjunct therapeutic effect of lasers with medication in the management of orofacial pain: double blind randomized controlled trial. Photomed Laser Surg. 2013;31(10):474-9.

Al-Maweri SA, Kalakonda B, AlAizari NA, Al-Soneidar WA, Ashraf S, Abdulrab S. Efficacy of low-level laser therapy in management of recurrent herpes labialis: a systematic review. Lasers Med Sci. 2018;33(7):1423-30.

Gomes RN, Viana LV, Ramos JS, Castro NM, Nicolau RA. Effects of photobiostimulation in the treatment of post-herpetic neuralgia: a case report. Rev Bras Geriatr Gerontol. 2018;21(1):102-7.

Abdel- Wahhab KG, Daoud EM, El Gendy A, Mourad HH, Mannaa FA, Saber MM. Efficiencies of low-level laser therapy (LLLT) and gabapentin in the management of peripheral neuropathy: diabetic neuropathy. Appl Biochem Biotechnol. 2018;186(1):161-73.

Rocha IR, Ciena AP, Rosa AS, Martins DO, Chacur M. Photobiostimulation reverses alodynia and peripheral nerve damage in streptozotocin-induced type 1 diabetes. Lasers Med Sci. 2017;32(3):495-501.

de Andrade ALM, Bossini PS, do Canto de Souza ALM, Sanchez AD, Parizotto NA. Effect of photobiomodulation therapy (808 nm) in the control of neuropathic pain in mice. Lasers Med Sci. 2017;32(4):865-72.

Seada YI, Nofel R, Sayed HM. Comparison between trans-cranial electromagnetic stimulation and low-level laser on modulation of trigeminal neuralgia. J Phys Ther Sci. 2013;25(8):911-4.

Holanda VM, Chavantes MC, Wu X, Anders JJ. The mechanistic basis for photobiomodulation therapy of neuropathic pain by near infrared laser light. Lasers Surg Med. 2017;49(5):516-24.

de Andrade AL, Bossini PS, Parizotto NA. Use of low-level laser therapy to control neuropathic pain: a systematic review. J Photochem Photobiol B. 2016;164:36-42.

Astasio-Picado A, Martínez EE, Gómez-Martín B. Comparison of thermal foot maps between diabetic patients with neurophatic, vascular, neurovascular, and no complications. Curr Diabetes Rev. 2019;15(6):503-9.

Gatt A, Falzon O, Cassar K, Ellul C, Camilleri KP, Gauci J. Establishing differences in thermographic patterns between the various complications in diabetic foot disease. Int J Endocrinol. 2018;12:9808295.

Submetido em:
21/01/2020

Aceito em:
13/05/2020

5f6a5b750e882587169fefc6 brjp Articles
2595-3192 (Eletrônico) 2595-0118 (Impresso)
BrJP ©2024 Todos os direitos reservados.

BrJP

Share this page
Page Sections