Relation between serum carbamazepine concentration and pain in dental patients with trigeminal neuralgia

ABSTRACT

The relation between changes in pain intensity, frequency and serum carbamazepine [CBZ] concentration was studied in 10 dental patients with trigeminal neuralgia. All patients included in this study were previously treated as dental patients with misdiagnosed pain. All patients were treated with a daily dose of CBZ [600 mg] for a period of 10 months. Serum CBZ concentration, blood examination and measuring pain intensity and frequency were performed every 3 months after initiation of CBZ therapy. It was found that CBZ concentration varies from period to period even within the same individual. Also, there was a fluctuation in pain intensity in most of the patients as in periods where the CBZ levels were low, pain was relatively well controlled and vice versa. There was a considerable interindividual differences in response to CBZ. However, pain frequency was found to be reduced with long-term therapy. Moreover, this study showed a correlation between CBZ levels and the particular side effects. Side effects such as ataxia, dizziness, skin rashes, and leucopenia were observed in very few elderly during high serum CBZ level periods. These effects were transient. Furthermore, this study revealed that most of the patients had transient improvement of pain after oral surgical interference which could be a provoking factor of pain as pulpitis and impacted tooth. Therefore, this study showed the importance of monitoring serum CBZ level, pain intensity, frequency and side effects during long-term CBZ therapy. Also, proper diagnosis of trigeminal neuralgia in dental patients suffering from pain should be considered. Further, the dental problems causing pain on top of TN should be treated