Mirogabalin, a nerve pain drug, may help manage post-traumatic trigeminal neuropathic (PTTN) occlusal pain following endodontic treatment, according to an observational study recently published in the Journal of Endodontics.
Furthermore, mirogabalin may offer a new treatment option for pain following root canal treatment, potentially avoiding tooth extraction by reducing overactive nerve signals, the authors wrote.
"Mirogabalin was effective in treating PTTN-occlusal pain," wrote the authors, led by Dr. Kohei Shimizu, PhD, of the Nihon University School of Dentistry in Japan (J Endod, December 27, 2024).
Postendodontic pain may persist despite successful root canal treatment, making diagnosis and management challenging, especially when neuropathic pain is involved.
This study aimed to evaluate the efficacy, safety, and optimal dosing of mirogabalin for managing occlusal pain due to PTTN pain after root canal treatment according to the International Classification of Orofacial Pain 2020 (ICOP) criteria, they wrote.
A total of 28 patients with PTTN-related occlusal pain during or after endodontic treatment were included in the study. Retreatment was performed by an endodontist if needed. Those who initially experienced occlusal pain but gradually adapted to biting without medication were placed in the provisional restoration group (PRG). Patients with severe pain during chewing who could not manage with a provisional restoration were assigned to the mirogabalin medication group (MMG).
Mirogabalin 10 mg/day was taken once daily before bedtime. Patients recorded daily changes in pain intensity using a visual analog scale (VAS) diary while practitioners documented VAS scores during consultations, they wrote.
In the PRG, VAS scores significantly decreased starting from week six and plateaued by week 11 (p < 0.05). This adaptation period was used to reduce or discontinue mirogabalin in the MMG.
After starting mirogabalin, VAS scores gradually decreased from week one (p < 0.05), and despite tapering the dose around week seven and discontinuing it by week 11, no recurrence of pain was observed after dose reduction or discontinuation.
However, the study had limitations, including its small sample size, highlighting the need for larger, more controlled trials, they wrote.
"This study indicates that in cases of occlusal pain due to post-traumatic trigeminal neuropathic pain after root canal treatment according to the ICOP criteria, mirogabalin therapy might present a novel treatment option that could potentially prevent tooth extraction due to unresolved pain," Shimizu et al concluded.
