Revised: May 31, 2014
Accepted: June 5, 2014
Published online: June 9, 2014
Neuropathic pain is chronic pain generated by disorders of the peripheral and central nervous system, including skull base tumours. A skull base tumour can be any type of tumour that forms in the skull base, and this includes vestibular schwannomas which arise from the sheath of the inner ear vestibulocochlear nerve (eighth cranial nerve). Growth of the tumour, surgical resection, and/or stereotactic radiotherapy may result in compression and/or irritation of the fifth cranial nerve (trigeminal nerve) resulting in facial pain and/or numbness. Non-trigeminal afferent input may contribute to the wide constellation of symptoms seen in orofacial pain patients. The purpose of this report was to develop a decision tool to guide the recognition and treatment of neuropathic pain in this specialized population. Recommendations for treatment are based on evidence presented in Canadian and international neuropathic treatment guidelines. Algorithms are included for assessment and treatment of adult patients with agents that are recognized to have analgesic efficacy within the broad context of neuropathic pain.
Core tip: The complexity of managing trigeminal neuralgia and neuropathic pain conditions among patients with skull base tumors requires a simple albeit comprehensive treatment algorithm that can be employed effectively by general practitioners, surgeons and other primary care prescribers in acute care or ambulatory clinical settings. We describe a simple treatment algorithm formulated on recommended best practice and based on clinical experience. It is intended to guide treatment, facilitate management and evaluation of outcome data (self-reported pain, quality of life measures) to elucidate the use of standardized approaches to pain management in patients with skull base etiology.