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World J Pharmacol. Jun 9, 2014; 3(2): 24-32
Published online Jun 9, 2014. doi: 10.5497/wjp.v3.i2.24
Pharmacological management of neuropathic pain in patients with vestibular schwannomas: Experience of the Atlantic Lateral Skull Base Clinic
Andrea LO Hebb, Jana Sawynok, Manohar Bance, Simon Walling, Ken Chisholm, David P Morris
Andrea LO Hebb, Atlantic Lateral Skull Base Clinic, Division of Neurosurgery, Dalhousie University, QEII Halifax Infirmary Site, Halifax NS B3H 3A7, Canada
Andrea LO Hebb, Capital District Health Authority, QEII Halifax Infirmary Site, 3rd Floor, Division of Neurosurgery, Halifax NS B3H 3A7, Canada
Jana Sawynok, Department of Pharmacology, Dalhousie University, Nova Scotia B3H 4R2, Canada
Manohar Bance, David P Morris, Division Otolaryngology, Dalhousie University, QEII Health Sciences Centre, Halifax NS B3H 2Y9, Canada
Simon Walling, Division of Neurosurgery, Dalhousie University, Halifax Infirmary Site, QEII Health Sciences Centre, Halifax NS B3H 3A7, Canada
Ken Chisholm, Department of Anesthesia and Pain Management, Dalhousie University, Halifax NS B3H 2Y9, Canada
Author contributions: All authors had contributed substantially to conception and design, or acquisition of data, or analysis and interpretation of data; drafted the article or revised it critically for important intellectual content and gave final approval of the version to be published.
Correspondence to: Dr. Andrea LO Hebb, MSc, PhD, RN, Capital District Health Authority, QEII Halifax Infirmary Site, 3rd Floor, Division of Neurosurgery, 1796 Summer Street, Halifax NS B3H 3A7, Canada.
Telephone: +1-902-473-4824 Fax: +1-902-425-4176
Received: April 29, 2014
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.

Keywords: Acoustic neuroma, Stereotactic radiotherapy, Tricyclic antidepressants, Serotonin-norepinephrine reuptake inhibitors, Calcium channel modulators, Tramadol, Opioids

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.