2021 Volume 49 Issue 4 Pages 172-174
We report the case of a 61-year-old woman whose severe neuropathic pain, caused by the extraction of the right maxillary lateral incisor, temporarily disappeared for seven months because of the development of tongue cancer. The patient’s right maxillary lateral incisor had been extracted because of a suspected tooth fracture 5 months prior to her first visit. After the extraction, she began to feel a tingling pain in the area of the tooth extraction site. Although the extraction site had healed well, she visited several dentists because of the pain but a cause could not be identified. Diclofenac sodium and over-the-counter analgesics were completely ineffective, and carbamazepine, which was prescribed for suspected trigeminal neuralgia, was ineffective.
At the time of the patient’s first visit to our hospital, her Visual Analogue Scale (VAS) result was 72/100 mm, and she complained of a tingling pain that lasted all day. No macroscopic abnormalities of the mucosa were visible, but allodynia was observed.
The patient was diagnosed with neuropathic pain following tooth extraction. Stellate ganglion blocks (SGB), adenosine 5-triphosphate (ATP) infusion, and oral pregabalin were ineffective. Fortunately, topical capsaicin therapy and oral tramadol (300 mg/day) almost eliminated the pain.
Seven years and seven months after the first visit, the patient suddenly developed tongue cancer near the right lateral incisor ; at this time, the neuropathic pain in the right maxillary lateral incisor disappeared.
The onset of the cancer might have caused conditioned pain modulation (CPM), which is a diffuse noxious inhibitory controls (DNIC)-like phenomenon.
The tongue cancer was resected, and the neuropathic pain in the maxillary gingiva remained absent for 7 months from the onset of the tongue cancer, but gradually reappeared thereafter. At present, the patient’s pain is being controlled using oral tramadol (300 mg/day) and oral pregabalin (150 mg/day).
