The Effectiveness of Gabapentin for Severe Mandibular Pain in Stage 2 Patients with Bisphosphonate–related Osteonecrosis of the Jaw : Report of 3 cases

Abstract

Bisphosphonate related osteonecrosis of the jaw （BRONJ） usually occurs after simple dentoalveolar surgery and has a significant impact on the quality of life of most patients. Some stage 2 patients with BRONJ experience severe pain, which cannot be sufficiently alleviated by the administration of analgesics such as nonsteroidal anti–inflammatory drugs（NSAIDs）. Gabapentin, an oral antiepileptic medicine, has been used for relieving neuropathic pain. We present 3 cases in which gabapentin were effective against severe pain in patients with stage 2 BRONJ. In two cases, symptoms developed after tooth extraction, but symptoms developed spontaneously in the other case. All patients complained of difficulty in masticating and sleeping because of intense lancinating pain in the mandible. NSAIDs were administered, but the induced analgesic effect was only slight. Pain intensity was assessed using a modified numeric rating scale （m–NRS）. Gabapentin was administered orally. The period of induction of an analgesic effect of gabapentin was defined as the time point when the m–NRS score started to decrease. The m–NRS score of all patients improved within 3 days of initiation of gabapentin therapy. Side effects such as dizziness and somnolence were not observed in any of the 3 patients. Our results suggest that gabapentin may be effective in the management of severe mandibular pain in stage 2 BRONJ patients.