STREPTOMYCIN AS A THERAPEUTIC OPTION IN REFRACTORY TRIGEMINAL NEURALGIA: A CASE SERIES
Main Article Content
Keywords
Trigeminal Neuralgia, Streptomycin, Perineural injection, Infraorbital Nerve, Inferior Alveolar Nerve, Neurolysis
Abstract
Background: Trigeminal neuralgia (TGN) is a chronic facial pain condition often resistant to standard pharmacological treatment. While invasive procedures provide relief in refractory cases, some patients remain reluctant to pursue surgical options. The purpose of this case series was to evaluate the efficacy of perineural streptomycin injections as a non-surgical alternative in such patients. Ten patients with classical TGN unresponsive to at least two antineuralgic medications and unwilling to undergo surgery were selected. Each received a perineural injection of streptomycin targeting either the infraorbital or inferior alveolar nerve. Outcomes were measured by Visual Analog Scale (VAS) and follow-up evaluations over a 6-month period. It has been observed that the all ten patients experienced significant pain relief (VAS reduction >80%) within 7 days post-injection. Duration of relief ranged from 3 to 6 months. Three patients were required repeat injections during the follow-up period. Minor, reversible adverse effects were observed in three cases. It has been concluded that the perineural streptomycin injection may represent a promising low-cost and minimally invasive alternative in patients with refractory TGN who declined surgical treatment. Streptomycin injection seems to be an easy, effective, and a safe method for pain relief in patients with trigeminal neuralgia. Nevertheless, further controlled studies are needed to approve this method as a routine procedure.
References
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29. Numikko TJ, Eldridge PR. Trigeminal neuralgia: pathophysiology. Diagnosis and current treatment. Br J Anaesth 2001; 87: 117-32.
30. Devor M, Amir R, Rappaport ZH. Pathophysiology of trigeminal neuralgia: the ignition hypothesis. Clin J Pain 2002; 18: 4-13.
31. Salim M, Kazi WA. Post herpetic neuralgia: use of streptomycin – a preliminary report. J Coll Physician Surg Pak. 1996; 6: 53-4.
32. Sokolovic M, Todorovic L, Stajcic Z, Petrovic V. Peripheral streptomycin/lidocaine injections in the treatment of idiopathic trigeminal neuralgia: a preliminary report. J Maxillofac Surg 1986; 14: 8-9.
33. Taha JM, Tew JM, Jr. Surgical treatment of trigeminal neuralgia. Crit Rev Neurosurg 1994; 4: 156-63.
34. Sokoll MD, Diecke FPJ. Some effects of streptomycin on frog nerve in vitro. Arch Int Pharmacodyn 1969; 177: 332-9.
35. Alkadhi KA, McIsaac RJ. Ganglion blocking effects of streptomycin. Arch Int Pharmacodyn 1978; 232: 58-67.
36. Kanpolat Y, Tatli M, Ugur HC, Kahilogullari G. Evaluation of platybasia in patients with idiopathic trigeminal neuralgia. Surg Neurol 2007; 67: 78-81.
37. Sohail A, Saeed M, Qazi SR. Efficacy of peripheral glycerol injection in the management of trigeminal neuralgia. Pak Oral Dent J 2006; 26: 93-6.
38. Khitab U, Khan M, Din RU, Wahid A, Rehman AU. Trigeminal neuralgia: a study on 242 patients. Pak Oral Dent J 2005; 25: 163-6.
39. Katusic S, Williams DB, Beard CM, Bergstralh EJ, Kurland LT. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences. Rochester, Minnesota 1945-1984. Neuroepidemiology 1991; 10: 276-81.
40. Zakrazewska JM. Patsalos PN. Long-term cohort study comparing medical (oxcarbazepine) and surgical management of intractable trigeminal neuralgia. Pain 2002; 95: 259-66.
41. Stajcic Z, Juniper RP, Todorovic L. Peripheral streptomycin/lidocaine injection vs lidocaine alone in the treatment of idiopathic trigeminal neuralgia: a double-blind controlled trial. J Craniomaxillofac Surg. 1990; 18: 243-6.
42. McLeod NM, Patton DW. Peripheral alcohol injections in the management of trigeminal neuralgia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104: 12-7.
43. Ankur G, Amit S, Aditi B, Anchal D, Sameer R, Ankit G. Analgesic Effects of Peripheral Injections of Streptomycin/Lignocaine In the treatment of Trigeminal Neuralgia-A Clinical Study. JARMS 2013; 5(2): 115-117.
44. Akhtar FM, ur Rehman MM, Ahmed M, Akmal M, Mushtaq S. Pain relief in neuropathic pain-a comparison between 0.5% bupivacaine and 0.5% bupivacaine streptomycin combination. PAFMJ 2016(2): 244-249.
45. Navez ML, Monella C, Bösl I, Sommer D, Delorme C. 5% lidocaine medicated plaster for the treatment of postherpetic neuralgia: a review of the clinical safety and tolerability. Pain Ther 2015; 4(1): 1-15.
46. Baron R, Mayoral V, Leijon G, Binder A, Steigerwald I, Serpell M. 5% lidocaine medicated plaster versus pregabalin in post-herpetic neuralgia and diabetic polyneuropathy: an open-label, non-inferiority two-stage RCT study. Curr Med Res Opin 2009; 25(7): 1663-1676.
47. Binder A, Bruxelle J, Rogers P, Hans G, Bösl I, Baron R. Topical 5% lidocaine (lignocaine) medicated plaster treatment for post-herpetic neuralgia. Clin Drug Investig 2009; 29(6): 393-408.
48. Abdel-Aziz S, Ghaleb A. Continuous Inferior Alveolar Nerve Block Using an Indwelling Catheter and Inferior Maxillary Artery Embolization for the Management of Atypical Trigeminal Neuralgia. Open J Anesthesiol 2013; 3(9): 375-378.
49. Sobouti F, Khatami M, Chiniforush N, Rakhshan V, Shariati M. Effect of singledose low-level helium-neon laser irradiation on orthodontic pain: a split-mouth singleblind placebo-controlled randomized clinical trial. Prog Orthod 2015; 16(1): 32.
50. Bendtsen L, Zakrzewska JM, Abbott J, et al.: European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019, 26:831-49.
51. Cruccu G, Gronseth G, Alksne J, et al.: AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008, 15:1013-28.
52. Moore D, Chong MS, Shetty A, Zakrzewska JM: A systematic review of rescue analgesic strategies in acute exacerbations of primary trigeminal neuralgia. Br J Anaesth. 2019, 123: e385-96.
53. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996, 334:1077-83.
54. Rubis A, Juodzbalys G: The use of botulinum toxin A in the management of trigeminal neuralgia: a systematic literature review. J Oral Maxillofac Res. 2020, 11: e2.
55. Zhang H, Lian Y, Xie N, Cheng X, Chen C, Xu H, Zheng Y: Factors affecting the therapeutic effect of botulinum toxin A on trigeminal neuralgia: a follow-up retrospective study of 152 patients. Exp Ther Med. 2019, 18:3375-82.
56. Yoshida K: Effects of Botulinum Toxin type A on pain among trigeminal neuralgia, myofascial temporomandibular disorders, and oromandibular dystonia. Toxins (Basel). 2021, 13:605.
57. Dinan JE, Smith A, Hawkins JM: Trigeminal neuralgia with extraoral trigger zone successfully treated with intraoral injections of botulinum toxin: a case report. Clin Neuropharmacol. 2020, 43:162-3
58. Branco R, Silva B G, Pereira A, et al. What Is New and Effective in Treating Refractory Trigeminal Neuralgia? Cureus. 2024;16(11): e73110.
2. Cheshira WP. Trigeminal neuralgia: diagnosis and treatment. Curr Neurol Neurosci Rep. 2005; 5: 79-85.
3. Chole R, Degwekar SS. Drug treatment of trigeminal neuralgia: a systemic review of the literature. J Oral Maxillofac Surg. 2007; 65: 40-5.
4. Beal MF, Hauser SL. Disturbios Comuns dos Nervos Cranianos. In: Harrison TR, Braunwald E, Fauci AS, eds. Medicina Interna. 15th ed. Rio de Janeiro: McGraw Hill, 2002: 2572-76.
5. Goh BT, Poon CY, Perk RHL. The importance of routine magnetic resonance imaging in trigeminal neuralgia diagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 92: 424-9.
6. Zhang, X.; Peng, L.; Liu, D. Radiofrequency Therapies for Trigeminal Neuralgia: A Systematic Review and Updated Meta-analysis. Pain Physician 2022, 25, E1327–E1337.
7. Headache Classification Committee of the International Headache Society (IHS) the International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018, 38:1-211.
8. Katusic S, Beard CM, Bergstralh E, Kurland LT: Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol. 1990, 27:89-95. 10.1002/ana.410270114
9. Hall GC, Carroll D, McQuay HJ: Primary care incidence and treatment of four neuropathic pain conditions: a descriptive study, 2002-2005. BMC Fam Pract. 2008, 9:26. 10.1186/1471-2296-9-26
10. Kayani AM, Silva MS, Jayasinghe M, Singhal M, Karnakoti S, Jain S, Jena R: Therapeutic efficacy of botulinum toxin in trigeminal neuralgia. Cureus. 2022, 14:e26856.
11. Haviv Y, Khan J, Zini A, Almoznino G, Sharav Y, Benoliel R: Trigeminal neuralgia (part I): revisiting the clinical phenotype. Cephalalgia. 2016, 36:730-46.
12. Cole CD, Liu JK, Apfelbaum RI: Historical perspectives on the diagnosis and treatment of trigeminal neuralgia. Neurosurg Focus. 2005, 18: E4. 10.3171/foc.2005.18.5.5
13. Maarbjerg S, Gozalov A, Olesen J, Bendtsen L: Trigeminal neuralgia - a prospective systematic study of clinical characteristics in 158 patients. Headache. 2014, 54:1574-82.
14. Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G: Trigeminal neuralgia diagnosis and treatment. Cephalalgia. 2017, 37:648-57.
15. Lambru G, Zakrzewska J, Matharu M: Trigeminal neuralgia: a practical guide. Pract Neurol. 2021, 21:392- 402.
16. Zhao, X.; Ge, S. The efficacy and safety of gabapentin vs. carbamazepine in patients with primary trigeminal neuralgia: A systematic review and meta-analysis. Front. Neurol. 2023, 14, 1045640.
17. Xu, R.; Xie, M.E.; Jackson, C.M. Trigeminal Neuralgia: Current Approaches and Emerging Interventions. J. Pain Res. 2021, 14, 3437–3463.
18. Moore, D.; Chong, M.S.; Shetty, A.; Zakrzewska, J.M. A systematic review of rescue analgesic strategies in acute exacerbations of primary trigeminal neuralgia. Br. J. Anaesth. 2019, 123, e385–e396.
19. Zhou, X.; Shen, Y.; Zhao, C.; Luo, F. Lidocaine aerosol sprayed on oral and/or nasal mucosa for the rescue of acute trigeminal neuralgia exacerbations: A retrospective study. Cephalalgia 2023, 43,
20. Gupta, M.; Chitneni, A.; Ghorayeb, J.; Schnetzer, B.; Klusek, M. Cervical Spinal Cord Stimulation for Trigeminal Neuralgia: A Narrative Review. Curr. Pain Headache Rep. 2022, 26, 639–645.
21. Schwenk, E.S.; Mariano, E.R. Designing the ideal perioperative pain management plan starts with multimodal analgesia. Korean J. Anesthesiol. 2018, 71, 345–352.
22. Di Stefano, G.; Truini, A.; Cruccu, G. Current and Innovative Pharmacological Options to Treat Typical and Atypical Trigeminal Neuralgia. Drugs 2018, 78, 1433–1442.
23. Zhang, J.; Yang, M.; Zhou, M.; He, L.; Chen, N.; Zakrzewska, J.M. non-antiepileptic drugs for trigeminal neuralgia. Cochrane Database Syst. Rev. 2013, 12, Cd004029.
24. Wiffen, P.J.; Derry, S.; Moore, R.A.; Kalso, E.A. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst. Rev. 2014, 2014, Cd005451
25. Ayub S, Ilyas M, Ali M. Surgical management of trigeminal neuralgia by microvascular decompression. J Postgrad Med Inst 2004;18: 507-11.
26. Shah SA, Murad N, Salaar A, Iqbal N. Trigeminal neuralgia: analysis of pain distribution and nerve involvement. Pak Oral Dent J. 2007; 28: 39-41.
27. Zakrzewska JM, Patsalos PN. Drugs used in the management of trigeminal neuralgia. Oral Surg Oral Med Oral Pathol. 1992;74: 439-50.
28. Sato J, Saitoh T, Notani K, Fukuda H, Kaneyame K, Segami N. Diagnostic significance of carbamazepine and trigger zones in trigeminal neuralgia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 97: 18- 22.
29. Numikko TJ, Eldridge PR. Trigeminal neuralgia: pathophysiology. Diagnosis and current treatment. Br J Anaesth 2001; 87: 117-32.
30. Devor M, Amir R, Rappaport ZH. Pathophysiology of trigeminal neuralgia: the ignition hypothesis. Clin J Pain 2002; 18: 4-13.
31. Salim M, Kazi WA. Post herpetic neuralgia: use of streptomycin – a preliminary report. J Coll Physician Surg Pak. 1996; 6: 53-4.
32. Sokolovic M, Todorovic L, Stajcic Z, Petrovic V. Peripheral streptomycin/lidocaine injections in the treatment of idiopathic trigeminal neuralgia: a preliminary report. J Maxillofac Surg 1986; 14: 8-9.
33. Taha JM, Tew JM, Jr. Surgical treatment of trigeminal neuralgia. Crit Rev Neurosurg 1994; 4: 156-63.
34. Sokoll MD, Diecke FPJ. Some effects of streptomycin on frog nerve in vitro. Arch Int Pharmacodyn 1969; 177: 332-9.
35. Alkadhi KA, McIsaac RJ. Ganglion blocking effects of streptomycin. Arch Int Pharmacodyn 1978; 232: 58-67.
36. Kanpolat Y, Tatli M, Ugur HC, Kahilogullari G. Evaluation of platybasia in patients with idiopathic trigeminal neuralgia. Surg Neurol 2007; 67: 78-81.
37. Sohail A, Saeed M, Qazi SR. Efficacy of peripheral glycerol injection in the management of trigeminal neuralgia. Pak Oral Dent J 2006; 26: 93-6.
38. Khitab U, Khan M, Din RU, Wahid A, Rehman AU. Trigeminal neuralgia: a study on 242 patients. Pak Oral Dent J 2005; 25: 163-6.
39. Katusic S, Williams DB, Beard CM, Bergstralh EJ, Kurland LT. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences. Rochester, Minnesota 1945-1984. Neuroepidemiology 1991; 10: 276-81.
40. Zakrazewska JM. Patsalos PN. Long-term cohort study comparing medical (oxcarbazepine) and surgical management of intractable trigeminal neuralgia. Pain 2002; 95: 259-66.
41. Stajcic Z, Juniper RP, Todorovic L. Peripheral streptomycin/lidocaine injection vs lidocaine alone in the treatment of idiopathic trigeminal neuralgia: a double-blind controlled trial. J Craniomaxillofac Surg. 1990; 18: 243-6.
42. McLeod NM, Patton DW. Peripheral alcohol injections in the management of trigeminal neuralgia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104: 12-7.
43. Ankur G, Amit S, Aditi B, Anchal D, Sameer R, Ankit G. Analgesic Effects of Peripheral Injections of Streptomycin/Lignocaine In the treatment of Trigeminal Neuralgia-A Clinical Study. JARMS 2013; 5(2): 115-117.
44. Akhtar FM, ur Rehman MM, Ahmed M, Akmal M, Mushtaq S. Pain relief in neuropathic pain-a comparison between 0.5% bupivacaine and 0.5% bupivacaine streptomycin combination. PAFMJ 2016(2): 244-249.
45. Navez ML, Monella C, Bösl I, Sommer D, Delorme C. 5% lidocaine medicated plaster for the treatment of postherpetic neuralgia: a review of the clinical safety and tolerability. Pain Ther 2015; 4(1): 1-15.
46. Baron R, Mayoral V, Leijon G, Binder A, Steigerwald I, Serpell M. 5% lidocaine medicated plaster versus pregabalin in post-herpetic neuralgia and diabetic polyneuropathy: an open-label, non-inferiority two-stage RCT study. Curr Med Res Opin 2009; 25(7): 1663-1676.
47. Binder A, Bruxelle J, Rogers P, Hans G, Bösl I, Baron R. Topical 5% lidocaine (lignocaine) medicated plaster treatment for post-herpetic neuralgia. Clin Drug Investig 2009; 29(6): 393-408.
48. Abdel-Aziz S, Ghaleb A. Continuous Inferior Alveolar Nerve Block Using an Indwelling Catheter and Inferior Maxillary Artery Embolization for the Management of Atypical Trigeminal Neuralgia. Open J Anesthesiol 2013; 3(9): 375-378.
49. Sobouti F, Khatami M, Chiniforush N, Rakhshan V, Shariati M. Effect of singledose low-level helium-neon laser irradiation on orthodontic pain: a split-mouth singleblind placebo-controlled randomized clinical trial. Prog Orthod 2015; 16(1): 32.
50. Bendtsen L, Zakrzewska JM, Abbott J, et al.: European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019, 26:831-49.
51. Cruccu G, Gronseth G, Alksne J, et al.: AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008, 15:1013-28.
52. Moore D, Chong MS, Shetty A, Zakrzewska JM: A systematic review of rescue analgesic strategies in acute exacerbations of primary trigeminal neuralgia. Br J Anaesth. 2019, 123: e385-96.
53. Barker FG 2nd, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996, 334:1077-83.
54. Rubis A, Juodzbalys G: The use of botulinum toxin A in the management of trigeminal neuralgia: a systematic literature review. J Oral Maxillofac Res. 2020, 11: e2.
55. Zhang H, Lian Y, Xie N, Cheng X, Chen C, Xu H, Zheng Y: Factors affecting the therapeutic effect of botulinum toxin A on trigeminal neuralgia: a follow-up retrospective study of 152 patients. Exp Ther Med. 2019, 18:3375-82.
56. Yoshida K: Effects of Botulinum Toxin type A on pain among trigeminal neuralgia, myofascial temporomandibular disorders, and oromandibular dystonia. Toxins (Basel). 2021, 13:605.
57. Dinan JE, Smith A, Hawkins JM: Trigeminal neuralgia with extraoral trigger zone successfully treated with intraoral injections of botulinum toxin: a case report. Clin Neuropharmacol. 2020, 43:162-3
58. Branco R, Silva B G, Pereira A, et al. What Is New and Effective in Treating Refractory Trigeminal Neuralgia? Cureus. 2024;16(11): e73110.
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Sep 24, 2025
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Dr Devesh Tiwari, Dr Gaurav Kumar Saha, Dr Sreedatree Banerjee, & Dr Pawan Srivastava. (2025). STREPTOMYCIN AS A THERAPEUTIC OPTION IN REFRACTORY TRIGEMINAL NEURALGIA: A CASE SERIES . Journal of Population Therapeutics and Clinical Pharmacology, 32(7), 1645-1659. https://doi.org/10.53555/zn1fq754
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Author Biographies
Dr Devesh Tiwari
Professor, Department of Dentistry, Hind Institute of Medical Science, Sitapur, UP, India.
Dr Gaurav Kumar Saha
Associate Professor, Department of Dentistry, TSM Medical College, Lucknow, UP, India.
Dr Sreedatree Banerjee
Senior Resident, Department of Dentistry, Hind Institute of Medical Science, Sitapur, UP, India.
Dr Pawan Srivastava
Assistant Professor, Department of Dentistry, Era’s Medical College & Hospital, Lucknow, UP, India.
How to Cite
Dr Devesh Tiwari, Dr Gaurav Kumar Saha, Dr Sreedatree Banerjee, & Dr Pawan Srivastava. (2025). STREPTOMYCIN AS A THERAPEUTIC OPTION IN REFRACTORY TRIGEMINAL NEURALGIA: A CASE SERIES . Journal of Population Therapeutics and Clinical Pharmacology, 32(7), 1645-1659. https://doi.org/10.53555/zn1fq754