(TC23) Unlocking the Potential of Gabapentin in Endodontic Practice

Abstract: While endodontic therapy boasts high success rates for the resolution of apical periodontitis, persistent post-treatment pain >6 months ranges from 7 to 19% of patients (approximately 2 million patients annually) and can persist for years, sometimes over 5 years. Management of persistent pain often relies on the chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids, which accompany serious side effects with no real resolution of pain. Moreover, approximately 43% of patients with unresolved pain seek a variety of unwarranted supplementary prescription medications as well as additional health care treatments, leading to increased healthcare costs. In cases where endodontic pathology is ruled out, central sensitization (CS) is believed to be the underlying cause in 1.6% of all cases. Therefore, management of CS via the use of centrally-acting drugs is conceivable in endodontic practice. Gabaoids are one such class of centrally-acting analgesics. Specifically, gabapentin, an oral anti-epileptic agent with FDA approval for diabetic neuropathy, has not been evaluated for the treatment of persistent post-endodontic pain. In this table clinic, we will present the use of gabapentin in the management of two cases with persistent post-endodontic pain and refractory to commonly used analgesics. Additionally, we will present a guideline for prescribing gabapentin and discuss potential side effects for its safe use in clinical practice. Overall, this table clinic will demonstrate the clinical use of gabapentin as an adjunct for the management of persistent post-endodontic pain by targeting the neural plasticity caused by CS.