Patients who suffer from chronic ocular pain that doesn’t improve with traditional therapies may find symptom relief with neuropathic treatments, specifically gabapeninoid drugs, a study in Eye Contact Lens reports.

Researchers started eight patients on an oral gabapentinoid (gabapentin and/or pregabalin) as part of their pain regimen. Two individuals reported complete ocular pain relief with a gabapentinoid in conjunction with their topical and oral medication regimen. Of the patients who took gabapentin or pregabalin, three individuals had significant improvement, one reported slight improvement and two others had no improvement.

Investigators also performed periocular nerve blocks (4mL of 0.5% bupivacaine mixed with 1mL of 80mg/mL methylprednisolone acetate) that targeted the periocular nerves (supraorbital, supratrochlear, infratrochlear and infraorbital) in 11 individuals, 10 of whom had previously used a gabapentinoid without improvement. Following the nerve block, the study reported seven individuals experienced pain relief that lasted from hours to months, while four had no improvements. Investigators also noted five individuals who experienced pain relief underwent repeat nerve blocks weeks to months later.

“In some cases, individuals who had constant and severe pain for years were pain-free after treatment,” the researchers noted in their paper. “Once pain reduction or relief was achieved, it was sustained while on a gabapentinoid for up to three years, and with periorbital injections, for up to seven months.”

Although larger prospective studies are needed to validate the current investigation’s findings, the results support the idea that targeting nerve function may be therapeutic in individuals with chronic ocular pain, the researchers suggest. “Future studies are needed to expand the results and evaluate other approaches, such as duloxetine and tri-cyclic antidepressants, for the primary treatment of ocular pain,” they note in the study.

Small LR, Galor A, Felix, ER, et al. Oral gabapentinoids and nerve blocks for the treatment of chronic ocular pain. Eye Contact Lens. June 14, 2019. [Epub ahead of print].