De-Escalating the Pain Pathway: A Narrative Review on Homeopathic Approaches to Post-Endodontic Neuralgia

Author

Rutambhara Sahu, Neelam Tiwari, Tanay Vyas, Manhit Singh Lehl, Saloni


Abstract

Post-endodontic neuralgia is a term used in this review to describe pain that is not odontogenic in nature but persists following endodontic treatment. Such pain may overlap with post-traumatic trigeminal neuropathy, idiopathic dentoalveolar pain and post-endodontic pain. The aim of this narrative review is to explore the epidemiology, clinical features, diagnosis, complications and possible role of homoeopathy in the management of patients with post-endodontic neuralgia. A literature review was performed on PubMed, Google Scholar, dental literature, Indian endodontic studies, the Journal of Integrated Standardized Homoeopathy, the Indian Journal of Research in Homoeopathy and classical homoeopathic texts. Continuing tooth pain after endodontic treatment is not rare, with systematic reviews showing that the prevalence of continuing tooth pain is around 5.3%. Non-odontogenic pain is a minority of the cases of continuing tooth pain. Indian clinical studies also show that post-obturation pain is a common problem following endodontic treatment. The diagnosis of post-endodontic neuralgia requires the exclusion of other causes of pain, such as missed canals, periapical disease, vertical root fracture, periodontal disease and referred pain from the orofacial region. Homoeopathy treats the individual patient according to their individualisation, causation, pain character, modalities, concomitants, mental state and general constitution. Medicines such as Hypericum perforatum, Arnica montana, Chamomilla, Magnesia phosphorica, Spigelia anthelmia, Kalmia latifolia, Mezereum, Staphysagria and Causticum may be considered for the treatment of post-endodontic neuralgia only if the symptoms of the patient correspond to the totality of the symptoms of the medicine. There is no direct evidence for the use of homoeopathy in the treatment of post-endodontic neuralgia but there is indirect evidence from studies of patients with trigeminal neuralgia, post-herpetic neuralgia, post-extraction pain and postoperative pain. Therefore, homoeopathy may be explored as an treatment of patients with post-endodontic neuralgia but should not replace dental, endodontic, neurological or pain-specialist care.


Keywords

Post-endodontic neuralgia; post-endodontic pain; persistent dentoalveolar pain; homoeopathy; neuropathic pain



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