Management of Persistent Post-Endodontic Pain With a Standardized Gabapentin Pyramid Protocol: A Case Series and Clinical Guidelines

Abstract

Introduction

Persistent postendodontic pain following endodontic therapy is a rare but substantial clinical challenge. Mechanisms that mediate peripheral neuropathy and/or central sensitization likely play a pivotal role in its development and chronification. The objective of this case series is to describe a management plan for persistent postendodontic pain and provide prescription guidelines using a standardized “Gabapentin Pyramid Protocol” for clinical practice.

Methods

Four cases of persistent postendodontic pain are presented. A peripheral etiology for pain was eliminated in all 4 cases. All patients were also refractory to conventional analgesics. Patients received the “Gabapentin Pyramid Protocol.”

Results

Three of the 4 cases experienced complete resolution of symptoms within the prescribed treatment period. In 1 case, symptoms were greatly reduced but recurred upon discontinuation of the drug.

Conclusions

The “Gabapentin Pyramid Protocol” represents an effective treatment option for persistent postendodontic pain, demonstrating significant symptom relief and potential for complete resolution.