Management of Chronic Post-Endodontic Pain with a Standardized Gabapentin Pyramid Protocol: A Case Series and Clinical Guidelines.

Introduction: Persistent post-endodontic 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 post-endodontic pain and provide prescription guidelines using a standardized "Gabapentin Pyramid Protocol" for clinical practice.

Methods: Four cases of persistent post-endodontic pain are presented. A peripheral etiology for pain was eliminated in all four cases. All patients were also refractory to conventional analgesics. Patients received the "Gabapentin Pyramid Protocol".

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

Conclusion: The "Gabapentin Pyramid Protocol" represents an effective treatment option for persistent post-endodontic pain, demonstrating significant symptom relief and potential for complete resolution.