Trigeminal neuralgia is a severe,disabling pain and its deafferentation remains a challenge for health providers.Transcranial direct current stimulation is a non-invasive stimulation technique which finds new utility ...Trigeminal neuralgia is a severe,disabling pain and its deafferentation remains a challenge for health providers.Transcranial direct current stimulation is a non-invasive stimulation technique which finds new utility in managing pain.There-fore,the introduction of alternative,non-invasive,safe,and effective methods should be considered in treating patients with trigeminal neuralgia unresponsive to conventional treatment.展开更多
OBJECTIVE To investigate whether electroacupuncture(EA)ameliorates abnormal trigeminal neuralgia(TN)orofacial pain and anxiety-like behavior by altering synaptic plasticity in the hippocampus CA1.METHODS A mouse infra...OBJECTIVE To investigate whether electroacupuncture(EA)ameliorates abnormal trigeminal neuralgia(TN)orofacial pain and anxiety-like behavior by altering synaptic plasticity in the hippocampus CA1.METHODS A mouse infraorbital nerve transection model(pTION)of neuropathic pain was established,and EA or sham EA was used to treat ipsilateral acu⁃puncture points(GV20-Baihui and ST7-Xia⁃guan).Golgi-Cox staining and transmission elec⁃tron microscopy(TEM)were administrated to observe the changes of synaptic plasticity in the hippocampus CA1.RESULTS Stable and persistent orofacial allodynia and anxiety-like behav⁃iors induced by pT-ION were related to changes in hippocampal synaptic plasticity.Golgi stain⁃ings showed a decrease in the density of dendritic spines,especially mushroom-type dendritic spines,in hippocampal CA1 neurons of pT-ION mice.TEM results showed that the density of synapses,membrane thickness of the postsynaptic density,and length of the synaptic active zone were decreased,whereas the width of the synaptic cleft was increased in pTION mice.EA attenu⁃ated pT-ION-induced orofacial allodynia and anx⁃iety-like behaviors and effectively reversed the abnormal changes in dendritic spines and syn⁃apse of the hippocampal CA1 region.CONCLU⁃SION EA modulates synaptic plasticity of hippo⁃campal CA1 neurons,and reduces abnormal oro⁃facial pain and anxiety-like behavior,providing evidence for a TN treatment strategy.展开更多
OBJECTIVE To assess the effi⁃cacy and safety of acupuncture-related treat⁃ments for postherpetic neuralgia(PHN),identify the most effective acupuncture and related treat⁃ments.METHODS PubMed,Cochrane Central Register ...OBJECTIVE To assess the effi⁃cacy and safety of acupuncture-related treat⁃ments for postherpetic neuralgia(PHN),identify the most effective acupuncture and related treat⁃ments.METHODS PubMed,Cochrane Central Register of Controlled Trials,Embase,Web of Science,and four Chinese databases,a clinical research registration platform,and grey literature were searched.We evaluated the risk of bias and quality in the included studies and per⁃formed a Bayesian multiple network meta-analysis.RESULTS We included 29 randomized controlled trials comprising 1973 patients,of which approximately 17.24%showed a high risk of bias.According to the Jadad scale,2,16,and 11 studies were high,medium,and low quality,respectively.The pairwise meta-analysis results revealed that the efficacy of all acupuncture-related treatments for pain relief related to PHN showed the difference was statistically significant com⁃pared with that of antiepileptics.The network meta-analysis results showed that pricking and cupping plus antiepileptics were the most effective,followed by electroacupuncture(EA)plus antiepileptics for pain relief in patients with PHN.EA plus antiepileptics ranked the best regarding reduced Pittsburgh Sleep Quality Index and Self-Rating Depression Scale scores in patients with PHN.No results were found regarding total response rate or quality of life among this study.Acupuncture-related treatments showed a lower incidence of adverse events than that of antiepi⁃leptics-related treatments.CONCLUSION Acu⁃puncture-related therapies may be potential treat⁃ment options for PHN and are relatively safe.Pricking and cupping plus antiepileptics are the most effective techniques for pain relief.EA plus antiepileptics is the best approach for improving insomnia and depression symptoms of PHN.展开更多
BACKGROUND Most of the first symptoms of avian influenza are respiratory symptoms,and cases with occipital neuralgia as the first manifestation are rarely reported.CASE SUMMARY A middle-aged patient complaining of par...BACKGROUND Most of the first symptoms of avian influenza are respiratory symptoms,and cases with occipital neuralgia as the first manifestation are rarely reported.CASE SUMMARY A middle-aged patient complaining of paroxysmal pain behind the ear was admitted to our hospital.The patient’s condition changed rapidly,and high fever,unexpected respiratory failure,and multiple organ failure developed rapidly.The patient was diagnosed with H7N9 avian influenza based on etiology.CONCLUSION We believe that the etiology of occipital neuralgia is complex and could be the earliest manifestation of severe diseases.The possibility of an infectious disease should be considered when occipital neuralgia is accompanied by fever.Avian influenza is one of these causative agents.展开更多
BACKGROUND Postherpetic neuralgia(PHN)is a typical neuropathic pain condition that appears in the lesioned skin regions following the healing of shingles.The pain condition tends to persist,which is often accompanied ...BACKGROUND Postherpetic neuralgia(PHN)is a typical neuropathic pain condition that appears in the lesioned skin regions following the healing of shingles.The pain condition tends to persist,which is often accompanied by negative emotions(e.g.,anxiety and depression)and substantially reduces the quality of life.In addition to analgesia(e.g.,pregabalin and gabapentin),nerve radiofrequency technology is an effective treatment for intractable PHN.However,there is still a significant portion of patients who do not benefit from this treatment.As a non-invasive form of brain stimulation,repetitive transcranial magnetic stimulation(rTMS)targeting the motor cortex is able to reduce neuropathic pain with grade A evidence.CASE SUMMARY Here we report two cases in which motor cortex rTMS was used to treat intractable PHN that did not respond to initial drug and radiofrequency therapies.Moreover,we specifically investigated rTMS efficacy at 3 mo following treatment.CONCLUSION Motor cortex rTMS can treat intractable PHN that did not respond to initial drug and radiofrequency therapies.展开更多
BACKGROUND Postherpetic neuralgia(PHN)is the most frequent and a difficult-to-treat complication of herpes zoster(HZ).Its symptoms include allodynia,hyperalgesia,burning,and an electric shock-like sensation stemming f...BACKGROUND Postherpetic neuralgia(PHN)is the most frequent and a difficult-to-treat complication of herpes zoster(HZ).Its symptoms include allodynia,hyperalgesia,burning,and an electric shock-like sensation stemming from the hyperexcitability of damaged neurons and varicella-zoster virus-mediated inflammatory tissue damage.HZ-related PHN has an incidence of 5%–30%,and in some patients,the pain is intolerable and can lead to insomnia or depression.In many cases,the pain is resistant to pain-relieving drugs,necessitating radical therapy.CASE SUMMARY We present the case of a patient with PHN whose pain was not cured by conventional treatments,such as analgesics,block injections,or Chinese medicines,but by bone marrow aspirate concentrate(BMAC)injection containing bone marrow mesenchymal stem cells.BMAC has already been used for joint pains.However,this is the first report on its use for PHN treatment.CONCLUSION This report reveals that bone marrow extract can be a radical therapy for PHN.展开更多
BACKGROUND Intractable postherpetic neuralgia(PHN)can be difficult to manage even with aggressive multimodal therapies.Patients who experience uncontrolled refractory cranial PHN despite conservative treatment may ben...BACKGROUND Intractable postherpetic neuralgia(PHN)can be difficult to manage even with aggressive multimodal therapies.Patients who experience uncontrolled refractory cranial PHN despite conservative treatment may benefit from an intrathecal drug delivery system(IDDS).For craniofacial neuropathic pain,the traditional approach has been to place the intrathecal catheter tip below the level of the cranial nerve root entry zones,which may lead to insufficient analgesia.CASE SUMMARY We describe a 69-year-old man with a 1-year history of PHN after developing a vesicular rash in the ophthalmic division of cranial nerve V(trigeminal nerve)distribution.The pain was rated 7-8 at rest and 9-10 at breakthrough pain(BTP)on a numeric rating scale.Despite receiving aggressive multimodal therapies including large doses of oral analgesics(gabapentin 150 mg q12 h,oxycodone 5 mg/acetaminophen 325 mg q6 h,and lidocaine 5%patch 700 mg q12 h)and sphenopalatine ganglion block,there was no relief of pain.Subsequently,the patient elected to have an implantable IDDS with the catheter tip placed at the interpeduncular cistern.The frequency of BTP episodes decreased.The patient’s continuous daily dose was adjusted to 0.032 mg/d after 3 mo of follow-up and stopped 5 mo later.He did not report pain or other discomfort at outpatient follow-up 6 mo and 1 year after stopping intracisternal hydromorphone.CONCLUSION The use of interpeduncular cistern intrathecal infusion with low-dose hydromorphone by IDDS may be effective for severe craniofacial PHN.展开更多
Radiofrequency thermocoagulation(RFT) of the gasserian ganglion is a routine and effective technique for the treatment of classical trigeminal neuralgia(CTN).In this study we compared its efficacy in patients with CTN...Radiofrequency thermocoagulation(RFT) of the gasserian ganglion is a routine and effective technique for the treatment of classical trigeminal neuralgia(CTN).In this study we compared its efficacy in patients with CTN and atypically symptomatic or mixed trigeminal neuralgia(MTN).Fifty-seven patients were treated with RFT for trigeminal neuralgia from June 2006 to February 2009.Thirty patients had CTN,and 27 had MTN.Outcomes were measured by using the visual analog pain scale(VAS) and patients' reports of quality of life(QOL),medication usage,and complications over a follow-up period of up to 3 years.Our results showed that the patients with MTN were younger,tended to have bilaterial involvement of the first division,and were unresponsive to treatment.All surgeries were completed smoothly.About 86.7% CTN patients and 48.1% MTN patients responded immediately to RFT.The VAS scores were significantly higher in the CTN group than in MTN group(P<0.05).Kaplan-Meier curves showed that 1-year,2-year,and 3-year pain relief rates were 76.7%,73.3%,and 73.3% in the CTN group and 46.6%,41.4%,and 41.4% in the MTN group,respectively.The rates of pain relief for both groups leveled off at 2 years.Complications included numbness,dysesthesia,and anesthesia dolorosa.RFT did not cause any deaths and complications were low.The treatment was very effective for CTN and,to some degrees,effective for MTN.If numbness,dysesthesia,and anesthesia dolorosa are limited to the trigger area,QOL will be greatly improved.展开更多
Objective:To describe the anatomical characteristics and patterns of neurovascular compression (NVC) in patients suffering trigeminal neuralgia(TN) by 3D high-resolution magnetic resonance imaging(MRI) method and imag...Objective:To describe the anatomical characteristics and patterns of neurovascular compression (NVC) in patients suffering trigeminal neuralgia(TN) by 3D high-resolution magnetic resonance imaging(MRI) method and image fusion technique.Methods:The anatomic structure of trigeminal nerve,brain stem and blood vessel was observed in 100 consecutive TN patients by 3D high resolution MRI(3D SPGR,contrast-enhanced T1 3D MP-RAGE and T2/T1 3D FIESTA). The 3D image sources were fused and visualized using 3D DOCTOR software.Results:One or several NVC sites,which usually appeared 0-9.8 mm away from brain stem,were found on the symptomatic side in 93%of the TN cases.Superior cerebellar artery was involved in 76%(71/93) of these cases.The other vessels including antero-inferior cerebellar artery,vertebral artery, basilar artery and veins also contributed to the occurrence of NVC.The NVC sites were found to be located in the proximal segment in 42%of these cases(39/93) and in the distal segment in 45% (42/93).Nerve dislocation or distortion was observed in 32%(30/93).Conclusions:Various 3D high resolution MRI methods combined with the image fusion technique could provide pathologic anatomic information for the diagnosis and treatment of TN.展开更多
To evaluate the effect of triple puncture on primary trigeminal neuralgia (pTN),64 patients with pTN were randomly assigned to two groups:treatment group and control group.The participants in the treatment group recei...To evaluate the effect of triple puncture on primary trigeminal neuralgia (pTN),64 patients with pTN were randomly assigned to two groups:treatment group and control group.The participants in the treatment group received triple puncture treatment of 6 times per week for 4 weeks,and those in control group were given carbamazepine (300-600 mg per day) for at least 1 month.Before and after treatment,the primary outcomes including the total efficiency rate and the VAS pain scores,and the secondary outcomes including the frequency of pain attack and adverse events were observed.Sixty-two participants finished the study (33 in treatment group and 29 in control group individually).After treatment,the symptoms (mainly pain) of the two groups were alleviated.The total efficiency rate in the treatment group and control group was 90.9% and 75.9% respectively.The VAS pain scores and frequency of pain attack were significantly reduced in the treatment group as compared with the control group (P<0.05).The incidence of adverse events in the treatment group and control group was 9.1% and 24.1% respectively.It can be inferred that triple puncture can effectively improve the quality of life of patients with pTN and has less side effects.展开更多
BACKGROUND Primary trigeminal neuralgia can achieve satisfactory results through clinical treatment and intervention.The pathogenesis of neuralgia caused by varicellazoster virus infection of the trigeminal nerve is m...BACKGROUND Primary trigeminal neuralgia can achieve satisfactory results through clinical treatment and intervention.The pathogenesis of neuralgia caused by varicellazoster virus infection of the trigeminal nerve is more complex,and it is still difficult to relieve the pain in some patients simply by drug treatment or surgical intervention.CASE SUMMARY A 66-year-old woman was hospitalized with herpetic neuralgia after herpes zoster ophthalmicus(varicella-zoster virus infects the ophthalmic branch of the trigeminal nerve).On admission,the patient showed spontaneous,electric shocklike and acupuncture-like severe pain in the left frontal parietal region,and pain could be induced by touching the herpes area.The numerical rating scale(NRS)was 9.There was no significant pain relief after pulsed radiofrequency and thermocoagulation of the ophthalmic branch of the trigeminal nerve.Combined with patient-controlled intravenous analgesia(PCIA)with esketamine,neuralgia was significantly improved.The patient had no spontaneous pain or allodynia at discharge,and the NRS score decreased to 2 points.The results of follow-up 2 mo after discharge showed that the NRS score was≤3,and the Pittsburgh Sleep Quality Index score was 5 points.There were no adverse reactions.CONCLUSION Trigeminal extracranial thermocoagulation combined with esketamine PCIA may be a feasible method for the treatment of refractory herpetic neuralgia after herpes zoster ophthalmicus.展开更多
In the present paper, 45 cases of acute trigemina] neuralgia were treated and observed by comparative method. Results showed no significant difference in transient analgesic effect (P】 0.05) but a significant differe...In the present paper, 45 cases of acute trigemina] neuralgia were treated and observed by comparative method. Results showed no significant difference in transient analgesic effect (P】 0.05) but a significant difference in therapeutic effect (P【 0.01) between the treatment and control groups. This indicates that blood-letting puncture with cupping is an effective therapy for the disease.展开更多
Objective: To investigate the successful rate and accuracy of percutaneous radiofrequency thermocoagulation (PRT) for treatment of primary trigeminal neuralgia (PTN) with customized navigated template via three dimens...Objective: To investigate the successful rate and accuracy of percutaneous radiofrequency thermocoagulation (PRT) for treatment of primary trigeminal neuralgia (PTN) with customized navigated template via three dimensional (3D) printing technique. Methods: 65 patients with PTN were recruited from January 2014 to March 2015 and randomly divided into two groups: template group (n = 28) and traditional group (n = 37). The patients in traditional group received PRT under guidance of C-arm fluoroscopy, while the ones in template group were treated with customized navigated templates. The data of time, depth and accuracy rate of puncture, the average effective dose equivalent of radiation, complications after operation were collected and analyzed. Results: No intra-operative failures occurred in the template group: the pain was alleviated immediately after operation. Accuracy rate of the template group was 100% while 96% was achieved in traditional group. However, the average time of puncture by the template was significantly reduced compared with traditional group (2.37 ± 0.64 minutes and 24.2 ± 6.55 minutes, respectively;P 0.05). No complications were observed in template group while several complications such as blooding, leakage of cerebrospinal fluid and dizziness were observed in traditional group. Conclusion: The application of customized template is advocated for improving the accuracy of PRT.展开更多
BACKGROUND Trigeminal neuralgia(TN) is a severe type of neuropathic pain which is often inadequately managed using conventional therapies. In this report, we present the first case of TN treated with gasserian ganglio...BACKGROUND Trigeminal neuralgia(TN) is a severe type of neuropathic pain which is often inadequately managed using conventional therapies. In this report, we present the first case of TN treated with gasserian ganglion nerve coblation(NC).CASE SUMMARY A 58-year-old man presented with right facial pain, mostly localized in the right zygomatic zone, alveolar region, and jaws. Similar to acupuncture and shock pain, the pain lasted about five seconds after each attack before resolving unaided. A diagnosis of TN was made, after which treatment with acupuncture therapy and oral carbamazepine was given. However, the pain was not satisfactorily controlled. Subsequently, gasserian ganglion NC of the right trigeminal nerve guided by computed tomography(CT) was performed on the patient. Following this procedure, the right zygomatic, alveolar, submandibular,and cheek pain disappeared completely. The right zygomatic and alveolar areas experienced mild numbness(level II). At 1-, 2-, 3-, and 6-mo follow-ups after surgery, the patient was painless and the numbness score was level I.CONCLUSION CT-guided gasserian ganglion(NC) is an effective treatment for TN and is associated with less or no postoperative numbness or hypoesthesia in comparison with current standard-of-care approaches.展开更多
BACKGROUND Although few studies have reported hyponatremia due to carbamazepine or oxcarbazepine in patients with epilepsy,no study has investigated cases of carbamazepine-or oxcarbazepine-induced hyponatremia or unst...BACKGROUND Although few studies have reported hyponatremia due to carbamazepine or oxcarbazepine in patients with epilepsy,no study has investigated cases of carbamazepine-or oxcarbazepine-induced hyponatremia or unsteady gait in patients with neuropathic pain.Herein,we report a case of oxcarbazepineinduced lower leg weakness in a patient with trigeminal neuralgia and summarize the diagnosis,treatment,and changes of clinical symptoms.CASE SUMMARY A 78-year-old male with a history of lumbar spinal stenosis was admitted to the hospital after he experienced lancinating pain around his right cheek,eyes,and lip,and was diagnosed with trigeminal neuralgia at the right maxillary and mandibular branch.He was prescribed oxcarbazepine(600 mg/d),milnacipran(25 mg/d),and oxycodone/naloxone(20 mg/10 mg/d)for four years.Four years later,the patient experienced symptoms associated with spinal stenosis,including pain in the lower extremities and unsteady gait.His serum sodium level was 127 mmol/L.Assuming oxcarbazepine to be the cause of the hyponatremia,oxcarbazepine administration was put on hold and the patient was switched to topiramate.At subsequent visit,the patient’s serum sodium level had normalized to 143 mmol/L and his unsteady gait had improved.CONCLUSION Oxcarbazepine-induced hyponatremia may cause lower extremity weakness and unsteady gait,which should be differentiated from those caused by spinal stenosis.展开更多
Twenty-five cases of Primary trigeminal neuralgia were treated satisfactorily by acupuncture at Xiaguan (St 7) through to the sphenopalatine ganglion, which is an important vegetative ganglion in the head.
Background: Trigeminal neuralgia is a chronic pain syndrome characterized by paroxysmal, shock-like, stabbing, recurrent episodes of pain localized in the distribution area of one or more branches of the trigeminal ne...Background: Trigeminal neuralgia is a chronic pain syndrome characterized by paroxysmal, shock-like, stabbing, recurrent episodes of pain localized in the distribution area of one or more branches of the trigeminal nerve. The Initial approach for treating trigeminal neuralgia consists of pharmacological therapy. Many patients experience initial pain relief with pharmacological therapy;however, most of those patients eventually undergo surgery. Patients and Methods: In this descriptive prospective study, we evaluate the efficiency and safety of percutaneous balloon compression (PBC) and percutaneous radiofrequency ablation (RFA) in treating patients with typical idiopathic trigeminal neuralgia. This study includes 21 patients (divided into two groups, PBC = 15 patients and RFA = six patients) who met our inclusion and exclusion criteria, from May 2018 to April 2019, with a follow-up period of six months. Results: At one month postoperative follow-up, all patients in both groups were pain-free. At six months postoperative follow-up, in group 1 (PBC), 14 (95.24%) patients were pain-free, while in group 2 (RFA) all patients remained pain-free. The most common encountered postoperative complications are masticatory muscles weakness (Four patients in PBC group, and one patient in RFA group) and facial hypothesia (12 patients in PBC group and four patients in RFA group). Conclusions: In our study, patients with trigeminal neuralgia were not controlled by drug treatment, but percutaneous balloon compression and percutaneous radiofrequency ablation proved to be very effective treatment options, with no major complications.展开更多
Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or th...Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves;to review outcomes including duration and degree of pain relief;to evaluate procedure’s complication rate and patient’s willingness to repeat the procedure;to compare effectiveness of the most recent RF ablation to patient’s first RF ablation. Methods: This is a single-center retrospective observational study of 23 patients with recurrent cervicogenic headaches and/or occipital neuralgia treated with repeated RF ablation of the C2 dorsal root ganglion and/or third occipital nerves. All patients receiving treatment from January 2010 to July 2014 are included in this single site retrospective study. This is an IRB approved medical chart review study. Results: 22 of 23 patients underwent follow-up. An average of 86.5% of participants reported pain relief on average of 25.4 weeks at time of follow-up. 41% reported side effects including suboccipital hyperesthesia and/or ear discomfort, 95% reported willingness to repeat the procedure again if severe symptoms recurred, 59% of patients reported the most recent RF ablation had the same results as the first, 32% reported the most recent RF was the most effective, and 9% reported that the first RF was the most effective. Conclusion: Repeated RF ablation is a feasible option for recurrent cervicogenic headaches and/or occipital neuralgia. Effectiveness of repeat intervention is the same or better than the first ablation. Though there was a higher likelihood of side effects including suboccipital neuralgia and/or ear discomfort on repeat treatment, the side effects were generally well tolerated.展开更多
Objective:To evaluate the clinical effects of bloodletting cupping therapy(BCT)for patients with postherpetic neuralgia.Methods:We comprehensively searched four Chinese databases(Wanfang,China National Knowledge Infra...Objective:To evaluate the clinical effects of bloodletting cupping therapy(BCT)for patients with postherpetic neuralgia.Methods:We comprehensively searched four Chinese databases(Wanfang,China National Knowledge Infrastructure,VIP Database for Chinese Technical Periodicals,China Biology Medicine disc)and foreign databases(Pubmed,Cochrane Library).The retrieval time was from the build-up time to May 2018.RevMan 5.3 software was used for statistical analysis.Results:We finally obtained 18 eligible studies.Compared with routine western medicine,BCT can significantly improve PHN(OR=7.45,95%CI,3.36-16.51,Z=4.95,P<0.01).BCT plus other methods of acupuncture with fire needle and filiform needle has significant therapeutic effect(OR=5.54,95%CI,3.01-10.19,P<0.01),BCT plus routine western medicine has significant therapeutic effect(OR=4.99,95%CI,2.73-9.11,P<0.00001).Conclusion:It showed that the therapeutic effects of BCT,BCT plus other acupuncture methods with fire needle and filiform needle,and BCT combined with western medicine are better than those treated with single western medicine.It is effective to treat postherpetic neuralgia with Bloodletting Cupping Therapy.展开更多
文摘Trigeminal neuralgia is a severe,disabling pain and its deafferentation remains a challenge for health providers.Transcranial direct current stimulation is a non-invasive stimulation technique which finds new utility in managing pain.There-fore,the introduction of alternative,non-invasive,safe,and effective methods should be considered in treating patients with trigeminal neuralgia unresponsive to conventional treatment.
基金the National Natural Science Foundation of China(82001190)Natural Sci⁃ence Foundation of Shandong Province(ZR2021LZY016)+1 种基金Natural Science Foundation of Shandong Province(ZR2020MH348)Science and Technology Foundation of Shandong Traditional Chinese Medicine(2020Q035)。
文摘OBJECTIVE To investigate whether electroacupuncture(EA)ameliorates abnormal trigeminal neuralgia(TN)orofacial pain and anxiety-like behavior by altering synaptic plasticity in the hippocampus CA1.METHODS A mouse infraorbital nerve transection model(pTION)of neuropathic pain was established,and EA or sham EA was used to treat ipsilateral acu⁃puncture points(GV20-Baihui and ST7-Xia⁃guan).Golgi-Cox staining and transmission elec⁃tron microscopy(TEM)were administrated to observe the changes of synaptic plasticity in the hippocampus CA1.RESULTS Stable and persistent orofacial allodynia and anxiety-like behav⁃iors induced by pT-ION were related to changes in hippocampal synaptic plasticity.Golgi stain⁃ings showed a decrease in the density of dendritic spines,especially mushroom-type dendritic spines,in hippocampal CA1 neurons of pT-ION mice.TEM results showed that the density of synapses,membrane thickness of the postsynaptic density,and length of the synaptic active zone were decreased,whereas the width of the synaptic cleft was increased in pTION mice.EA attenu⁃ated pT-ION-induced orofacial allodynia and anx⁃iety-like behaviors and effectively reversed the abnormal changes in dendritic spines and syn⁃apse of the hippocampal CA1 region.CONCLU⁃SION EA modulates synaptic plasticity of hippo⁃campal CA1 neurons,and reduces abnormal oro⁃facial pain and anxiety-like behavior,providing evidence for a TN treatment strategy.
基金National Key Research and Development plan for the Modernization of Traditional Chinese Medicine (2018YFC1707700)National Key Research and Development plan for the Modernization of Traditional Chinese Medicine (2018YFC1707706)National Administration of Traditional Chinese Medicine Evidencebased Capacity Building Project (2019XZZXZJ005)
文摘OBJECTIVE To assess the effi⁃cacy and safety of acupuncture-related treat⁃ments for postherpetic neuralgia(PHN),identify the most effective acupuncture and related treat⁃ments.METHODS PubMed,Cochrane Central Register of Controlled Trials,Embase,Web of Science,and four Chinese databases,a clinical research registration platform,and grey literature were searched.We evaluated the risk of bias and quality in the included studies and per⁃formed a Bayesian multiple network meta-analysis.RESULTS We included 29 randomized controlled trials comprising 1973 patients,of which approximately 17.24%showed a high risk of bias.According to the Jadad scale,2,16,and 11 studies were high,medium,and low quality,respectively.The pairwise meta-analysis results revealed that the efficacy of all acupuncture-related treatments for pain relief related to PHN showed the difference was statistically significant com⁃pared with that of antiepileptics.The network meta-analysis results showed that pricking and cupping plus antiepileptics were the most effective,followed by electroacupuncture(EA)plus antiepileptics for pain relief in patients with PHN.EA plus antiepileptics ranked the best regarding reduced Pittsburgh Sleep Quality Index and Self-Rating Depression Scale scores in patients with PHN.No results were found regarding total response rate or quality of life among this study.Acupuncture-related treatments showed a lower incidence of adverse events than that of antiepi⁃leptics-related treatments.CONCLUSION Acu⁃puncture-related therapies may be potential treat⁃ment options for PHN and are relatively safe.Pricking and cupping plus antiepileptics are the most effective techniques for pain relief.EA plus antiepileptics is the best approach for improving insomnia and depression symptoms of PHN.
文摘BACKGROUND Most of the first symptoms of avian influenza are respiratory symptoms,and cases with occipital neuralgia as the first manifestation are rarely reported.CASE SUMMARY A middle-aged patient complaining of paroxysmal pain behind the ear was admitted to our hospital.The patient’s condition changed rapidly,and high fever,unexpected respiratory failure,and multiple organ failure developed rapidly.The patient was diagnosed with H7N9 avian influenza based on etiology.CONCLUSION We believe that the etiology of occipital neuralgia is complex and could be the earliest manifestation of severe diseases.The possibility of an infectious disease should be considered when occipital neuralgia is accompanied by fever.Avian influenza is one of these causative agents.
文摘BACKGROUND Postherpetic neuralgia(PHN)is a typical neuropathic pain condition that appears in the lesioned skin regions following the healing of shingles.The pain condition tends to persist,which is often accompanied by negative emotions(e.g.,anxiety and depression)and substantially reduces the quality of life.In addition to analgesia(e.g.,pregabalin and gabapentin),nerve radiofrequency technology is an effective treatment for intractable PHN.However,there is still a significant portion of patients who do not benefit from this treatment.As a non-invasive form of brain stimulation,repetitive transcranial magnetic stimulation(rTMS)targeting the motor cortex is able to reduce neuropathic pain with grade A evidence.CASE SUMMARY Here we report two cases in which motor cortex rTMS was used to treat intractable PHN that did not respond to initial drug and radiofrequency therapies.Moreover,we specifically investigated rTMS efficacy at 3 mo following treatment.CONCLUSION Motor cortex rTMS can treat intractable PHN that did not respond to initial drug and radiofrequency therapies.
文摘BACKGROUND Postherpetic neuralgia(PHN)is the most frequent and a difficult-to-treat complication of herpes zoster(HZ).Its symptoms include allodynia,hyperalgesia,burning,and an electric shock-like sensation stemming from the hyperexcitability of damaged neurons and varicella-zoster virus-mediated inflammatory tissue damage.HZ-related PHN has an incidence of 5%–30%,and in some patients,the pain is intolerable and can lead to insomnia or depression.In many cases,the pain is resistant to pain-relieving drugs,necessitating radical therapy.CASE SUMMARY We present the case of a patient with PHN whose pain was not cured by conventional treatments,such as analgesics,block injections,or Chinese medicines,but by bone marrow aspirate concentrate(BMAC)injection containing bone marrow mesenchymal stem cells.BMAC has already been used for joint pains.However,this is the first report on its use for PHN treatment.CONCLUSION This report reveals that bone marrow extract can be a radical therapy for PHN.
基金Supported by National Natural Science Foundation of China,No.81891004Tianjin Natural Science Foundation of China,No.21JCQNJC01140.
文摘BACKGROUND Intractable postherpetic neuralgia(PHN)can be difficult to manage even with aggressive multimodal therapies.Patients who experience uncontrolled refractory cranial PHN despite conservative treatment may benefit from an intrathecal drug delivery system(IDDS).For craniofacial neuropathic pain,the traditional approach has been to place the intrathecal catheter tip below the level of the cranial nerve root entry zones,which may lead to insufficient analgesia.CASE SUMMARY We describe a 69-year-old man with a 1-year history of PHN after developing a vesicular rash in the ophthalmic division of cranial nerve V(trigeminal nerve)distribution.The pain was rated 7-8 at rest and 9-10 at breakthrough pain(BTP)on a numeric rating scale.Despite receiving aggressive multimodal therapies including large doses of oral analgesics(gabapentin 150 mg q12 h,oxycodone 5 mg/acetaminophen 325 mg q6 h,and lidocaine 5%patch 700 mg q12 h)and sphenopalatine ganglion block,there was no relief of pain.Subsequently,the patient elected to have an implantable IDDS with the catheter tip placed at the interpeduncular cistern.The frequency of BTP episodes decreased.The patient’s continuous daily dose was adjusted to 0.032 mg/d after 3 mo of follow-up and stopped 5 mo later.He did not report pain or other discomfort at outpatient follow-up 6 mo and 1 year after stopping intracisternal hydromorphone.CONCLUSION The use of interpeduncular cistern intrathecal infusion with low-dose hydromorphone by IDDS may be effective for severe craniofacial PHN.
基金supported by a grant from the Beijing Municipal Project of Science and Technology (No.Y0204003040631)
文摘Radiofrequency thermocoagulation(RFT) of the gasserian ganglion is a routine and effective technique for the treatment of classical trigeminal neuralgia(CTN).In this study we compared its efficacy in patients with CTN and atypically symptomatic or mixed trigeminal neuralgia(MTN).Fifty-seven patients were treated with RFT for trigeminal neuralgia from June 2006 to February 2009.Thirty patients had CTN,and 27 had MTN.Outcomes were measured by using the visual analog pain scale(VAS) and patients' reports of quality of life(QOL),medication usage,and complications over a follow-up period of up to 3 years.Our results showed that the patients with MTN were younger,tended to have bilaterial involvement of the first division,and were unresponsive to treatment.All surgeries were completed smoothly.About 86.7% CTN patients and 48.1% MTN patients responded immediately to RFT.The VAS scores were significantly higher in the CTN group than in MTN group(P<0.05).Kaplan-Meier curves showed that 1-year,2-year,and 3-year pain relief rates were 76.7%,73.3%,and 73.3% in the CTN group and 46.6%,41.4%,and 41.4% in the MTN group,respectively.The rates of pain relief for both groups leveled off at 2 years.Complications included numbness,dysesthesia,and anesthesia dolorosa.RFT did not cause any deaths and complications were low.The treatment was very effective for CTN and,to some degrees,effective for MTN.If numbness,dysesthesia,and anesthesia dolorosa are limited to the trigger area,QOL will be greatly improved.
基金Supported by the Science Foundation of Haikou Health Bureau (grant No.2010-SWY-13-058)Haikou Science Technology Information Bureau (grant No.2009-049-1)
文摘Objective:To describe the anatomical characteristics and patterns of neurovascular compression (NVC) in patients suffering trigeminal neuralgia(TN) by 3D high-resolution magnetic resonance imaging(MRI) method and image fusion technique.Methods:The anatomic structure of trigeminal nerve,brain stem and blood vessel was observed in 100 consecutive TN patients by 3D high resolution MRI(3D SPGR,contrast-enhanced T1 3D MP-RAGE and T2/T1 3D FIESTA). The 3D image sources were fused and visualized using 3D DOCTOR software.Results:One or several NVC sites,which usually appeared 0-9.8 mm away from brain stem,were found on the symptomatic side in 93%of the TN cases.Superior cerebellar artery was involved in 76%(71/93) of these cases.The other vessels including antero-inferior cerebellar artery,vertebral artery, basilar artery and veins also contributed to the occurrence of NVC.The NVC sites were found to be located in the proximal segment in 42%of these cases(39/93) and in the distal segment in 45% (42/93).Nerve dislocation or distortion was observed in 32%(30/93).Conclusions:Various 3D high resolution MRI methods combined with the image fusion technique could provide pathologic anatomic information for the diagnosis and treatment of TN.
文摘To evaluate the effect of triple puncture on primary trigeminal neuralgia (pTN),64 patients with pTN were randomly assigned to two groups:treatment group and control group.The participants in the treatment group received triple puncture treatment of 6 times per week for 4 weeks,and those in control group were given carbamazepine (300-600 mg per day) for at least 1 month.Before and after treatment,the primary outcomes including the total efficiency rate and the VAS pain scores,and the secondary outcomes including the frequency of pain attack and adverse events were observed.Sixty-two participants finished the study (33 in treatment group and 29 in control group individually).After treatment,the symptoms (mainly pain) of the two groups were alleviated.The total efficiency rate in the treatment group and control group was 90.9% and 75.9% respectively.The VAS pain scores and frequency of pain attack were significantly reduced in the treatment group as compared with the control group (P<0.05).The incidence of adverse events in the treatment group and control group was 9.1% and 24.1% respectively.It can be inferred that triple puncture can effectively improve the quality of life of patients with pTN and has less side effects.
文摘BACKGROUND Primary trigeminal neuralgia can achieve satisfactory results through clinical treatment and intervention.The pathogenesis of neuralgia caused by varicellazoster virus infection of the trigeminal nerve is more complex,and it is still difficult to relieve the pain in some patients simply by drug treatment or surgical intervention.CASE SUMMARY A 66-year-old woman was hospitalized with herpetic neuralgia after herpes zoster ophthalmicus(varicella-zoster virus infects the ophthalmic branch of the trigeminal nerve).On admission,the patient showed spontaneous,electric shocklike and acupuncture-like severe pain in the left frontal parietal region,and pain could be induced by touching the herpes area.The numerical rating scale(NRS)was 9.There was no significant pain relief after pulsed radiofrequency and thermocoagulation of the ophthalmic branch of the trigeminal nerve.Combined with patient-controlled intravenous analgesia(PCIA)with esketamine,neuralgia was significantly improved.The patient had no spontaneous pain or allodynia at discharge,and the NRS score decreased to 2 points.The results of follow-up 2 mo after discharge showed that the NRS score was≤3,and the Pittsburgh Sleep Quality Index score was 5 points.There were no adverse reactions.CONCLUSION Trigeminal extracranial thermocoagulation combined with esketamine PCIA may be a feasible method for the treatment of refractory herpetic neuralgia after herpes zoster ophthalmicus.
文摘In the present paper, 45 cases of acute trigemina] neuralgia were treated and observed by comparative method. Results showed no significant difference in transient analgesic effect (P】 0.05) but a significant difference in therapeutic effect (P【 0.01) between the treatment and control groups. This indicates that blood-letting puncture with cupping is an effective therapy for the disease.
文摘Objective: To investigate the successful rate and accuracy of percutaneous radiofrequency thermocoagulation (PRT) for treatment of primary trigeminal neuralgia (PTN) with customized navigated template via three dimensional (3D) printing technique. Methods: 65 patients with PTN were recruited from January 2014 to March 2015 and randomly divided into two groups: template group (n = 28) and traditional group (n = 37). The patients in traditional group received PRT under guidance of C-arm fluoroscopy, while the ones in template group were treated with customized navigated templates. The data of time, depth and accuracy rate of puncture, the average effective dose equivalent of radiation, complications after operation were collected and analyzed. Results: No intra-operative failures occurred in the template group: the pain was alleviated immediately after operation. Accuracy rate of the template group was 100% while 96% was achieved in traditional group. However, the average time of puncture by the template was significantly reduced compared with traditional group (2.37 ± 0.64 minutes and 24.2 ± 6.55 minutes, respectively;P 0.05). No complications were observed in template group while several complications such as blooding, leakage of cerebrospinal fluid and dizziness were observed in traditional group. Conclusion: The application of customized template is advocated for improving the accuracy of PRT.
文摘BACKGROUND Trigeminal neuralgia(TN) is a severe type of neuropathic pain which is often inadequately managed using conventional therapies. In this report, we present the first case of TN treated with gasserian ganglion nerve coblation(NC).CASE SUMMARY A 58-year-old man presented with right facial pain, mostly localized in the right zygomatic zone, alveolar region, and jaws. Similar to acupuncture and shock pain, the pain lasted about five seconds after each attack before resolving unaided. A diagnosis of TN was made, after which treatment with acupuncture therapy and oral carbamazepine was given. However, the pain was not satisfactorily controlled. Subsequently, gasserian ganglion NC of the right trigeminal nerve guided by computed tomography(CT) was performed on the patient. Following this procedure, the right zygomatic, alveolar, submandibular,and cheek pain disappeared completely. The right zygomatic and alveolar areas experienced mild numbness(level II). At 1-, 2-, 3-, and 6-mo follow-ups after surgery, the patient was painless and the numbness score was level I.CONCLUSION CT-guided gasserian ganglion(NC) is an effective treatment for TN and is associated with less or no postoperative numbness or hypoesthesia in comparison with current standard-of-care approaches.
文摘BACKGROUND Although few studies have reported hyponatremia due to carbamazepine or oxcarbazepine in patients with epilepsy,no study has investigated cases of carbamazepine-or oxcarbazepine-induced hyponatremia or unsteady gait in patients with neuropathic pain.Herein,we report a case of oxcarbazepineinduced lower leg weakness in a patient with trigeminal neuralgia and summarize the diagnosis,treatment,and changes of clinical symptoms.CASE SUMMARY A 78-year-old male with a history of lumbar spinal stenosis was admitted to the hospital after he experienced lancinating pain around his right cheek,eyes,and lip,and was diagnosed with trigeminal neuralgia at the right maxillary and mandibular branch.He was prescribed oxcarbazepine(600 mg/d),milnacipran(25 mg/d),and oxycodone/naloxone(20 mg/10 mg/d)for four years.Four years later,the patient experienced symptoms associated with spinal stenosis,including pain in the lower extremities and unsteady gait.His serum sodium level was 127 mmol/L.Assuming oxcarbazepine to be the cause of the hyponatremia,oxcarbazepine administration was put on hold and the patient was switched to topiramate.At subsequent visit,the patient’s serum sodium level had normalized to 143 mmol/L and his unsteady gait had improved.CONCLUSION Oxcarbazepine-induced hyponatremia may cause lower extremity weakness and unsteady gait,which should be differentiated from those caused by spinal stenosis.
文摘Twenty-five cases of Primary trigeminal neuralgia were treated satisfactorily by acupuncture at Xiaguan (St 7) through to the sphenopalatine ganglion, which is an important vegetative ganglion in the head.
文摘Background: Trigeminal neuralgia is a chronic pain syndrome characterized by paroxysmal, shock-like, stabbing, recurrent episodes of pain localized in the distribution area of one or more branches of the trigeminal nerve. The Initial approach for treating trigeminal neuralgia consists of pharmacological therapy. Many patients experience initial pain relief with pharmacological therapy;however, most of those patients eventually undergo surgery. Patients and Methods: In this descriptive prospective study, we evaluate the efficiency and safety of percutaneous balloon compression (PBC) and percutaneous radiofrequency ablation (RFA) in treating patients with typical idiopathic trigeminal neuralgia. This study includes 21 patients (divided into two groups, PBC = 15 patients and RFA = six patients) who met our inclusion and exclusion criteria, from May 2018 to April 2019, with a follow-up period of six months. Results: At one month postoperative follow-up, all patients in both groups were pain-free. At six months postoperative follow-up, in group 1 (PBC), 14 (95.24%) patients were pain-free, while in group 2 (RFA) all patients remained pain-free. The most common encountered postoperative complications are masticatory muscles weakness (Four patients in PBC group, and one patient in RFA group) and facial hypothesia (12 patients in PBC group and four patients in RFA group). Conclusions: In our study, patients with trigeminal neuralgia were not controlled by drug treatment, but percutaneous balloon compression and percutaneous radiofrequency ablation proved to be very effective treatment options, with no major complications.
文摘Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves;to review outcomes including duration and degree of pain relief;to evaluate procedure’s complication rate and patient’s willingness to repeat the procedure;to compare effectiveness of the most recent RF ablation to patient’s first RF ablation. Methods: This is a single-center retrospective observational study of 23 patients with recurrent cervicogenic headaches and/or occipital neuralgia treated with repeated RF ablation of the C2 dorsal root ganglion and/or third occipital nerves. All patients receiving treatment from January 2010 to July 2014 are included in this single site retrospective study. This is an IRB approved medical chart review study. Results: 22 of 23 patients underwent follow-up. An average of 86.5% of participants reported pain relief on average of 25.4 weeks at time of follow-up. 41% reported side effects including suboccipital hyperesthesia and/or ear discomfort, 95% reported willingness to repeat the procedure again if severe symptoms recurred, 59% of patients reported the most recent RF ablation had the same results as the first, 32% reported the most recent RF was the most effective, and 9% reported that the first RF was the most effective. Conclusion: Repeated RF ablation is a feasible option for recurrent cervicogenic headaches and/or occipital neuralgia. Effectiveness of repeat intervention is the same or better than the first ablation. Though there was a higher likelihood of side effects including suboccipital neuralgia and/or ear discomfort on repeat treatment, the side effects were generally well tolerated.
基金the National Natural Science Foundation of Hebei(No.H2018201179).
文摘Objective:To evaluate the clinical effects of bloodletting cupping therapy(BCT)for patients with postherpetic neuralgia.Methods:We comprehensively searched four Chinese databases(Wanfang,China National Knowledge Infrastructure,VIP Database for Chinese Technical Periodicals,China Biology Medicine disc)and foreign databases(Pubmed,Cochrane Library).The retrieval time was from the build-up time to May 2018.RevMan 5.3 software was used for statistical analysis.Results:We finally obtained 18 eligible studies.Compared with routine western medicine,BCT can significantly improve PHN(OR=7.45,95%CI,3.36-16.51,Z=4.95,P<0.01).BCT plus other methods of acupuncture with fire needle and filiform needle has significant therapeutic effect(OR=5.54,95%CI,3.01-10.19,P<0.01),BCT plus routine western medicine has significant therapeutic effect(OR=4.99,95%CI,2.73-9.11,P<0.00001).Conclusion:It showed that the therapeutic effects of BCT,BCT plus other acupuncture methods with fire needle and filiform needle,and BCT combined with western medicine are better than those treated with single western medicine.It is effective to treat postherpetic neuralgia with Bloodletting Cupping Therapy.
