A Trial of Intravenous Lidocaine on the Pain and Allodynia of Postherpetic Neuralgia

This study investigated the effect of intravenous lidocaine at two doses (1 mg/kg and 5 mg/kg over 2 hours) and an intravenous saline placebo on the pain and allodynia of postherpetic neuralgia (PHN). Twenty-four patients were studied using a randomized, double-blind, within-patient crossover design. Each patient received normal saline, lidocaine 0.5 mg/kg/h, and lidocaine 2.5 mg/kg/h for a 2-h period. The McGill Pain Questionnaire Short Form, visual analogue scores (VAS), and area of allodynia were measured at intervals during the infusions. Free plasma lidocaine levels were also measured. The results were statistically analyzed using Student’s t-test for paired data. The VAS for ongoing pain showed a significant reduction after all the infusions (P < 0.05). For dynamic pressure-provoked pain, the VAS was unaffected by placebo but showed a reduction at an equal level of significance with both lidocaine infusions (P < 0.05). The area of allodynia of PHN, as mapped by brush stroke, declined in association with intravenous lidocaine (0.5 mg/kg/h = P < 0.05; 2.5 mg/kg/h = P < 0.001). Placebo had no significant effect on the area of allodynia. These findings demonstrate a positive effect on pain and allodynia following a brief intravenous infusion of lidocaine. The higher dose infusion may produce plasma levels in the toxic range, with no significant clinical increase in response.     

A型肉毒毒素治疗三叉神经痛

目的:观察A型肉毒毒素治疗三叉神经痛(TN)的临床疗效。方法:选取57例TN患者,随机分为A、B 2组。A组28例患者口服卡马西平片治疗;B组29例在疼痛部位及板机点周围皮下注射肉毒素治疗。治疗后1,3及6个月时随访,行简式McGill疼痛问卷表(SF-MPQ)及生活质量评价量表(SF-36)评分,并观察不良反应。结果:治疗中脱失7例,A组3例,B组4例。与治疗前3个月SF-MPQ及SF-36平均分作为基础水平比较,治疗1,3及6个月后2组SF-MPQ评分明显下降,SF-36明显上升(P<0.01),B组表明更明显(P<0.05,P<0.01)。治疗过程中,A组出现不适患者多于B组。结论:A型肉毒毒素疼痛点皮下注射治疗TN发作作用高峰1～3个月,维持时间6个月,且临床疗效显著,不良反应轻微。     

Trigeminal Neuralgia in a Patient With Spontaneous Intracranial Hypotension

Spontaneous intracranial hypotension and trigeminal neuralgia are examples of pain syndromes arising from shifting anatomical relationships in the posterior fossa. We report both conditions occurring in the same patient and resolving following surgical closure of a cervical nerve root sleeve dural defect. This case further elucidates the pathophysiologic basis of both forms of head pain.     

微血管减压术治疗三叉神经痛的疗效及其并发症的预防与处理

目的探讨微血管减压术治疗三叉神经痛的疗效及其并发症的预防与处理策略。方法采用微血管减压术治疗93例三叉神经痛患者,对其临床疗效及术后并发症等临床资料进行回顾性分析。结果 93例中89例术后疼痛症状消失,有效率为95.70%。术后并发症的发生情况：皮下积液4例,脑脊液漏1例,听力下降3例,耳鸣3例,面神经功能障碍4例,手术无效4例,死亡1例。结论微血管减压术治疗三叉神经痛是一种十分成熟的技术,规范手术的各种操作和积极应用监测技术能够尽量避免各种并发症的发生,显著提高手术的安全性。     

微血管减压术治疗原发性三叉神经痛手术体会

目的：探讨原发性三叉神经痛微血管减压的手术效果及其影响因素。方法：选择正规药物治疗无效的三叉神经痛患者行核磁共振检查,排除继发性病因引起三叉神经痛的患者,对30例原发性三叉神经痛患者行微血管减压术。结果：28例患者术后疼痛立即消失,1例患者症状明显缓解,1例无效,无死亡患者,有效率为97%,随访1年有1例复发。结论：术前核磁共振检查能否发现责任血管,对手术和术后效果影响大;但同时与术者的经验和显微操作熟练程度密切相关。     

庆大霉素复合罗哌卡因或利多卡因复合曲安缩松治疗三叉神经痛的早期疗效

目的比较庆大霉素复合罗哌卡因与曲安缩松治疗三叉神经痛的早期疗效。方法90例三叉神经痛患者随机分为罗哌卡因组和曲安缩松组,分别用庆大霉素复合罗哌卡因或曲安缩松行外周神经阻滞。比较治疗前、治疗后1d、3d、1周、2周、1个月、2个月和3个月时的治疗效果,以及两组患者治疗前后卡马西平用量的变化。结果治疗后,两组患者各时间点数字评分(NRS)均较治疗前降低,罗哌卡因组治疗后1d、1个月、2个月及3个月时的NRS值均优于曲安缩松组。结论庆大霉素复合罗哌卡因治疗三叉神经痛效果较好;曲安缩松对三叉神经痛亦有一定效果,可用于病情不太严重的患者。     

Trigeminal Neuralgia During Sleep

▪ Abstract:   Pain paroxysms in trigeminal neuralgia (TN) are sudden and extremely intense. Nonetheless, many clinicians who treat TN report that patients are rarely if ever awakened at night by pain attacks. If true, this observation is important as it implies the presence of a powerful sleep protective mechanism. We queried TN patients and their habitual sleep partners about painful awakenings and discovered that such awakenings are in fact quite common. As during the day, pain paroxysms during sleep are typically induced by natural stimuli at TN trigger points. Brief attacks sometimes occur without frankly awakening the patient, but they appear nonetheless to be painful. ▪     

Trigeminal Neuralgia. Clinical Manifestations of First Division Involvement

A series of 19 patients with what originally had been diagnosed as a first division (V₁) trigeminal neuralgia was collected. The inclusion criteria were severe, rather short-lasting pain attacks within the V₁ area, combined with trigger mechanisms. There were 10 women and 9 men, and the mean age of onset was 57.8 years. Fifteen of 16 with adequate information on attack duration had paroxysms of a "few seconds'" duration or less, whereas 10 patients had paroxysms lasting ≥2 seconds. In an exceptional case, only "more long-lasting" attacks (greater than 30 seconds' duration) were experienced.
In regard to autonomic phenomena, lacrimation was most frequently present (in a total of 8 patients; 3 rather regularly, 5 more irregularly). The combination of lacrimation, conjunctival injection, and rhinorrhea was present in only 2 (of 19), and in neither of them in a major way. Typically, autonomic phenomena occurred during the later stages of disease and during particularly severe and long-lasting attacks. Seven of 14 with adequate information also had nocturnal attacks. Initially, a more or less complete carbamazepine effect was reported by 10 of 13 patients. Precipitation mechanisms were the same as with second and third division tic, but were mainly located within the V₁ area, particularly initially.
A comparison with SUNCT syndrome has been made. SUNCT is a predominantly male disorder, with only exceptional attacks of ≥10 seconds' duration, and generally with attacks of 15 seconds or longer. Autonomic symptoms and signs are more pronounced than in V₁ tic. Carbamazepine generally provides minor, if any, benefit in SUNCT. The present work strongly indicates that the two disorders are essentially different.     

Cerebrospinal Fluid Neuropeptides and Monoaminergic Transmitters in Patients With Trigeminal Neuralgia

The pathogenesis of trigeminal neuralgia remains largely unknown. "Peripheral" as well as "central" causes have been suggested. To investigate the role of serotonergic, noradrenergic, dopaminergic, and peptidergic systems, we determined the concentrations of epinephrine, norepinephrine, and their breakdown product, vanillylmandelic acid, in the cerebrospinal fluid of 16 patients (55.3 ±± 8.3 years) with trigeminal neuralgia. As a marker for the dopaminergic system, we determined cerebrospinal fluid concentrations of dopamine and its metabolite, homovanillic acid. As a marker for the serotonergic system, we measured cerebrospinal fluid levels of the serotonin metabolite, 5-hydroxyindoleacetic acid. In addition, levels of the neuropeptides, substance P and somatostatin, were determined.
The concentration of norepinephrine (P<0.01) and its metabolite, vanillylmandelic acid, (P<0.05) were significantly decreased in our patients. The level of the dopamine metabolite, homovanillic acid, was also significantly reduced (P<0.01). Also significantly decreased was 5-hydroxyindoleacetic acid (P<0.01). Substance P was significantly elevated (P<0.05). Somatostatin was significantly decreased (P<0.05).
We hypothesize that the sum of complex neurochemical changes plays a role in the pathogenesis of trigeminal neuralgia. The elevated substance P could support the concept of a neurogenic inflammation in the trigeminovascular system, whereas changes in the monoaminergic transmitters and their metabolites seem to reflect a more central dysfunction possibly due to a longer duration of the disease and an accompanying depression.     

半导体激光穴位照射联合局部封闭治疗原发性三叉神经痛57例

目的探讨半导体激光穴位照射联合局部封闭治疗原发性三叉神经痛的临床疗效。方法57例原发性三叉神经痛患者根据不同疼痛部位采用不同穴位接触照射,每一穴位各照射3min,间隔2min;同时用2％利多卡因2．5mL＋25％硫酸镁溶液2．5mL对不同部位局部封闭浸润注射。结果57例患者随访3个月,总有效率为98．2％;随访6个月,总有效率为94．7％;随访1年,总有效率为89．5％;随访2年,总有效率为86．0％。结论半导体激光穴位照射联合局部封闭治疗原发性三叉神经痛,有较好的疗效且可反复多次治疗,尤其对无法进行手术的老年患者采用射频温控热凝治疗更适用。     

1. Trigeminal Neuralgia

Trigeminal neuralgia is a common cause of facial pain. It has a significant impact on the quality of life and the socioeconomic functioning of the patient. The aim of this review is to provide recommendations for medical management of trigeminal neuralgia based on current evidence. Based upon the analyses of the literature combined with experience in pain management, symptoms, assessment, differential diagnosis, and treatment possibilities of trigeminal neuralgia are described and discussed. Recommendations for pain management are given and are displayed in a clinical practice algorithm. Treatment should be multidisciplinary. Various treatment options and their risks should be discussed with the patient. The first treatment of choice is carbamazepine or oxcarbazepine. In younger patients, the first choice of invasive treatment is probably microvascular decompression. For elderly patients, radiofrequency treatment of Gasserian ganglion is recommended and the technique is described in detail.     

Trigeminal Neuralgia in Pregnancy: A Management Challenge

Pregnancy is known to aggravate pre‐existing chronic painful conditions. Trigeminal neuralgia (TN), albeit a disease of the elderly, may afflict pregnant females, which can further complicate its management. Teratogenic effects of the commonly used drugs on the developing fetus limit pharmacological treatment. Moreover, safety of commonly performed interventional therapies is marred by their inherent fetomaternal effects and more importantly the risk for radiation effects on the fetus due to the use of fluoroscopy. This rare coexistence of TN in pregnancy has not been reported before. Here we present a case of TN in a young woman, whose pain was aggravated when she became pregnant, and she was treated successfully by conventional radiofrequency ablation of the Gasserian ganglion.