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Facial pain induces the alteration of transient receptor potential vanilloid receptor 1 expression in rat trigeminal ganglion

Objective To investigate the involvement of transient receptor potential vanilloid receptor 1 （TRPV1） in the facial inflammatory pain in relation to thermal hyperalgesia and cold pain sensation. Methods Facial inflammatory pain model was developed by subcutaneous injection of turpentine oil （TO） into rat facial area. Head withdrawal thermal latency （HWTL） and head withdrawal cold latency （HWCL） were measured once a day for 21 d after TO treatment using thermal and cold measurement apparatus. The immunohistochemical staining, cell-size frequency analysis and the survey of average optical density （OD） value were used to observe the changes of TRPV1 expression in the neurons of the trigeminal ganglion （TG）, peripheral nerve fibers in the vibrissal pad, and central projection processes in the trigeminal sensory nuclei caudalis （Vc） on day 3, 5, 7, 14, and 21 after TO injection. Results HWTL and HWCL decreased significantly from day 1 to day 14 after TO injection with the lowest value on day 5 and day 3, respectively, and both recovered on day 21. The number of TRPV1-labeled neurons increased remarkably from day 1 to day 14 with a peak on day 7, and returned back to the normal level on day 21. In control rats, only small and medium-sized TG neurons were immunoreactive （IR） to TRPV1, and the TRPV1-IR terminals were abundant in both the vibrissal pad and the Vc. Within 2 weeks of inflammation, the expression of TRPV1 in small and medium-sized TG neurons increased obviously. Also the TRPV1 stained terminals and fibers appeared more frequent and denser in both the vibrissal pad skin and throughout laminae Ⅰ and the outer zone of laminae Ⅱ （Ⅱo） of Vc. Conclusion Facial inflammatory pain could induce hyperalgesia to noxious heat and cold stimuli, and result in increase of the numbers of TRPV1 positive TG neurons and the peripheral and central terminals of TG. These results suggest that the phenotypic changes of TRPV1 expression in small and medium-sized TG neurons and terminals might play an important role in the development and maintenance of TO-induced inflammatory thermal hyperalgesia and cold pain sensation.

Therapeutic Effects of the Point-injection Therapy on Primary Trigeminal Neuralgia An Observation of 103 Cases

From 1996 to 1999, the author treated 103 cases of primary trigeminal neuralgia by point-injection with lidocaine, VB1 and VB12, and obtained quite good therapeutic results. A report follows.

THREE-DIMENSIONAL COMPUTED TOMOGRAPHY-GUIDED RADIOFREQUENCY TRIGEMINAL RHIZOTOMY FOR TREATMENT OF IDIOPATHIC TRIGEMINAL NEURALGIA

Objective To evaluate the effectiveness of three-dimensional computed tomography （3D-CT） guided radiofi＇equency trigeminal rhizotomy （RF-TR） in treatment of idiopathic trigeminal neuralgia （1TN）. Methods From 1999 to 2001, 18 patients with ITN were treated with percutaneous controlled RF-TR. Intraoperative 3D-CT scanning was performed to guide the trajectory of the puncture. After correction of the needle tip according to the CT scans and stimulation effects, 2 to 5 lesions were made for a duration of 60-90 seconds at a temperature of 60℃ to 75℃ depending on the pain distribution and the age of patient. The needles located in foramen ovale. Pain alleviated immediately with no serious complication in all patients. The patients were followed up for an average of 31.5 months （range 24-41 months）. Acute pain relief was experienced by 17 patients after the procedure, reaching an initial success rate of 94.4%. Early （〈 6 months） pain recurrence was observed in 2 patients （11.1%）, whereas late （〉 6 months） recurrence was reported in 3 patients （16.7%）. Thirteen patients had complete pain control, with no need for medication thereafter. Five cases experienced partial pain relief, but required medication at a lower dose than in the preoperative period. Conclusion 3D-CT foramen ovale locations can raise the successful rate of puncture, enhance the safety, and reduce the incidence rate of complication.

Quantitative assessment of sensory functions after 3 surgical approaches for trigeminal neuralgia by current perception threshold measurement

Objective： To quantitatively identify and grade trigeminal sensory functions after 3 major surgical procedures of trigeminal neuralgia using a newly developed quantitative sensory testing technique, current perception threshold measurement （CPTM）. Methods： In the current study, there were 48 trigeminal neuralgia patients without history of prior surgical treatment. These patients received one of the following 3 surgical procedures, microvascular decompression （MVD）, peripheral nerve block with alcohol （PNB）, or percutaneous radiofrequency thermocoagulation （PRFT）. The quantitative sensory testing measurement, CPTM, and conventional qualitative sensory testing measurements were performed preoperatively and postoperatively to evaluate and grade the trigeminal sensory functions All 3 major cutaneous sensory fiber types, large myelinated fibers （A beta）, small myelinated fibers （A delta） and unmyelinated fibers（C） were allowed to quantitatively evaluate and grade by CPTM. The results of the measurements were statistically analyzed using a one-way analysis of variance （single factor）. Each subject was his/her own control for comparison of the preoperative to postoperative state on the asymptomatic and symptomatic sides. Subjects were tested 48 h preoperatively and 4 weeks postoperatively. Results： PNB with alcohol and PRFT caused significant sensory dysfunction postoperatively in every fiber type, indicating damage to all fibers. On the contrary, the sensory function in all 3 fiber types was unchanged after MVD management. Conclusion： Among the 3 major surgical procedures tested, only MVD preserves sensory function in trigeminal system. CPTM is of quantitative nature on the evaluation of sensory functions of nerve fibers

Expression of hNav1.8 sodium channel protein in affected nerves of patients with trigeminal neuralgia

Objective: To explore the pathogenesis of trigeminal neuralgia (TN) and to provide a new target for the drug treatment of TN by studying the expression of tetrodotoxin-resistant hNav1. 8 sodium channel protein in affected nerves of patients with TN. Methods: Twelve affected inferior alveolar nerves were obtained from patients with idiopathic TN, to whom the drug therapy was not effective. As negative control, one nonnal inferior alveolar nerve was obtained from patients who accepted the combined radical neck dissection with glossectomy and mandibulectomy. One muscle sample was obtained as normal control. One dorsal root ganglion from rat was as positive control. These tissues and prepared hNav1. 8 antibody were conducted immunohistochemistry response. Results: hNav1.8 channel protein was expresses in all the 12 specimens of the affected nerves of patients with TN, but not in the muscle sample and the normal inferior alveolar nerve. Conclusion: The abnormal expression of hNav1. 8 channel protein in the affected nerves of patients with TN may play an important role in the pathogenesis of TN.

CLINICAL STUDY ON TREATMENT OF TRIGEMINAL NEURALGIA BY NEEDLING MENTAL AND MANDIBULAR FORAMINA

In the present paper, 126 patients with neuralgia involving the mandibular branch of trigeminal nerve were treated mainly by puncturing the mental foramen and the mandibular foramen. The two foramina are both located in the focus through which the Stomach Channel of Foot Yangming passes. Among the 126 patients, 42 were attributed to the light type, 61 to the moderate type one and the other 23 to serious type. Acupuncture treatment was given once daily, 30 min every time, with 10 days being a therapeutic course. After 3 courses of treatment, results showed that 29 (69.1%) light type cases, 35(57.4%) moderate type cases and 6 (26.1%) serious type cases were cured. It displays that the less serious the symptom, the higher is the cure rate, and the shorter the duration of disease, the better is the therapeutic effect.

TREATMENT OF 18 CASES OF TRIGEMINAL NEURALGIA WITH ELONGATED NEEDLE

In this paper, a total of 18 cases of primary trigeminal neuralgia were treated with elongated needle. Of the 18 cases, 5 were male and 15 female, ranging in age from 27 to 58 years and in disease duration from 3 days to 8 years. Main acupoints used were Taiyang (EX-HN 5) to Xiaguan (ST 7, for penetration needling), Xiajiache, Fengchi (GB 20), Yanglingquan (GB 34) and Taichong (LR 3). The treatment was given once daily, with 12 sessions being a therapeutic course. After 2 courses of treatment, of the 18 cases, 10 cases were cured, 7 experienced improvement in pain and one failed in the treatment, with an effective rate of 94.4%. The key point for treating trigeminal neuralgia is applying penetrative needling from EX-HN 5 to ST 7 to achieve ideal needling sensations.

ANALYSIS ON THE THERAPEUTIC EFFECT OF ACUPUNCTURE TREATMENT OF 2656 CASES OF PRIMARY TRIGEMINAL NEURALGIA

In the present paper, the clinical therapeutic effect of acupuncture therapy for treatment of primary prosopalgia was observed and its influencing factors were analyzed in 2656 patients. Yuyao (EX HN 4), Touwei (ST 8), Sibai (ST 2), Quanliao (SI 18), Xiaguan (ST 7) and Jiachengjiang were punctured selectively according to the involvement of different branches of the trigeminal nerve. After treatment, of the 2656 cases, the trigeminal neuralgia disappeared in 1469 (55.31%), 727 (27.37%) had marked improvement, 430 (16.19%) had improvement and 30 (1.13%) had no any significant effect. The three years’ follow up visit in 245 cases showed a relapse in 187 cases (76.3%). We think that the therapeutic effect is closely related to the needling manipulations. Only when an electric shock like needling sensation appeared (i.e. “qi reaching the affected area") after inserting the acupuncture needle into the chief acupoints, a better therapeutic effect would be achieved.

Fire needle combined with blood-letting therapy for a case of 20-year trigeminal neuralgia

Background： Trigeminal neuralgia （TN） is a neuropathic pain syndrome. It is the most frequent cranial neuralgia and defined as sudden, usually unilateral and lightning-like, knife-like or burning-like recurrent episodes of pain within the distribution area of one or more divisions of the trigeminal nerve. Here we reported that an 81-year-old woman with TN who complained of severe pain on her right face showed a complete clinical relief after comprehensive therapy containing fire needle, filiform needle and blood-letting therapy. Methods： The patient was applied fire needle combined with filiform needle therapy （3 times / week for 4 months） and three consecutive fire needle combined with blood-letting therapy （3 times / week for one week）. Fire needle was inserted into the back points of Du meridian, the first lateral line of bladder meridian, the right spreading area of the trigeminal nerve and the points around the pain radiation site. The filiform needle acupuncture was applied to the points on the right face including Yuyao （EX-HN4）, Yangbai （GB14）, Toulinqi （GB15）, et al; points on the abdomen including Xiawan （RN10）, Qihai （RN16）, Guanyuan （RN14） and the bilateral points including Tianshu （ST25）, Daheng （SP15）, Zusanli （ST36）, et al. Finally, the three-edged fire needle punctured the points of Yangbai （GB41）, Shangguan （GB3）, Jiache （ST6） on the right face accompanied by the cupping method on the bleeding points. Results： The patient reported the complete disappearance of pain and could open mouth and eat normally. The face was normal and no triggering pain recurred after one-month follow-up. Conclusions： The fire needle combined with blood-letting therapy can cure the TN and might provide an alternative non-drug therapy for those patients who still suffered from TN after other medical treatments or whom that refused surgical treatment.

Observation of therapeutic effect on primary trigeminal neuralgia treated with contralateral needling technique (Ju Ci)

Objective To observe the differences in therapeutic effects on primary trigeminat neuralgia between contralateral needling technique and routine acupuncture. Methods One hundred and thirty cases were randomly divided into contralateral needling group and routine acupuncture group, 65 cases in each one. In contralateral needling group, contralateral needling technique was adopted on the acupoints on the opposite side corresponding to the affected face in neuralgia. According to the localization of trigeminal neuralgia, the points were selected. For example, for ophthalmologic branch, Yuyao （鱼腰 EX- HN 4） and Touwei （头维 ST 8） were selected as the main point. In routine acupuncture group, the corresponding acupoints were selected on the affected side of the face. The points were same as that in contralateral needling group, Three courses of treatment were required in two groups. The clinical efficacy was evaluated 4 weeks after the end of treatment. Results The total effective rate was 95.4% （62/65） in contralateral needling group, which was superior to that in routine acupuncture group E86.2% （56/65）1 （P〈0. 001）. Conclusion Contralateral needling technique achieves apparently superior effects on primary trigeminal neuralgia compared with routine acupuncture.

Specific effect of acupuncture on the neural pathway in the acute stage of migraine headache

To discuss the hazard of migraine in acute phase and analgesic effect, acupoint selection features, method as well as mechanism of acupuncture; to put forward relevant questions, answer these questions, propose relative specificity hypothesis on neural pathway of analgesic effect of acupoints in different nerve distribution areas（trigeminal nerve distribution area, occipital nerve distribution area, and spinal nerve distribution area） in treatment of migraine in acute phase, and analyze the deficiencies of hypothesis.

Treatment of 32 Cases of Primary Trigeminal Neuralgia by Acupuncture plus Moxibustion with Warming Needle on Xiaguan （ST 7）

The main acupoints of Acupuncture therapy were Xiaguan （ST 7）, Sanjian （LI 3）, Xiangu （ST 43）, Zulinqi （GB 41）, Sanyinjiao （SP 6） and Taixi （KI 3）. Moxibustion with warming needle on Xiaguan （ST 7）, reduction method on Sanjian （LI 3） on the unaffected side and Xiangu （ST 43） and Zulinqi （GB 41） on the affected side, reinforcement method on Sanyinjiao （SP 6） and Taixi （KI 3） on the affected side were given. Moreover, according to the affected area, the local acupoints were added, Yangbai （GB 14） for the opthalmic branch, Quanliao （SI 18） for the maxillary branch and Jiache （ST 6） for the mandibular branch. Among 32 cases, after 24 acupuncture treatments, 4 cases were cured, 19 cases got marked effectiveness, 7 cases was improved and 2 cases had no effectiveness.

Clinical Observation on Treatment of Primary Trigeminal Neuralgia by Point Penetrating Injection plus Ear Pressing

Objective： To investigate the therapeutic effect of primary refractory trigeminal neuralgia. Methods： Twenty-eight cases of primary trigeminal neuralgia were treated by point penetrating injection plus ear pressing, controlled by 28 cases treated only by acupuncture, Results： The total effective rate was 96,43% in observation group and 78.57% in control group. There wasa significant difference in the total effective rate between the two groups （P〈0.05）. Results： Point penetrating injection plus ear pressing is the effective method in treating primary trigeminal neuralgia.

Clinical Observation on Trigeminal Neuralgia Treated by Acupuncture plus Electrophoresis

Objective： To evaluate the clinical effect of combined acupuncture and electrophoresis in treating trigeminal neuralgia. Methods： Sixty patients were randomly allocated to two groups. The treatment group received acupuncture plus electrophoresis, and the control group took Carbamazepine and Methylcobalamin. The therapeutic effects would be evaluated after 30 d. Results： The total effective rate was 93.3% in the treatment group versus 70.0% in the control group. During the follow-up study （6 months to 1 year）, 3 cases got relapsed in the treatment group, occupying 11.1%, and 6 got relapsed in the control group, occupying 28.6%. Conclusion： Combined acupuncture and electrophoresis has a precise effect in treating trigeminal neuralgia, and it bears an advantage of simple operation and maintaining cutaneous sensation.

Evaluation of the effect of acupuncture on pain of patients with refractory trigeminal neuralgia

Objective To assess the effect of acupuncture on pain of patients with refractory trigeminal neuralgia(TN).Methods Acupuncture was accomplished for 14 patients with refractory TN,3 sessions in a week for 10 sessions.Every treatment session lasted about 30 min.The pain severity of patients was evaluated by visual analog scale(VAS)at days 0,3,7,14,21 and 1 month later as follow up.The data were analyzed by SPSS version 18.0.Results The mean age of participants was(59.4±13.2)years old.The VAS points decreased from day 0 to the follow-up.As the results showed,the amount of VAS points decreased by acupuncture has emerged more significance in comparisons between days 0,3 and days 14,21,and the one-month follow-up,the differences in VAS points on the mentioned days were significant(P<0.05).Conclusion Acupuncture can cause proper pain relief for refractory TN.Acupuncture can induce an analgesic effect after multiple repetitions of therapeutic sessions.

Study on the Relation Between MRI Findings and Acupuncture Effect in Trigeminal Neuralgia Patients

Objective： To observe the relationship between acupuncture and MRI （Magnetic Resonance Imaging） findings in patients with trigeminal neuralgia （TN）. Methods： A total of 32 idiopathic TN patients who completed acupuncture treatment protocol were recruited in this trial. The relationship between acupuncture effect and MRI findings were analyzed by using MRI-B-FFE （Balanced Fast Field Echo） technique to record MRI information, such as the distance from the brainstem to the contact point of offending vessels and trigeminal nerve, the contact angle of offending vessels and trigeminal nerve, and the ratio of the diameter of the contact vessel to trigeminal nerve width. Results： After acupuncture treatment, 9 cases got marked effect, 19 got improvement, and 4 got no effect. Acupuncture effect was neither associated with the distance from the brainstem to the contact point of the offending vessel and trigeminai nerve （P〉0.05） nor the ratio of the diameter of the offending vessel to trigeminal nerve width （P〉0.05）; however, it was indeed associated with the running course of the offending vessels （P〈0.05）. Conclusion： The bigger the angle between the offending vessels and trigeminal nerve, the poorer the acupuncture effect. The B-FFE technique can be used for screening acupuncture-indicated TN patients.