Efficacy and safety of acupuncture for trigeminal neuralgia: A protocol for systematic review and meta-analysis.

BACKGROUND: Trigeminal neuralgia (TN) is a disease accompanied by severe facial pain, which seriously affects the daily life of patients. Acupuncture is widely used by Traditional Chinese Medicine doctors to treat various painful diseases. Acupuncture combined with the treatment of trigeminal neuralgia can increase the analgesic effect and reduce side effects. However, there is still a lack of more quality multi-center clinical controlled trials and comprehensive meta-analysis, and a lack of more comprehensive and stronger evidence-based medical evidence. METHODS: The 2 reviewers used the same search strategy to search CNKI, PubMed, Web of Science, Cochrane Library, Scopus, EBSCO, and the search date is until July 19, 2020. Two people read the retrieved literatures independently, and then delete duplications. Then, use the "risk of bias" tool in Cochrane Handbook 5.2 to score. Only documents with a score greater than 5 can be included. Make a table of literature characteristics, extract baseline patient data, research methods and possible risks of bias in the literature, interventions in treatment and control groups, outcome evaluation indicators (BNI, VAS, ER and AE), and research funding support. Use Review Manager 5.3.5 for meta-analysis, use Stata 15 for regression analysis to find the source of heterogeneity, and then perform subgroup analysis to resolve the heterogeneity based on the corresponding source. RESULTS: The analysis of BNI, VAS, ER and AE data can provide high-quality evidence for high-quality synthesis and/or descriptive analysis of the effectiveness and safety of acupuncture treatment of various causes of urinary retention. CONCLUSION: This study can provide more comprehensive and strong evidence to prove whether acupuncture is effective and safe in the treatment of TN patients. REGISTRATION: The research has been registered and approved on the PROSPERO website. The registration number is CRD42019119606.

A New Rat Model of Thalamic Pain Produced by Administration of Cobra Venom to the Unilateral Ventral Posterolateral Nucleus.

BACKGROUND: Thalamic pain is a neuropathic pain syndrome that occurs as a result of thalamic damage. It is difficult to develop therapeutic interventions for thalamic pain because its mechanism is unclear. To better understand the pathophysiological basis of thalamic pain, we developed and characterized a new rat model of thalamic pain using a technique of microinjecting cobra venom into the ventral posterolateral nucleus (VPL) of the thalamus. OBJECTIVES: This study will establish a new thalamic pain rat model produced by administration of cobra venom to the unilateral ventral posterolateral nucleus. STUDY DESIGN: This study used an experimental design in rats. SETTING: The research took place in the laboratory at the Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine. METHODS: Male Sprague-Dawley rats were subjected to the administration of cobra venom or saline into the left VPL. The development of mechanical hyperalgesia and changes in pain-related behaviors and motor function were measured after intrathalamic cobra venom microinjection using the von Frey test, video recording, and cylinder test, respectively. On postoperative days 7 to 35, both electroacupuncture and pregabalin (PGB) were administered to verify that the model reproduced the findings in humans. Moreover, the organizational and structural alterations of the thalamus were examined via transmission electron microscopy (TEM). RESULTS: The threshold for mechanical stimuli in the left facial skin was significantly decreased on day 3 after thalamic pain modeling as compared with pre-venom treatment. Furthermore, the ultrastructural alterations of neurons such as indented neuronal nuclei, damaged mitochondria and endoplasmic reticulum, and dissolved surrounding tissues were observed under TEM. Moreover, electroacupuncture treatment ameliorated mechanical hyperalgesia, pain-like behaviors, and motor dysfunction, as well as restore normal structures of neurons in the thalamic pain rat model. However, no such beneficial effects were noted when PGB was administered. LIMITATIONS: The pathophysiological features were different from the present model and the patients in clinical practice (in most cases strokes, either ischemic or hemorrhagic). CONCLUSION: The cobra venom model may provide a reasonable model for investigating the mechanism of thalamic pain and for testing therapies targeting recovery and pain after thalamic lesions. KEY WORDS: Thalamic pain, cobra venom, electroacupuncture, pregabalin, indented neuronal nuclei, damaged mitochondria, dissolved endoplasmic reticulum, golgi body.

Anatomy and clinical applications of the maxillary nerve in dentistry: a literature review.

UNLABELLED: Few reports in the literature have addressed the course of the maxillary nerve, its regional branches and their significance in anaesthetic procedures. It was observed that the maxillary nerve varies in its branching pattern and the knowledge of the course and distribution of these branches may be useful for dental surgeons and anaesthetists while working in this region. Keeping these points in view, this review is aimed at presenting information about the course, distribution, possible variations, clinical significance and the anaesthetic applications of the maxillary nerve and its branches in dental procedures. CLINICAL RELEVANCE: Knowledge of the anatomy of the maxillary nerve is of relevance to the regional anaesthetic technique of this nerve.

Bidirectional calcium signaling between satellite glial cells and neurons in cultured mouse trigeminal ganglia.

Astrocytes communicate with neurons, endothelial and other glial cells through transmission of intercellular calcium signals. Satellite glial cells (SGCs) in sensory ganglia share several properties with astrocytes, but whether this type of communication occurs between SGCs and sensory neurons has not been explored. In the present work we used cultured neurons and SGCs from mouse trigeminal ganglia to address this question. Focal electrical or mechanical stimulation of single neurons in trigeminal ganglion cultures increased intracellular calcium concentration in these cells and triggered calcium elevations in adjacent glial cells. Similar to neurons, SGCs responded to mechanical stimulation with increase in cytosolic calcium that spread to the adjacent neuron and neighboring glial cells. Calcium signaling from SGCs to neurons and among SGCs was diminished in the presence of the broad-spectrum P2 receptor antagonist suramin (50 muM) or in the presence of the gap junction blocker carbenoxolone (100 muM), whereas signaling from neurons to SGCs was reduced by suramin, but not by carbenoxolone. Following induction of submandibular inflammation by Complete Freund's Adjuvant injection, the amplitude of signaling among SGCs and from SGCs to neuron was increased, whereas the amplitude from neuron to SGCs was reduced. These results indicate for the first time the presence of bidirectional calcium signaling between neurons and SGCs in sensory ganglia cultures, which is mediated by the activation of purinergic P2 receptors, and to some extent by gap junctions. Furthermore, the results indicate that not only sensory neurons, but also SGCs release ATP. This form of intercellular calcium signaling likely plays key roles in the modulation of neuronal activity within sensory ganglia in normal and pathological states.

Neuroanatomical basis of acupuncture treatment for some common illnesses.

The acupuncture treatment formulae for some common conditions are reviewed. These conditions include low back pain, sciatica, trigeminal neuralgia, facial nerve palsy, asthma, nausea and vomiting, gastritis and dysmenorrhoea. It is found that in many cases, the acupuncture points traditionally used for the treatment have a neuroanatomical significance from the viewpoint of Western medicine. And from that one can hypothesise a plausible mechanism of action as to how acupuncture achieves its therapeutic effects in terms of contemporary Western medicine. These mechanisms of action include intramuscular stimulation for treating muscular pain and nerve stimulation for treating neuropathies. The sympathetic ganglion may be involved in the acupuncture treatment of asthma. Somato-autonomic reflex may be responsible for the acupuncture effect on gastritis.

A multiarray mapping method to minimize morbidity from thermocoagulation as treatment of refractory trigeminal neuralgia.

BACKGROUND: Conventional percutaneous thermocoagulation of postgasserian fibers has shown high success rates, with significant residual morbidity. METHODS: This communication summarizes conclusions of multiple publications on our computerized mapping method and technique, and presents new data on short- and long-term results on trigeminal pain, including an actuarial analysis, complications. RESULTS: In TTN, 97.4% of 75 procedures produced initial pain relief without medication. In all, 84.7% of appropriate verbal responses were achieved by proper location of the needle at the chosen target, requiring an average of 1.45 tracts per procedure. Needle tip was located between 1 and 15 mm below the sellar floor in 97.0% of procedures and in an angle of 40 degrees to 80 degrees regarding the clivus profile projection in 99.1%. A 93% reduction of corneal analgesia and a 100% suppression of major dysesthesias and cranial nerve palsies were found. CONCLUSION: We have shown a significant reduction of morbidity from percutaneous thermocoagulation of postgasserian fibers with similar short- and long-term results as those shown in 11 recently selected series. Strict adherence to all details of our new method and technique is essential. Future multiinstitutional studies are needed to confirm and enrich this small series.

The effect of traditional herbal medicines; Uyakujunkisan on trigeminal neuralgia in an elderly patient--a case report and literature review.

This report describes the successful treatment of a 72-year-old female with refractory trigeminal neuralgia using a traditional herbal medicine, Uyakujunkisan (UJS). The case report is of a 65-year-old female who developed right-sided trigeminal neuralgia that was partially responsive to carbamazepine (CZ). The pain gradually increased in intensity and at 72 years of age she presented for herbal medicine therapy. Cranial MRI demonstrated vascular compression of the right trigeminal nerve at the cerebellopontine angle by the anterior inferior cerebellar artery. Although microvascular decompression was considered, UJS was prescribed after informed consent. After 3 weeks of treatment with UJS, dramatic improvement of symptoms permitted a decrease in CZ dose.

Review of the treatment of trigeminal neuralgia with gamma knife radiosurgery.

BACKGROUND: Trigeminal neuralgia is a debilitating condition caused by compression of the trigeminal nerve, ganglions, or divisions. Gamma knife radiosurgery has been increasingly used in the treatment of trigeminal neuralgia as a non-invasive alternative to microvascular decompression and rhizotomies. METHODS: We reviewed the medical literature regarding outcomes, time course, and prognostic factors for successful pain control in gamma knife radiosurgery. The dosimetry, target, complications of treatment, as well as perceived quality of life in treatment were also reviewed. RESULTS AND CONCLUSION: The growing body of literature suggests that the low rates of complications of gamma knife radiosurgery, coupled with the high success rates and patient satisfaction, allow it to be increasingly used as primary intervention for trigeminal neuralgia for appropriate patients.

Metabolite concentration ratios in thalami of patients with migraine and trigeminal neuralgia measured with 1H-MRS.

OBJECTIVE: To investigate the metabolite concentration ratios including N-acetylaspartate (NAA), choline-containing compounds (Cho) and creatine plus phosphocreatine (Cr) in thalami of patients with migraine without aura, patients with trigeminal neuralgia and healthy comparison subjects using multi-voxel proton magnetic resonance spectroscopy (1H-MRS). METHODS: 1H-MRS was performed with a 3.0 T MR system on the thalamus bilaterally in 20 patients with migraine without aura, 16 patients with trigeminal neuralgia and 14 healthy control subjects. RESULTS: In the patients with trigeminal neuralgia, metabolite concentration ratios except for Cho/Cr in thalami were different from those of healthy subjects (p>0.05). In migraine group, only NAA/Cho is low in the left thalamus (p>0.05). Comparing the metabolite concentration ratios of affected and contralateral sides in migraine and trigeminal neuralgia groups, only NAA/Cr showed a significant difference (p>0.05). CONCLUSION: It was proved that migraine and trigeminal neuralgia seemed to be associated with an abnormal balance of the neural activity in the thalamus using 1H-MRS. There was some significant difference between metabolite concentration ratios in two diseases. 1H-MRS may serve as a useful non-invasive tool for evaluating thalamic neural activity and therapy effect in clinical performance of patients with migraine without aura.

Gamma knife surgery for refractory postherpetic trigeminal neuralgia: targeting in one session both the retrogasserian trigeminal nerve and the centromedian nucleus of the thalamus.

OBJECT: The authors tested the hypothesis that two targets are needed to treat postherpetic trigeminal neuralgia (TN): one in the trigeminal nerve for the direct sharp pain and one in the thalamus for the diffuse burning pain. METHODS: Three patients with refractory postherpetic TN were treated with gamma knife surgery (GKS) through a novel two-target approach. In a single treatment session, both the trigeminal nerve and centromedian nucleus were targeted. First, the trigeminal nerve, ipsilateral to the facial pain, was treated with 60 to 80 Gy. Second, the centromedian nucleus was localized using standard coordinates and by comparing magnetic resonance images with a stereotactic atlas. A single dose of 120 to 140 Gy was delivered to the target point with a single 4-mm isocenter. Patients were followed clinically and with neuroimaging studies. Pain relief was scored as excellent (75-100%), good (50-75%), poor (25-50%); or none (0-25%). Follow up ranged from 6 to 53 months. There were no GKS-related complications. Two patients died of unrelated medical illnesses but had good or excellent pain relief until death. One patient continues to survive with 44 months follow up and no decrease in pain intensity, but with a decreased area of pain. CONCLUSIONS: Combined GKS of the centromedian nucleus and trigeminal nerve in a single treatment session is feasible and safe, and the effect was promising. A larger study is required to confirm and expand these results.

Orofacial neurogenic pain and maxillofacial ischemic osteonecrosis. A review.

Cavitary alveolar osteopathy was described as an oral disorder of infectious origin characterized by the presence of osteopathic alveolar cavity lesions of significant size though radiologically undetectable and secondary to dental extractions for chronic infectious processes of the alveolar bone of the jaws. Such cavitary alveolar osteopathy has been implicated as a common cause in the origin of idiopathic trigeminal neuralgia and atypical facial pain. The concept of cavitary alveolar osteopathy caused by ischemic necrosis of alveolar bone was introduced in 1992. Recent coagulation studies have reported ischemic alterations in alveolar bone marrow as a cause of cavitation; following tooth extraction, maxillary osteonecrosis could result from thrombosis with or without hyperfibrinolysis, which in turn would lead to obstruction of the vascular spaces -- thereby compromising regional blood flow.

Trigeminal neuralgia triggered by auditory stimuli in multiple sclerosis.

OBJECTIVES: To describe a patient with a demyelinating brainstem lesion who developed right-sided trigeminal neuralgia triggered by auditory stimuli and to discuss the pathophysiological mechanisms underlying this unusual phenomenon. DESIGN: Case report. SETTING: Referral center. PATIENT: A 27-year-old man who presented with clinical signs of a brainstem lesion developed right-sided trigeminal neuralgia triggered by auditory stimuli to the right ear. Magnetic resonance imaging and electrophysiological studies demonstrated a demyelinating lesion in the pons affecting the right lateral lemniscus and the right trigeminal pathway. This phenomenon completely subsided within 4 days. After a relapse, the diagnosis of clinically definite multiple sclerosis was made. CONCLUSION: Lateral spread of impulse activity within the demyelinating pontine lesion is the likely explanation for the unusual phenomenon of trigeminal neuralgia triggered by auditory stimuli.