scholarly journals A Case of Multiple Recurrences of Trigeminal Neuralgia: Attributed to Central Sensitization?

2021 ◽  
Author(s):  
Yuankun Cai ◽  
Xiuling Zhang ◽  
Xuan Dai ◽  
Songshan Chai ◽  
Bangkun Yang ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Central Sensitization ◽  
Facial Pain ◽  
Trigger Point ◽  
Trigger Points ◽  
Disease Development ◽  
Multiple Recurrence ◽  
Case Presentation ◽  
Multiple Recurrences ◽  
Surgical Treatments

Abstract Background Although many hypotheses about the pathogenesis of trigeminal neuralgia have been developed, there is little discussion about the multiple recurrences of trigeminal neuralgia. Case presentation Here we report a patient with refractory multiple recurrent trigeminal neuralgia, in which we accordingly found that an increase in facial pain trigger points and a rapid movement of the upper limb extremity could trigger an onset of trigeminal neuralgia. We offer hypothesis on the multiple recurrences of trigeminal neuralgia by explaining the cause of multiple trigger points in this patient. Conclusions Given that central sensitization is involved in a number of mechanisms of pain development and is associated with some of the symptoms of trigeminal neuralgia. We hypothesized that central sensitization may have been involved in the disease development of this case of refractory trigeminal neuralgia, which led to the development of trigger point generalization and multiple recurrence after surgical treatments.

scholarly journals A novel method to treat recurrent facial pain: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Jintakorn Kuvatanasuchati ◽  
Karoon Leowsrisook
Keyword(s):  
Case Report ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Case Presentation ◽  
Facial Movements ◽  
Novel Treatment ◽  
Effective Cost ◽  
Novel Method

Abstract Background Chronic facial pain is a serious condition affecting millions of people worldwide. The reasons for chronic facial pain vary, and currently, the methods of treating chronic facial pain are expensive, invasive, and, based on current findings, ineffective. The purpose of this study is to develop and test an effective, cost-friendly method to treat patients with chronic facial pain. This study will examine the effectiveness of a novel treatment of a patient suffering from trigeminal neuralgia. Case presentation A 70-year-old Thai female visited the advanced general dentistry clinic at the Faculty of Dentistry, Mahidol University, Bangkok, Thailand. She was suffering from facial pain on her left side and was diagnosed by a physician as having trigeminal neuralgia. She experienced a sharp shooting pain that was triggered by facial movements such as chewing, speaking, or brushing teeth, and touching certain areas of her face. Bouts of pain lasted from a few seconds to several minutes, and episodes of several attacks lasted days, weeks, months, or longer prior to her visit to the advanced general dentistry clinic at Mahidol University. Physician designed an occlusal equilibration appliance for treating the patient by inserting the appliance in the mouth for dental occlusal equilibration (deprogram). The patient used this appliance by placing it in the mouth continuously (day and night) and removed it only when eating. After using the appliance for 2 weeks, the patient appeared to feel and look better prior to taking medication and was able to eat normally. The patient was pain free after treatment for a duration of 9 months. However, after 9 months, the pain reoccurred and manifested itself. Conclusion This novel treatment of recurrent facial pain showed an improvement of the patient’s chronic facial pain and serves as evidence to being a novel method for treating those suffering from trigeminal neuralgia.

Myofascial Trigger Points and Sensitization: An Updated Pain Model for Tension-Type Headache

Cephalalgia ◽  
2007 ◽  
Vol 27 (5) ◽  
pp. 383-393 ◽  
Author(s):  
C Fernández-de-las-Peñas ◽  
ML Cuadrado ◽  
L Arendt-Nielsen ◽  
DG Simons ◽  
JA Pareja
Keyword(s):  
Central Sensitization ◽  
Trigger Point ◽  
Trigger Points ◽  
Tension Type Headache ◽  
Referred Pain ◽  
Tender Points ◽  
Myofascial Trigger Points ◽  
Pain Model ◽  
Type Headache ◽  
Chemical Mediators

Present pain models for tension-type headache suggest that nociceptive inputs from peripheral tender muscles can lead to central sensitization and chronic tension-type headache (CTTH) conditions. Such models support that possible peripheral mechanisms leading to pericranial tenderness include activation or sensitization of nociceptive nerve endings by liberation of chemical mediators (bradikinin, serotonin, substance P). However, a study has found that nonspecific tender points in CTTH subjects were not responsible for liberation of algogenic substances in the periphery. Assuming that liberation of algogenic substances is important, the question arising is: if tender muscle points are not the primary sites of on-going neurogenic inflammation, which structure can be responsible for liberation of chemical mediators in the periphery? A recent study has found higher levels of algogenic substances, and lower pH levels, in active myofascial trigger point (TrPs) compared with control tender points. Clinical studies have demonstrated that referred pain elicited by head and neck muscles contribute to head pain patterns in CTTH. Based on available data, an updated pain model for CTTH is proposed in which headache can at least partly be explained by referred pain from TrPs in the posterior cervical, head and shoulder muscles. In this updated pain model, TrPs would be the primary hyperalgesic zones responsible for the development of central sensitization in CTTH.

scholarly journals P.086 The clinical significance of trigeminal neuralgia nomenclature

2016 ◽  
Vol 43 (S2) ◽  
pp. S40-S40
Author(s):  
SV Nolin ◽  
L Barchet ◽  
A Kaufmann
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Classification Systems ◽  
Headache Disorders ◽  
Trigeminal Neuropathy ◽  
Study Population ◽  
Surgical Treatments

Background: A diagnosis of trigeminal neuralgia (TN) may be broadly applied to many neuralgic facial pains, while more stringent criteria are required for management decisions, outcome assessment, and pathophysiological correlations. Our aim was to evaluate existing classification systems of facial pain. Methods: The study population was comprised of 534 Manitobans referred to neurosurgery for facial pain from 2001 to 2013. A retrospective chart review identified presenting features; pain distribution, nature, and duration. The recorded diagnoses (rDx) were then re-classified according to the International Classification of Headache Disorders (ICHD-3) and Burchiel System of TN1 and TN2. Results: There was complete correlation between rDx and ICHD-3 for typical TN (tTN) in 266(49.8%) patients, atypical TN (aTN) in 39(7.3%), and idiopathic facial pain (IFP) in 59(11%). Idiopathic trigeminal neuropathy (iTn) in 35(6.6%) was not classified in ICHD-3. Burchiel-TN1 included heterogeneous diagnoses including tTN (266), aTN (27), iTn (2) and IFP (8); Burchiel-TN2 included aTN (10), iTn (23), and IFP (15). Another 135(25.5%) had other facial pain diagnoses. Conclusions: Classification of TN is especially important when selecting and evaluating surgical treatments. Diagnostic criteria should clearly differentiate between unique conditions and ideally have basis on underlying etiology. The ICHD-3 nomenclature best satisfies these aims although should be expanded to include iTn.

scholarly journals Injecction of trigger points in the temporal muscles of patients with miofascial syndrome

2015 ◽  
Vol 73 (10) ◽  
pp. 861-866 ◽  
Author(s):  
Svetlana Sabatke ◽  
Rosana Herminia Scola ◽  
Eduardo S. Paiva ◽  
Pedro André Kowacs
Keyword(s):  
Facial Pain ◽  
Myofascial Pain ◽  
Trigger Point ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Trigger Points ◽  
Control Group ◽  
Headache Frequency ◽  
Headache Intensity

Objective : The aim was to examine the effect of blocking trigger points in the temporal muscles of patients with masticatory myofascial pain syndrome, fibromyalgia and headache.Method : Seventy patients with one trigger point were randomly divided into 3 groups: injection with saline or anesthetic and non-injected (control).Results : Pain was reduced in 87.71% patients injected with saline and 100% injected with anesthetic. Similar results were obtained for headache frequency. With regard to headache intensity, the injection groups differed from the control group, but not between themselves.Conclusion : Treatment with injection at trigger points decreased facial pain and frequency and intensity of headache. Considering the injected substance there was no difference.

scholarly journals Percutaneous radiofrequency treatment of the gasserian ganglion for trigeminal neuralgia complicated by trochlear nerve palsy: a case report

2021 ◽  
pp. rapm-2020-102285
Author(s):  
Pascal SH Smulders ◽  
Michel AMB Terheggen ◽  
José W Geurts ◽  
Jan Willem Kallewaard
Keyword(s):  
Trigeminal Neuralgia ◽  
Cranial Nerve ◽  
Facial Pain ◽  
Anatomical Variations ◽  
Anterior Inferior Cerebellar Artery ◽  
Gasserian Ganglion ◽  
Radiofrequency Treatment ◽  
Experienced Pain ◽  
Cerebellar Artery ◽  
Trochlear Nerve Palsy

BackgroundTrigeminal neuralgia (TN) has the highest incidence of disorders causing facial pain. TN is provoked by benign stimuli, like shaving, leading to severe, short-lasting pain. Patients are initially treated using antiepileptic drugs; however, multiple invasive options are available when conservative treatment proves insufficient. Percutaneous radiofrequency treatment of the trigeminal, or gasserian, ganglion (RF-G) is a procedure regularly used in refractory patients with comorbidities. RF-G involves complex needle maneuvering to perform selective radiofrequency heat treatment of the affected divisions. We present a unique case of cranial nerve 4 (CN4) paralysis after RF-G.Case presentationA male patient in his 60s presented with sharp left-sided facial pain and was diagnosed with TN, attributed to the maxillary and mandibular divisions. MRI showed a vascular loop of the anterior inferior cerebellar artery without interference of the trigeminal complex. The patient opted for RF-G after inadequate conservative therapy. The procedure was performed by an experienced pain physician and guided by live fluoroscopy. The patient was discharged without problems but examined the following day for double vision. Postprocedural MRI showed enhanced signaling between the trigeminal complex and the brainstem. Palsy of CN4 was identified by a neurologist, and spontaneous recovery followed 5 months after the procedure.ConclusionsMention of postprocedural diplopia in guidelines is brief, and the exact incidence remains unknown. Different mechanisms for cranial nerve (CN) palsy have been postulated: incorrect technique, anatomical variations, and secondary heat injury. We observed postprocedural hemorrhage and hypothesized that bleeding might be a contributing factor in injury of CNs after RF-G.

scholarly journals The Automatization of a New Thermography Method Using Invasive Nociceptive Stimulation to Confirm an Autonomic Phenomenon within a Trigger Point Referred Pain Zone

2021 ◽  
Vol 11 (7) ◽  
pp. 893
Author(s):  
Elżbieta Skorupska ◽  
Tomasz Dybek ◽  
Michał Rychlik ◽  
Marta Jokiel ◽  
Paweł Dobrakowski
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Trigger Point ◽  
Invasive Procedure ◽  
Trigger Points ◽  
International Classification Of Diseases ◽  
Referred Pain ◽  
Low Back ◽  
Classification Of Diseases ◽  
Software Utility

The trigger points (TrPs) related to chronic low back pain that mimic sciatica have been lately recognized and included in the International Classification of Diseases, 11th Revision. This study examined the MATLAB software utility for the objective stratification of low back pain patients using the Minimally Invasive Procedure (MIP). The two diagnostic MIP parameters were: average temperature (ΔTavr) and autonomic referred pain (AURP). Chronic sciatica patients with TrPs (n = 20) and without TrPs (n = 20) were examined using the MIP. A significant increase in both parameters was confirmed for the thigh ROI of the TrP-positive patients, with ΔTavr being the leading parameter (p = 0.016, Exp(β) = 2.603). A continued significance of both parameters was confirmed from 6′00″ to 15′30″ (p < 0.05). The maximum AURP value was confirmed at 13′30″ (p < 0.05) (TrPs(+) 20.4 ± 19.9% vs. TrPs(-) 3.77 ± 9.14%; p = 0.000; CI (0.347,0.348)).

scholarly journals The local spread of pheochromocytoma after adrenalectomy with a rupture of the tumor capsule at the time of the surgery

Open Medicine ◽  
2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Ryszard Pogorzelski ◽  
Sadegh Toutounchi ◽  
Patryk Fiszer ◽  
Ewa Krajewska ◽  
Izabela Łoń ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Chromaffin Cell ◽  
Cell Tumor ◽  
Cell Seeding ◽  
Case Presentation ◽  
Tumor Capsule ◽  
Exact Localization ◽  
Local Spread ◽  
The Right ◽  
Multiple Recurrences

AbstractIntroduction: We present a case of a 29-year-old patient treated due to fully symptomatic pheochromocytoma of the right adrenal gland. Case presentation: Patient was operated on and an open right-sided adrenalectomy was performed. At the time of the surgery, a rupture of the tumor capsule occurred. Five years post-operatively, a recurrence of the symptoms of chromaffin-cell tumor was noted. After the exact localization of the multiple recurrences, the patient was reoperated on. Conclusion: The case of pheochromocytoma is presented due to the possibility of chromaffin-cell seeding into the peritoneum, with no signs of distal metastases so far.

Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers

1974 ◽  
Vol 40 (2) ◽  
pp. 143-156 ◽  
Author(s):  
William H. Sweet ◽  
James G. Wepsic
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Electrical Heating ◽  
Gasserian Ganglion ◽  
Foramen Ovale ◽  
Content Type ◽  
Corneal Scarring ◽  
Radiofrequency Heating ◽  
Neurological Morbidity ◽  
Fine Print

✓ The authors report their experience in the treatment of trigeminal neuralgia with controlled increments of radiofrequency heating from an electrode placed in the Gasserian ganglion or its posterior rootlets. Touch is preserved in some or all of a trigeminal zone rendered analgesic. The electrode tip is introduced through the foramen ovale and placed among the desired rootlets with the help of a combination of radiographs and the conscious patient's response to electrical stimulation with a square wave signal and gentle electrical heating. The degree of heat is measured by a thermister at the electrode tip. The patient's cooperation is maintained by the use of the neurolept anesthetic Innovar and the production of brief unconsciousness for the painful parts of the operation by methohexital (Brevital). Of 274 patients with facial pain so treated, 214 had trigeminal neuralgia; 91% of the latter group experienced relief of pain and 125 followed for 2½ to 6 years had a recurrence rate of 22%. In a total of 353 procedures, there has been no mortality and no neurological morbidity outside the trigeminal nerve. Only six of the patients with trigeminal neuralgia have complained significantly of postoperative paresthesias. The most serious undesired result has been the production of an anesthetic cornea in 28 patients, one of whom lost the sight of one eye due to corneal scarring. Correlating findings in our patients with those in studies by other authors, we conclude that the preservation of some touch is due to resistance to heating by the heavily myelinated A-beta fibers.

scholarly journals Neuralgias of the Trigeminal Nerve

2000 ◽  
Vol 5 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Allan S Gordon
Keyword(s):  
Neuropathic Pain ◽  
Differential Diagnosis ◽  
Trigeminal Neuralgia ◽  
Clinical Features ◽  
Trigeminal Nerve ◽  
Postherpetic Neuralgia ◽  
Facial Pain ◽  
The Other ◽  
Atypical Facial Pain ◽  
Trigeminal Neuropathic Pain

Practitioners are often presented with patients who complain bitterly of facial pain. The trigeminal nerve is involved in four conditions that are sometimes mixed up. The four conditions - trigeminal neuralgia, trigeminal neuropathic pain, postherpetic neuralgia and atypical facial pain - are discussed under the headings of clinical features, differential diagnosis, cause and treatment. This article should help practitioners to differentiate one from the other and to manage their care.

Imaging of Trigeminal Neuralgia and Other Facial Pain

2021 ◽  
Vol 31 (4) ◽  
pp. 485-508
Author(s):  
Rudolf Boeddinghaus ◽  
Andy Whyte
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain
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