Paroxysmal Lancinating Pain Research Articles

Ultrasound Guided Infraorbital Nerve Radiofrequency Thermocoagulation in Patients with Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a sudden intensive orofacial pain disorder characterized by a unilateral recurrent paroxysmal lancinating pain occurring in the area of trigeminal nerve distribution. Diagnosis is made with characteristic clinical presentations and requires brain magnetic resonance imaging to rule out intracranial tumor or multiple sclerosis which potentially causes secondary TN. Among the various interventional managements, the conventional radiofrequency thermocoagulation (RFT) of Gasserian ganglion results in the highest rate of complete pain relief. We report two cases who presented severe facial pain due to intractable TN of V2 division. For pain relief, Gasserian ganglion RFT was planned. However, both patients could not tolerate the neck extension and chin-up position. Therefore, ultrasound guided infraorbital nerve RFT which does not require such position was performed successfully. When the patients came to the pain clinic 2 weeks later, the numerical rating scale for TN was 2/10 with mild hypoesthesia of V2 division. Infraorbital nerve RFT is an alternative option in patients who is unable to tolerate the ganglion RFT. Keywords: Radio waves, Trigeminal nerve, Trigeminal neuralgia, Ultrasonography

Gamma knife radiosurgery: Making lives merrier for refractory trigeminal neuralgia

Trigeminal neuralgia (TN), also known as tic Dolorex, is a unilateral paroxysmal lancinating pain affecting one or more of the branches of the trigeminal nerve. The treatment of TN can be very challenging despite the numerous options patients and physicians can choose from. Stereotactic radiosurgery (SR) with gamma knife surgery (GKS) is a rapidly emerging surgical modality in the management of medically refractory TN. GKS is the most recent and least invasive neurosurgical treatment alternative to microvascular decompression and rhizotomies. The gamma knife is a complex machine that uses cobalt-60 as energy and is able to focus a precise intersection of 201 beams of these gamma rays to perform radiosurgery. It is associated with a low risk of facial paresthesia, an approximately 80% rate of significant pain relief, and a low recurrence rate.

Occipital Neuralgia

Occipital pain is a common complaint amongst patients with headache, and the differential can include many primary headache disorders such as cervicogenic headache or migraine. Occipital neuralgia is an uncommon cause of occipital pain characterized by paroxysmal lancinating pain in the distribution of the greater, lesser or third occipital nerves. Greater occipital nerve blockade with anesthetics and/or corticosteroids can aid in confirming the diagnosis and providing pain relief. However, nerve blocks are also effective in migraine headache and misdiagnosis can result in a false positive. Physical therapy and preventive medication with antiepileptics and tricyclic antidepressants are often effective treatments for occipital neuralgia. Refractory cases may require intervention with pulsed radiofrequency or occipital nerve stimulation.

Trigeminal Neuralgia Caused by a Choroid Plexus Papilloma of the Cerebellopontine Angle: Case Report and Review of the Literature

This report describes a 59-year old woman with a rare choroid plexus papilloma of the cerebellopontine angle presenting with trigeminal neuralgia. The patient was admitted complaining of a 12-year history of paroxysmal lancinating pain throughout the right side of her face. Treatment with carbamazepine, Chinese medicine and a peripheral neurectomy had not relieved the pain. At operation, a 0.5 x 0.5 x 0.5 cm neoplasm was found in the cerebellopontine angle, which was firmly adherent to the roots of the seventh and eighth cranial nerves and the brainstem. There was no apparent tumour bulk or vascular compression around the trigeminal nerve root entry zone. Subtotal tumour excision and selective partial rhizotomy were performed. The patient's facial pain gradually resolved. Involvement of the trigeminal nucleus in the brainstem by the cerebellopontine angle tumour is suggested as the possible cause for trigeminal neuralgia in this case.

Idiopathic familial trigeminal neuralgia: a case report

Trigeminal neuralgia (TN) is paroxysmal, lancinant pain often described as an "electric wave" by patients, with involvement of the divisions of the fifth cranial nerve. Demyelinating, compressive, ischaemic diseases are involved in the physiopathology of TN, but there are some cases without explanation. Familial TN (FTN) is a rare condition, about 1%-2% of all TN cases, while sporadic cases are the most common. To date, there have been about 126 reports of FTN. We describe the case of a 66-year-old man who had been complaining for 3 years of right-side paroxysmal lancinating pain in the second division of the fifth cranial nerve. A brain MRI with angiographic sequences did not show neurovascular conflicts or other pathological conditions. The patient had a family history of TN, which had been diagnosed in 3 other family members (father, sister and first cousin), who had undergone medical or surgical treatment for TN. There was no family history of hypertension, metabolic disorders, neurological or traumatic diseases. Animal studies have shown a probable involvement of genes codifying for calcium channels as the starting alterations in trigeminal excitability. Our FTN could be a good model to investigate the role of gene mutations in this condition.

Postherpetic Neuralgia: The Never‐Ending Challenge

Postherpetic neuralgia (PHN) is defined as pain that persists 1 to 3 months following the rash of herpes zoster (HZ). PHN affects about 50% of patients over 60 years of age and 15% of all HZ patients. Patients with PHN may experience two types of pain: a steady, aching, boring pain and a paroxysmal lancinating pain, usually exacerbated by contact with the involved skin. Herpes zoster is initially a clinical diagnosis, based on the observation of a typical dermatomal distribution of rash and radicular pain. HZ is pathologically characterized by inflammatory necrosis of dorsal root ganglia, occasionally associated with evidence of neuritis, leptomeningitis, and segmental unilateral degeneration of related motor and sensory roots. Although acyclovir has been used successfully as standard therapy for varicella zoster virus (VZV) infection in the past decade, resistant strains of VZV are often recognized in immunocompromised patients. Therapy with acyclovir and the use of corticosteroids have been reported to prevent PHN in up to 60% of HZ patients. Management of chronic pain in PHN is more problematic. The only therapy proven effective for PHN in controlled study is the use of tricyclic antidepressants, including amitriptyline and desipramine. There is good evidence of efficacy from randomized trials that gabapentin and pregabalin (new anticonvulsant drugs) are of benefit in the reduction of pain from PHN. As alternative therapies, topical agents such as capsaicin, lidocaine or opioid analgesic treatment may give satisfactory results. Interventions with low risk, such as transcutaneous electrical nerve stimulation (TENS), are appropriate. Evidence is scant for the value of surgical and procedural interventions in general, although there are numerous, small studies supporting the use of specific interventions such as nerve blocks, neurosurgical procedures, and neuroaugmentation. Although antiviral agents are appropriate for acute HZ, and the use of neural blockade and sympathetic blockade may be helpful in reducing pain in selected patients with HZ, there is little evidence that these interventions will reduce the likelihood of developing PHN. Postherpetic neuralgia remains a difficult pain problem. This review describes the epidemiology and pathophysiology of PHN and discusses proposed mechanisms of pain generation with emphasis on the various pharmacological treatments and invasive modalities currently available.

Recurrent or refractory trigeminal neuralgia after microvascular decompression, radiofrequency ablation, or radiosurgery

Trigeminal neuralgia (TN) is characterized by paroxysmal lancinating pain in the trigeminal nerve distribution. When TN is refractory to medical management, patients are referred for microvascular decompression (MVD), radiofrequency ablation, or radiosurgery. After the initial treatment, patients may have refractory or recurrent symptoms requiring retreatment. The purpose of this study was to determine what factors are associated with the need for retreatment and which modality is most effective. To define this population further, the authors evaluated a cohort of patients who required retreatment for TN. The mean follow-up periods were 51 months from the first treatment and 23 months from the last one, and these were comparable among treatment groups. Trigeminal neuralgia can recur after neurosurgical treatment. In this study the authors demonstrate that the number of patients requiring retreatment is not negligible. Lower retreatment rates were seen in patients who initially underwent radiosurgery, compared with those in whom MVD or radiofrequency ablation were performed. Radiosurgery was more likely to be the final treatment for recurrent TN regardless of the initial treatment. After retreatment, the majority of patients attained complete or very good pain relief. Pain relief after retreatment correlates with postoperative facial numbness.

Delirium during the Treatment of Postherpetic Neuralgia -A case report-

Postherpetic neuralgia is sequelae to a herpes zoster infection. It represents with intractable burning pain, allodynia and paroxysmal lancinating pain. Although various therapeutic modalities have been applied to relieve these pains, no definite remedies have been established. Herein is report a patient with postherpetic neuralgia, treated with combination drug therapy; intravenous ketamine, oral dextromethorphan, anticonvulsant, antidepressant, opioid and nonsteroidal anti-inflammatory drugs. He developed sudden delirium after the third administration of intravenous ketamine, and required 5 days hospitalization to recover from his symptom. Furthermore, he was accidentally found to have an arterial aneurysm of his left middle cerebral artery, which had unruptured.

Idopathic tigeminal neuralgia: Radiophrequency rhizotomy of ganglion Gasseri

Idiopathic trigeminal neuralgia (ITN), (tic dou-loureux), may be defined as a chronic painfull disorder of the sensory divisions of the trigeminal nerve, with unexplained cause and pathogenesis. The clinical features are characterized by recurrent paroxysmal lancinating pain confined to distribution of one or more branches of the nerve. Radiofrequency rhizotomy (RFR) of ganglion Gasseri is a methode of choise in treatment of ITN. We present the series of 1600 patients suffering from ITN who underwent RFR between 1984 and 2001. Ages ranged from 29 to 88 years, with a mean age of 62 years. Total pain relief immediately after a single radiofrequency lesion was achieved in 1469 (92%) of patients. After one year a recurrence of pain was present in 145 (10%). Age, sex and duration of illness were unrelated to outcome. Patients previously treated by open surgery appeared to receive less benefit from subsequent RFR. Clinical outcome correlated with the degree of sensory deficit created by RFR. Patients acquiring dense deficit demonstrated a reduced risk of recurrence: 203/1129 (18%) of patients with dense sensory loss and 75/258 (29%) of those with a partial deficit developed a recurrence by three years, whereas almost all patients (78/82) without initial sensory loss suffered a recurrence by three years. Serious complications resulting from RFR were infrequent and the most common was the permanent dysesthesia in 9 (0.6%) of patients. Our results suggest that the RFR is an well bearable and effective longterm surgical treatment for ITN, especially for older and poor-risk patients.

The Effect of an Intravenous Ketamine Infusion on a Patient Who Had Suffered from Postherpetic Neuralgia

people recover from herpes zoster with no pain, but some patients, especially elderly people, go to the state of postherpetic neuralgia. Herpes zoster viruses destroy all the nerves from skin to dorsal root ganglion and nerves at the spinal level. After this central sensitization, abnormal ephaptic relays occur. Patients complain of allodynia, spontaneous burning pain, paroxysmal lancinating pain, and dullness on the lesion site. Now many remedies are available but a panacea does not exist. Ketamine is an antagonist of the N-methyl-D-aspartate (NMDA) receptor that has a crucial role in central sensitization. We met a 66-year-old woman who had suffered from postherpetic neuralgia for 10 years. We tried nerve blocks several times and medicated with various drugs but the outcome was not satisfactory. Lastly we tried ketamine infusion therapy and the result was excellent.