OBJECTIVETo observe the differences of therapeutic effect in primary trigeminal neuralgia (PTN) of hyperactive of liver yang type treated by deep and shallow puncturing at Xiaguan (ST 7).

METHODSSixty-three cases of PTN of hyperactive of liver yang type were randomly divided into a deep puncturing group (32 cases) and a shallow puncturing group (31 cases). Xiaguan (ST 7) of affected region, Hegu (LI 4) and Taichong (LV 3) of bilateral sides, Cuanzhu (BL 2), Sibai (ST 2) and Jiachengjiang (Extra) relevant to the affected branch of nerve stem were selected in both groups. In deep puncturing group, Xiaguan (ST 7) was punctured to the depth of spheno-palatine ganglion (SPG); Cuanzhu (BL 2), Sibai (ST 2) and Jiachengjiang (Extra) were respectively punctured to the depth of supraorbital foramen, infraorbital foramen and mental foramen. In shallow group, routine puncturing was applied; the needles were connected with G6805 electric acupuncture apparatus, and switched on for 30 min every time; the treatment was applied every other day. Pain index, traditional Chinese medicine symptoms index and clinical therapeutic effect were observed after 2 courses of treatment.

RESULTSIn deep puncturing group, the VAS scores and the traditional Chinese medicine symptoms scores (pain degree, pain frequency, upsetting, conjunctival congestion, bitter mouth and hypochondriac pain) after treatment were much more lower than those before treatment (all P < 0.01); in shallow puncturing group, except hypochondriac pain (P > 0.05), other indices above after treatment were obviously lower than those before treatment (P < 0.01, P < 0.05). Compared with the indices in both groups after treatment, the VAS scores, the pain degree, conjunctival congestion and total scores of traditional Chinese medicine symptoms in deep puncturing group were more significant (all P < 0.05). The total effective rate was 93.8% (30/32) in deep puncturing group, superior to that of 87.1% (27/31) in shallow puncturing group (P < 0.05). No any adverse reaction was observed in both groups.

CONCLUSIONThe therapeutic effect of trigeminal neuralgia of hyperactive of liver yang type treated with electroacupuncture is remarkable, and deep puncturing at Xiaguan(ST 7) to SPG is more effective than routine puncturing.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Diagnosis, Differential ; Female ; Humans ; Liver ; physiopathology ; Male ; Middle Aged ; Trigeminal Neuralgia ; diagnosis ; physiopathology ; therapy

OBJECTIVETo evaluate trigeminal function of patients with chronic masticatory muscle pain (MMP) using trigeminal somatosensory evoked potential (TSEP) and analyze mechanism of changes compared to the controls.

METHODSTwelve chronic MMP patients and 12 matched controls participated in this study. TSEPs of bilateral masseter regions and inferior alveolar nerves were measured and compared between patient and control groups. The collected waves were concluded and those with appearance rate over 75% - 100% were selected. The latencies of waves were analyzed by use of the paired t test and independent-samples t test.

RESULTSFive stable-appearing waves were obtained and named P1, N1, P2, N2, P3. The latency of P1 was significant reduced in patients (P < 0.05). The latencies of other waves were prolonged, but only P2 and N2 in left were significantly changed (P < 0.05).

CONCLUSIONSTSEP latencies of chronic MMP patients changed in certain regular pattern and TSEP could be used as a parameter to disclose the trigeminal system abnormalities of the patients. The reduced latency of P1 might indicate the increasing conductivity of trigeminal nerves under level of ganglion Gasseri and the prolongation of latency of P2 was possibly related to inhibitory effects of the brain stem.

Adult ; Case-Control Studies ; Chronic Disease ; Evoked Potentials, Somatosensory ; physiology ; Female ; Humans ; Male ; Masticatory Muscles ; physiopathology ; Middle Aged ; Neuralgia ; diagnosis ; physiopathology ; Trigeminal Nerve ; physiopathology ; Young Adult

Occipital neuralgia is defined by the International Headache Society as paroxysmal shooting or stabbing pain in the dermatomes of the greater or lesser occipital nerve. Various treatment methods exist, from medical treatment to open surgical procedures. Local injection with corticosteroid can improve symptoms, though generally only temporarily. More invasive procedures can be considered for cases that do not respond adequately to medical therapies or repeated injections. Radiofrequency lesioning of the greater occipital nerve can relieve symptoms, but there is a tendency for the pain to recur during follow-up. There also remains a substantial group of intractable patients that do not benefit from local injections and conventional procedures. Moreover, treatment of occipital neuralgia is sometimes challenging. More invasive procedures, such as C2 gangliotomy, C2 ganglionectomy, C2 to C3 rhizotomy, C2 to C3 root decompression, neurectomy, and neurolysis with or without sectioning of the inferior oblique muscle, are now rarely performed for medically refractory patients. Recently, a few reports have described positive results following peripheral nerve stimulation of the greater or lesser occipital nerve. Although this procedure is less invasive, the significance of the results is hampered by the small sample size and the lack of long-term data. Clinicians should always remember that destructive procedures carry grave risks: once an anatomic structure is destroyed, it cannot be easily recovered, if at all, and with any destructive procedure there is always the risk of the development of painful neuroma or causalgia, conditions that may be even harder to control than the original complaint.
Anesthetics/therapeutic use ; Botulinum Toxins/therapeutic use ; Electric Stimulation ; Humans ; Magnetic Resonance Imaging ; Nerve Block ; Neuralgia/*diagnosis/surgery/therapy ; Spinal Nerves/anatomy & histology/*physiopathology ; Steroids/pharmacology

Neuropathic pain can be divided into sympathetically maintained pain (SMP) and sympathetically independent pain (SIP). Rats with tibial and sural nerve transection (TST) produce neuropathic pain behaviors, including spontaneous pain, tactile allodynia, and cold allodynia. The present study was undertaken to examine whether rats with TST would represent SMP- or SIP-dominant neuropathic pain by lumbar surgical sympathectomy. The TST model was generated by transecting the tibial and sural nerves, leaving the common peroneal nerve intact. Animals were divided into the sympathectomy group and the sham group. For the sympathectomy group, the sympathetic chain was removed bilaterally from L2 to L6 one week after nerve transection. The success of the sympathectomy was verified by measuring skin temperature on the hind paw and by infra red thermography. Tactile allodynia was assessed using von Frey filaments, and cold allodynia was assessed using acetone drops. A majority of the rats exhibited withdrawal behaviors in response to tactile and cold stimulations after nerve stimulation. Neither tactile allodynia nor cold allodynia improved after successful sympathectomy, and there were no differences in the threshold of tactile and cold allodynia between the sympathectomy and sham groups. Tactile allodynia and cold allodynia in the neuropathic pain model of TST are not dependent on the sympathetic nervous system, and this model can be used to investigate SIP syndromes.
Tibial Neuropathy/*classification/physiopathology ; Tibial Nerve/*injuries ; Sympathectomy ; Sural Nerve/*injuries ; Rats, Sprague-Dawley ; Rats ; Neuralgia/*classification/diagnosis ; *Models, Animal ; Male ; Animals

Neuropathic pain can be divided into sympathetically maintained pain (SMP) and sympathetically independent pain (SIP). Rats with tibial and sural nerve transection (TST) produce neuropathic pain behaviors, including spontaneous pain, tactile allodynia, and cold allodynia. The present study was undertaken to examine whether rats with TST would represent SMP- or SIP-dominant neuropathic pain by lumbar surgical sympathectomy. The TST model was generated by transecting the tibial and sural nerves, leaving the common peroneal nerve intact. Animals were divided into the sympathectomy group and the sham group. For the sympathectomy group, the sympathetic chain was removed bilaterally from L2 to L6 one week after nerve transection. The success of the sympathectomy was verified by measuring skin temperature on the hind paw and by infra red thermography. Tactile allodynia was assessed using von Frey filaments, and cold allodynia was assessed using acetone drops. A majority of the rats exhibited withdrawal behaviors in response to tactile and cold stimulations after nerve stimulation. Neither tactile allodynia nor cold allodynia improved after successful sympathectomy, and there were no differences in the threshold of tactile and cold allodynia between the sympathectomy and sham groups. Tactile allodynia and cold allodynia in the neuropathic pain model of TST are not dependent on the sympathetic nervous system, and this model can be used to investigate SIP syndromes.
Tibial Neuropathy/*classification/physiopathology ; Tibial Nerve/*injuries ; Sympathectomy ; Sural Nerve/*injuries ; Rats, Sprague-Dawley ; Rats ; Neuralgia/*classification/diagnosis ; *Models, Animal ; Male ; Animals

Charcot-Marie-Tooth disease (CMT) is the most common inherited motor and sensory neuropathy. Previous studies have found that, according to CMT patients, neuropathic pain is an occasional symptom of CMT. However, neuropathic pain is not considered to be a significant symptom associated with CMT and, as a result, no studies have investigated the pathophysiology underlying neuropathic pain in this disorder. Thus, the first animal model of neuropathic pain was developed by our laboratory using an adenovirus vector system to study neuropathic pain in CMT. To this end, glycyl-tRNA synthetase (GARS) fusion proteins with a FLAG-tag (wild type [WT], L129P and G240R mutants) were expressed in spinal cord and dorsal root ganglion (DRG) neurons using adenovirus vectors. It is known that GARS mutants induce GARS axonopathies, including CMT type 2D (CMT2D) and distal spinal muscular atrophy type V (dSMA-V). Additionally, the morphological phenotypes of neuropathic pain in this animal model of GARS-induced pain were assessed using several possible markers of pain (Iba1, pERK1/2) or a marker of injured neurons (ATF3). These results suggest that this animal model of CMT using an adenovirus may provide information regarding CMT as well as a useful strategy for the treatment of neuropathic pain.
Animals ; Charcot-Marie-Tooth Disease/*diagnosis/*physiopathology ; *Disease Models, Animal ; Glycine-tRNA Ligase/*genetics/metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Transgenic ; Mutagenesis, Site-Directed ; Mutation/genetics ; Neuralgia/*diagnosis/*physiopathology

Charcot-Marie-Tooth disease (CMT) is the most common inherited motor and sensory neuropathy. Previous studies have found that, according to CMT patients, neuropathic pain is an occasional symptom of CMT. However, neuropathic pain is not considered to be a significant symptom associated with CMT and, as a result, no studies have investigated the pathophysiology underlying neuropathic pain in this disorder. Thus, the first animal model of neuropathic pain was developed by our laboratory using an adenovirus vector system to study neuropathic pain in CMT. To this end, glycyl-tRNA synthetase (GARS) fusion proteins with a FLAG-tag (wild type [WT], L129P and G240R mutants) were expressed in spinal cord and dorsal root ganglion (DRG) neurons using adenovirus vectors. It is known that GARS mutants induce GARS axonopathies, including CMT type 2D (CMT2D) and distal spinal muscular atrophy type V (dSMA-V). Additionally, the morphological phenotypes of neuropathic pain in this animal model of GARS-induced pain were assessed using several possible markers of pain (Iba1, pERK1/2) or a marker of injured neurons (ATF3). These results suggest that this animal model of CMT using an adenovirus may provide information regarding CMT as well as a useful strategy for the treatment of neuropathic pain.
Animals ; Charcot-Marie-Tooth Disease/*diagnosis/*physiopathology ; *Disease Models, Animal ; Glycine-tRNA Ligase/*genetics/metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Transgenic ; Mutagenesis, Site-Directed ; Mutation/genetics ; Neuralgia/*diagnosis/*physiopathology