OBJECTIVETo observe the clinical efficacy on primary trigeminal neuralgia treated with joint needling method at the trigger point.

METHODSOne hundred and three cases of primary trigeminal neuralgia were divided into a joint needling group (53 cases) and a conventional needling group (50 cases) according to the visit sequence. In the joint needling group, the joint needling method was used at the trigger point in the mandibular joint [the positive point near to Xiaguan (ST 7)]; the conventional needling was used at Hegu (LI 4), Waiguan (TE 5), Taichong (LR 3) and Neiting (ST 44). In the conventional needling group, Xiaguan (ST 7) and Fengchi (GB 20) were used and the supplementary acupoints were selected according to the involved branches of trigeminal nerve. The conventional needling method was used. The Visual Analogue Scale (VAS) and the score of trigeminal neuralgia were adopted to assess the pain severity and the comprehensive symptoms before treatment and after the 1st and 2nd sessions of treatment separately. The efficacy was assessed.

RESULTSAfter the 1st and 2nd sessions of treatment, VAS score and the comprehensive symptom score were reduced obviously as compared with those before treatment in either group (P < 0.05, P < 0.01). The score reducing in the joint needling group was much superior to that in the conventional needling group (both P < 0.05). The total effective rate was 90.6% (48/53) and 72. 0% (36/50) in the joint needling group and the conventional needling group respectively. The effect in the joint needling group was better than that in the conventional needling group (P < 0.05).

CONCLUSIONThe joint needling method at the trigger point achieves the significant efficacy on primary trigeminal neuralgia, which is superior to that with the conventional needling method.

Acupuncture Points ; Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Neuralgia ; physiopathology ; therapy ; Trigeminal Nerve ; physiopathology ; Trigeminal Neuralgia ; physiopathology ; therapy ; Trigger Points ; physiopathology ; Young Adult

Diseases and injuries to the nervous system can lead to a devastating chronic pain condition called neuropathic pain. We review changes that occur in the peripheral nervous system that may play a role in this disease. Common animal models for neuropathic pain involve an injury to one or more peripheral nerves. Following such an injury, the nerve fibers that have been injured exhibit many abnormal properties including the development of spontaneous neural activity as well as a change in the expression of certain genes in their cell body. Recent data indicate that adjacent, uninjured nerve fibers also exhibit significant changes. These changes are thought to be driven by injury-induced alterations in the milieu surrounding the uninjured nerve and nerve terminals. Thus, alteration in neural signaling in both injured and uninjured neurons play a role in the development of neuropathic pain after peripheral nerve injury.
Animals ; Disease Models, Animal ; Nerve Fibers ; pathology ; Neuralgia ; physiopathology ; Neurons, Afferent ; cytology ; Peripheral Nerve Injuries ; physiopathology

PURPOSE: Pain from osteoarthritis (OA) is generally classified as nociceptive (inflammatory). Animal models of knee OA have shown that sensory nerve fibers innervating the knee are significantly damaged with destruction of subchondral bone junction, and induce neuropathic pain (NP). Our objective was to examine NP in the knees of OA patients using painDETECT (an NP questionnaire) and to evaluate the relationship between NP, pain intensity, and stage of OA. MATERIALS AND METHODS: Ninety-two knee OA patients were evaluated in this study. Pain scores using Visual Analogue Scales (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), painDETECT, duration of symptoms, severity of OA using the Kellgren-Lawrence (KL) system, and amount of joint fluid were evaluated and compared using a Spearman's correlation coefficient by rank test. RESULTS: Our study identified at least 5.4% of our knee OA patients as likely to have NP and 15.2% as possibly having NP. The painDETECT score was significantly correlated with the VAS and WOMAC pain severity. Compared with the painDETECT score, there was a tendency for positive correlation with the KL grade, and tendency for negative correlation with the existence and amount of joint fluid, but these correlations were not significant. CONCLUSION: PainDETECT scores classified 5.4% of pain from knee OA as NP. NP tended to be seen in patients with less joint fluid and increased KL grade, both of which corresponded to late stages of OA. It is important to consider the existence of NP in the treatment of knee OA pain.
Aged ; Aged, 80 and over ; Female ; Humans ; Knee/pathology/physiopathology ; Male ; Middle Aged ; Neuralgia/*physiopathology ; Osteoarthritis, Knee/*physiopathology

OBJECTIVE: To investigate the abnormalities in regional homogeneity of brain activity in patients with diabetic peripheral neuropathy (DPN) using resting-state functional magnetic resonance imaging (rs-fMRI) and explore the association between brain activity changes and DPN. METHODS: A regional homogeneity (ReHo) approach was used to compare the local synchronization of rs-fMRI signals among 20 patients with painful DPN, 16 patients with painless DPN, and 16 type 2 diabetic patients without DPN (non-DPN group). RESULTS: Compared with the those without DPN, the patients with painful DPN showed high ReHo in the left inferior temporal gyrus and the right central posterior gyrus, and low ReHo in the posterior cingulate gyrus, right inferior parietal gyrus, and the left superior parietal gyrus ( < 0.05);the patients with painless DPN group showed high ReHo in the left inferior temporal gyrus, the right middle temporal gyrus, and the right superior frontal gyrus, and low ReHo in the left thalamus ( < 0.05).No significant differences in ReHo were found between the patients with painful DPN and painless DPN (>0.05). CONCLUSIONS The patients with DPN have altered ReHo in multiple brain regions and impairment of a default mode network, for which the left temporal gyrus may serve as a functional compensatory brain area. ReHo disturbance in the central right posterior gyrus may play a central role in the pain symptoms associated with painful DPN.
Brain ; diagnostic imaging ; physiopathology ; Brain Mapping ; methods ; Diabetic Neuropathies ; physiopathology ; Gyrus Cinguli ; diagnostic imaging ; physiopathology ; Humans ; Magnetic Resonance Imaging ; methods ; Neuralgia ; physiopathology ; Temporal Lobe ; diagnostic imaging ; physiopathology

Peripheral nerve injury often results in abnormal neuropathic pain such as allodynia or hyperalgesia. Acupuncture, a traditional Oriental medicine, has been used to relieve pain and related symptoms. However, the efficiency of acupuncture in relieving neuropathic pain is not clear. The aim of this study was to investigate the anti-allodynic effects of acupuncture through behavioral and electrophysiological examinations. Male Sprague-Dawley rats were subjected to neuropathic surgery consisting of a tight ligation and transection of the left tibial and sural nerves, under pentobarbital anesthesia. The acupuncture experiment consisted of four different groups, one treated at each of three different acupoints (Zusanli (ST36), Yinlingquan (SP9), and a sham-acupoint) and a control group. Behavioral tests for mechanical allodynia and cold allodynia were performed for up to two weeks postoperatively. Extracellular electrophysiological recordings were made from the dorsal roots using platinum wire electrodes. Mechanical and cold allodynia were significantly reduced after acupuncture treatment at the Zusanli and Yinlingquan acupoints, respectively. Electrophysiological neural responses to von Frey and acetone tests were also reduced after acupuncture at the same two acupoints. These results suggest that acupuncture may be beneficial in relieving neuropathic pain.
Spinal Nerve Roots/*physiology ; Rats, Sprague-Dawley ; Rats ; Neuralgia/physiopathology/*therapy ; Male ; Electrophysiology ; Animals ; *Acupuncture Analgesia

Peripheral nerve injury often results in abnormal neuropathic pain such as allodynia or hyperalgesia. Acupuncture, a traditional Oriental medicine, has been used to relieve pain and related symptoms. However, the efficiency of acupuncture in relieving neuropathic pain is not clear. The aim of this study was to investigate the anti-allodynic effects of acupuncture through behavioral and electrophysiological examinations. Male Sprague-Dawley rats were subjected to neuropathic surgery consisting of a tight ligation and transection of the left tibial and sural nerves, under pentobarbital anesthesia. The acupuncture experiment consisted of four different groups, one treated at each of three different acupoints (Zusanli (ST36), Yinlingquan (SP9), and a sham-acupoint) and a control group. Behavioral tests for mechanical allodynia and cold allodynia were performed for up to two weeks postoperatively. Extracellular electrophysiological recordings were made from the dorsal roots using platinum wire electrodes. Mechanical and cold allodynia were significantly reduced after acupuncture treatment at the Zusanli and Yinlingquan acupoints, respectively. Electrophysiological neural responses to von Frey and acetone tests were also reduced after acupuncture at the same two acupoints. These results suggest that acupuncture may be beneficial in relieving neuropathic pain.
Spinal Nerve Roots/*physiology ; Rats, Sprague-Dawley ; Rats ; Neuralgia/physiopathology/*therapy ; Male ; Electrophysiology ; Animals ; *Acupuncture Analgesia

Activation of microglia plays a vital role in the initiation and maintenance of specific neuropathic pain states. By activating microglia in central nervous system, Toll-like receptor 4 (TLR4) can promote the release of proinflammatory cytokines and neuroactive compounds, participate in the initiation and maintenance of neuropathic pain, and trigger the opiate side effects. Therefore, TLR4 may be a potential therapeutic target for neuropathic pain. Inhibition of TLR4 has shown some biological effects in neuropathic pain models and ibudilast (the TLR4 pathway-inhibiting agent) has been approved for for phase 2 clinical trials. This article briefly reviews the structure, function, and mechanism of TLR4 as well as the development of TLR4-targeted drugs.
Humans ; Neuralgia ; drug therapy ; physiopathology ; Toll-Like Receptor 4 ; antagonists & inhibitors ; physiology

Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Neuralgia ; surgery ; Spinal Nerves ; physiopathology

Voltage-gated sodium channels are critical for the generation and conduction of nerve impulses. Recent studies show that in primary sensory neurons, the expression and dynamic regulation of several sodium channel subtypes play important roles in neuropathic pain. A number of SCN9A (encoding Nav1.7) gene point mutations are related with human genetic pain disorders. Transgenic and specific knockout techniques have revealed that Nav1.3, Nav1.8, Nav1.9 are important for the development and maintenance of neuropathic pain condition. Specific blockers of these sodium channels have been demonstrated to be effective in alleviating allodynia and hyperalgesia. Here we reviewed the roles of sodium channels in neuropathic pain, which may be applicable for the development of new drugs with enhanced efficacy for neuropathic pain treatment.
Animals ; Humans ; Neuralgia ; genetics ; metabolism ; physiopathology ; Neurons ; metabolism ; physiology ; Sodium Channels ; genetics ; metabolism ; physiology

OBJECTIVETo provide a set of the self-help and mutual-aid treatment with moxibustion to deal with myofasicial pain syndrome (MPS) of the back for the military soldiers.

METHODSFifty-eight cases were randomly devided into a moxibustion group (30 cases) and a plaster application group (28 cases). In the moxibustion group, the suspended moxibustion was applied to Yanglingquan (GB 34) for 15 min. The moxibustion massage device was used to massage the pain area. Under the physician's guides, the self-help or mutual-aid treatment was adopted. In the plaster application group, Goupi Gao (a black plaster used in TCM) was used on the local pain area. The treatment was given once every day in either group, lasting for 5 days. The clinical symptom scale, clinical physical sign scale, functional disturbance scale, functional disturbance index, comprehensive economic benefit and the others were adopted to analyze and compare the clinical efficacies between the two groups.

RESULTSBoth moxibustion and the plaster application achieved a certain efficacy on MPS of the back in the soldiers and either of them received the obvious improvements in the clinical symptoms, physical signs and functional disturbance (P < 0.01, P < 0.05). The results in the moxibustion group were superior to those in the plaster application group (P < 0.01, P < 0.05). In terms of the comprehensive economic benefit index, the result in the moxibustion group was better than that in the plaster application group. The total effective rate was 96.7% (29/30) in the moxibustion group and was 35.7% (10/28) in the plaster application group. The efficacy in the moxibustion group was superior to that in the plaster application group (P < 0.01).

CONCLUSIONThe self-help or mutual-aid treatment with moxibustion achieves the satisfactory clinical efficacy on MPS of the back in the military soldiers. It reduces the conventional medical cost and the military medical expenditure. This therapeutic approach is suitable to be promoted in the military.

Adult ; Facial Neuralgia ; physiopathology ; therapy ; Humans ; Military Personnel ; Moxibustion ; methods ; Young Adult