• Journal of Dental Anesthesia and Pain Medicine
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• 제21권5호
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• pp.379-396
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• 2021

Background: Trigeminal neuralgia (TN) is characterized by brief, unilateral, sharp, stabbing, and shooting pain of the fifth cranial nerve. The objective of this systematic review with meta-analysis was to determine the effect of medications compared to placebo in adult patients with TN. Methods: Review authors identified randomized placebo-controlled trials (RCTs) from PubMed, Web of Science, Cochrane, and EMBASE up to February 2021. We assessed the inclusion and exclusion criteria as well as the risk of bias of the studies based on the Cochrane Handbook. A total of 324 unduplicated references were scanned independently and reduced to eight relevant RCTs, with 89 patients included. Medications investigated included oral carbamazepine, subcutaneous sumatriptan, lidocaine (intranasal, 8% spray on the oral mucosa or intravenous), buprenorphine (ganglionic local opioid analgesia), and oral Nav1.7, a selective sodium channel blocker. Results: Meta-analyses showed that overall patients receiving lidocaine reported a significantly lower post-treatment intensity of pain -3.8 points on a 0-10 scale (95% Cl = -4.653 to -2.873; P < 0.001). Patients who received lidocaine were 8.62 times more likely to have pain improvement than patients on placebo (P < 0.001). In one RCT, patients receiving oral carbamazepine showed a significant improvement in pain intensity of -32% compared to the placebo (P < 0.001). In one trial, patients receiving 3 mg subcutaneous sumatriptan had a significantly lower intensity of pain on average -6.1 points on a scale of 0-10 compared to placebo (P < 0.001) and a significant improvement in pain intensity of -75% compared to the improvement in the placebo group (P < 0.001). Patients who received subcutaneous sumatriptan were 10 times more likely to have pain improvement than those who received placebo (P = 0.001) in one study. Due to the unclear/high risk of bias and small sample size, the quality of the evidence for lidocaine in the treatment of TN was low. Conclusion: Further studies are needed for carbamazepine, sumatriptan, buprenorphine, and oral Nav1.7 sodium channel blockers, as only one study reported outcomes.

• Journal of Oral Medicine and Pain
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• 제44권3호
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• pp.123-126
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• 2019

Vestibular schwannoma, also known as acoustic neuroma, is a rare benign brainstem tumor surrounding the vestibular division of the 8th cranial nerve. The presenting symptoms are hearing loss, tinnitus, and dizziness. Unabated growth can compress 5th (trigeminal nerve) and 7th (facial nerve) cranial nerve, which can cause nerve dysfunction such as orofacial pain, sensory abnormalities, or trigeminal neuralgia. We report a 51-year-old woman who presented with orofacial dysesthesia on her left side of the face with abnormal findings on 5th cranial nerve and 8th (vestibulocochlear nerve) cranial nerve examination. Brain magnetic resonance imaging scan revealed cerebellopontine angle tumor. She was referred to a neurosurgeon and diagnosed with vestibular schwannoma.

• 대한치과마취과학회지
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• 제3권1호
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• pp.6-9
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• 2003

Background: The use of neurolytic agents to control neuropathic pain has been described from the last century Phenol and ethyl alcohol have been widely used as neurolytic agents, however, their neurolytic effect is variable in efficacy and duration of action, and infrequently accompanied with grave complications. It has been found that 5% lidocaine causes irreversible conduction blockade in animal studies. The goal of this study was to evaluate the neurolytic effect of 5%o lidocaine on various neuropathic pain syndromes for prolonged analgesia. Methods: Twenty-five patients with a diagnosis of neuropathic pain including trigeminal neuralgia (n = 7), postherpetic neuralgia (n = 10), and postsurgical neuralgia (n = 8) were selected after failure of routine therapeutic regimens. After performing a diagnostic nerve block with 1% lidocaine and 5% lidocaine was injected. The patients were followed for 6 months. Visual analog scale (VAS) scores and side effects were recorded for each patients. Results: A significant decrease in pain scores after neurolytic blockade with 5% lidocaine was seen in all of three pain groups. All the patients reported immediate and prolonged pain relief lasting from 4 weeks to 6 months. None of patients exhibited any appreciable side effects or complications. Conclusions: We suggest that 5% lidocaine may be used safely and effectively for the purpose of prolonged analgesia in selected patients with intractable neuropathic pain syndromes.

• The Korean Journal of Pain
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• 제1권2호
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• pp.154-163
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• 1988

In 1983, Sten H$\ddot{a}$kanson first reported the clinical safety and efficacy of retrogasserian glycerol injection as a treatment of typical trigeminal neuralgia in 96 of 100 patients during a follow-up period of 1~6 years. Since September 1987, we have injected sterile pure glycerol into the trigeminal cistern using an anterior percutaneous approach via the foramen ovale (H$\ddot{a}$rtel route) for treatment of tic douloureux in 12 patients who were suffering from attacks pain of following discontinuation of carbamazepine. The results were as follows; 1) Eight patients were completely free from pain attacks with a single dose of glycerol (0.4 ml). The remaining four patients needed a second dose (0.4 ml) several days later following the single dose. The degree of patient's subjective satisfaction by those injections was very good in 11 and fair in one. 2) During the follow-up period (1~13 months), persistent sensory deficit as determined by the pin prick test, appeared to be mild in 10 and moderate in one patient. There was no sensory deficit in one patient. further attacks of pain from those injections were still noted. 3) As a transient complication, there was headache in all patient, facial hematoma in 4, nausea and vomiting in two each, and vertigo and herpes simplex in one each. In conclusion, we confirmed that the above glycerol injections into the trigeminal cistern were clinically very effective as a treatment of tic douloureux even though the follow-up period was short.

• 대한약침학회지
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• 제17권1호
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• pp.74-79
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• 2014

Objectives: This study was conducted to clarify the analgesic effect of toad cake and toad-cake-containing herbal drugs. Methods: We counted the writhing response of mice after the intraperitoneal administration of acetic acid as a nociceptive pain model and the withdrawal response after the plantar surface stimulation of the hind paw induced by partial sciatic nerve ligation of the mice as a neuropathic pain model to investigate the analgesic effect of toad cake and toad-cake-containing herbal drugs. A co-treatment study with serotonin biosynthesis inhibitory drug 4-chloro-DL-phenylalanine methyl ester hydrochloride (PCPA), the catecholamine biosynthesis inhibitory drug ${\alpha}$-methyl-DL-tyrosine methyl ester hydrochloride (AMPT) or the opioid receptor antagonist naloxone hydrochloride was also conducted. Results: Analgesic effects in a mouse model of nociceptive pain and neuropathic pain were shown by oral administration of toad cake and toad-cake-containing herbal drugs. The effects of toad cake and toad-cake-containing herbal drugs disappeared upon co-treatment with PCPA, but not with AMPT or naloxone in the nociceptive pain model; the analgesic effect of toad-cake-containing herbal drugs also disappeared upon co-treatment with PCPA in the neuropathic pain model. Conclusion: Toad cake and toad-cake-containing herbal drugs have potential for the treatments of nociceptive pain and of neuropathic pain, such as post-herpetic neuralgia, trigeminal neuralgia, diabetic neuralgia, and postoperative or posttraumatic pain, by activation of the central serotonin nervous system.

• 한방안이비인후피부과학회지
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• 제26권3호
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• pp.87-94
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• 2013

Objectives : This is a clinical report on a 63-year-old female patient with Trigeminal Neuralgia (TN) treated by oriental medicine treatments. Methods : The patient was treated by acupuncture, moxibustion and herb medication. The improvement of the patient was judged by Visual Analog Scale(VAS). Results : The pain had been gradually reduced and VAS became 2 after the treatment for 25 days. Conclusions : Oriental medicine treatment including Bogigeopung-san was very effective to improve the TN patient's symptoms. It is necessary to have more observations and cases on the patients with TN.

• Radiation Oncology Journal
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• 제24권2호
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• pp.88-95
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• 2006

목적: 삼차신경통 환자에서 사이버나이프 방사선수술이 효과적이며 안전한 치료방법인지 알아보고자 하였다. 대상 및 방법: 2004년 3월부터 2005년 5월까지 수술 후 실패하였거나 수술이 부적합한 삼차신경통 환자 26명을 대상으로 사이버나이프 방사선수술을 시행하여 후향적 분석을 하였다. 치료 표적은 삼차신경근 진입구역으로부터 3 mm 떨어진 지점의 삼차신경 최고 근위부를 제외한 6 mm 길이의 삼차신경 부위를 설정하고, 그 부위에 80% 등선량 곡선에 단일 조사로 총방사선량은 $60{\sim}64Gy$를 조사하였다(중앙선량: 64 Gy). 결과: 추적관찰기간은 $3{\sim}15$개월이었다(중앙추적관찰기간 : 9개월). 대상환자 26명에서 사이버나이프 방사선수술 후 24시간 이내에 50% (13/26)에서 통증 완화를 관찰하였으며. 7일 이내에 조기 통증 완화를 보였던 환자는 96.2% (25/26)이었다. 치료 실패는 7.7% (2/26)에서 나타났으며 통증 개선 실패와 통증 재발이 각각 1명에서 관찰되었다. 치료 부작용으로 안면감각 감퇴가 11.5% (3/26)에서 관찰되었다. 결론: 삼차신경통 환자를 대상으로 사이버나이프 방사선수술을 시행한 예비 결과로 비교적 안전하며, 효과적인 치료임을 확인하였다.

• The Korean Journal of Pain
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• 제11권1호
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• pp.101-104
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• 1998

Backgrouds: Twent five years have passed since the opening of the first pain clinic in korea, in 1973 at Yonsei University Hospital. The number of pain clinics are gradually increasing in recent times. It is important to plan for future pain clinics with emphasis on improving the quality of pain management. Therefore we reviewed the patients in our hospital to help us in planning for the future of our pain clinic. Methods: We analyzed 2656 patients who had visited our Kim Chan Pain Clinic, accordance to age, sex, disease, and type of treatment block, from July 1996 to August 1997. Results: The prevalent age group was in the fifties, 27.3%, seventy years and older compromised 9.2%. The most common disease were as follows: lower back pain(46.2%); cervical and upper extremities pain(23.1%); trigeminal neuralgia(7.2%); and hyperhydrosis(5.8%) Both nerve blocks and medication were prescribed as treatment. Lumbar epidural block(16.3%) and stellate ganglion block(15.6%) were the most frequent blocks performed among various nerve blocks. Among nerve block under C-arm guidance, lumbar facet joint block(24.4%) and lumbar root block(22.5%) were performed most frequently. Trigeminal nerve block(18.4%), thoracic(17.0%) and lumbar sympathetic ganglion block(11.4%) were next most prevalent blocks performed frequent block. Conclusions: Treatments at our hospital were focused on nerve blocks and medications prescriptions. Nerve blocks are of particular importance in the diagnosis and treatment of chronic pain. However in future, to raise the quality of pain management, we need to fucus on a multidisciplinary/interdisciplinary team approach.

• 대한치과보존학회:학술대회논문집
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• 대한치과보존학회 2001년도 춘계학술대회
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• pp.252-252
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• 2001

;The Varicella zoster virus can cause two infectious diseases. The primary infection of this virus leads to Chicken pox and it goes into a latent period until it reveals itself again. When secondarily shown. it is called Herpes Zoster. Herpes Zoster can usually be seen between T-3 and L-2 of immunodepressant patients but in 13%. it is seen in the trigeminal nerve branch. During the predrominal stage. burning sensation, itching. and sharp pain can be experienced unilaterally where the nerve branch is distributed. Patients can also express tooth pain in this stage. After 2-4 days the acute stage begins with its characteristic unilateral macule showing vesicle formation. In this stage fever and fatigue can be experienced. Continuous pain even after the acute stage is called postherpetic neuralgia; deep pain and burning sensation can be expressed by the patient. The sequelae of this disease consists of rare osteomyelitis. necrosis of the jaws. or loss of teeth.teeth.

• Journal of Oral Medicine and Pain
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• 제35권1호
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• pp.93-99
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• 2010

대상포진(Herpes Zoster:HZ)은 수두 대상포진 바이러스(Varicella Zoster virus)에 의해 야기된 속발성 또는 잠복성 감염이다. 증령에 따라 바이러스 특이적 면역 및 세포 매개 면역력이 감소하면서 바이러스가 재활성화되기 때문에, 대상포진은 주로 노년층에서 호발한다. 대상포진에 이환되면, 극심한 급성 통증이 발생하게 되고 수개월에 걸쳐서 회복하게 된다. 포진후신경통(Postherpetic neuralgia:PNH)은 대상포진의 대표적인 합병증의 하나로, 대상포진에 이환된 후 발생한 통증이 3개월 이상 회복되지 않을 때, 포진후신경통으로 진단할 수 있다. 임상적 증상으로는 주기적으로 찌르는 듯한 통증이 동반되는 타는 듯한 통증, 이질통이 발생할 수 있으며, 감각저하 또는 지각이상을 보일 수 있다. $Neurometer^{(R)}$(neuroselective sensory nerve conduction threshold: sNCT, Automated current perception threshold: CPT, neurotron incorporated. Baltimore, Maryland. 21209 U.S.A.)는 신경의 감각이상을 평가하는 데 유용하게 쓰이는 평가기구이다. 이번 증례는 포진후신경통을 주소로 내원한 환자의 치료 증례를 통해, 포진후신경통의 발생기전을 고찰해보고, 그 치료법에 대하여 알아보고, 또한 치료과정 중의 경과관찰 방법으로서 $Neurometer^{(R)}$를 이용하여, 감각이상의 평가 및 경과관찰시 지각이상에 대한 정량적인 평가를 시도하였다.