• Journal of Oral Medicine and Pain
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• v.25 no.2
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• pp.229-234
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• 2000

The patient, 62-years-old woman, had a constant dull pain in the right mandible and an intermittent spontaneous burning sensation of the mouth. The pain began 6 months ago. About 5 years ago, a trauma in her right mandible which was so severe that kept her in the hospital for 2 days. This was followed by mouth opening disturbance with pain for about 2 years. However, she did not have a treatment for the temporomandibular disorder symptoms. After then, she experienced the trigeminal neuralgia characterized by an electrical pain which lasted about 30 minutes in her right face and head when touching the skin or hair. After taking a year course treatment of trigeminal neuralgia, the symptom disappeared. The pain was a constant dull pain and a intermittent burning pain which are contradictory. And the pain responded to various modalities such as physical therapy, anti-inflammatory drug, carbamazepine, and amitriptyline, among which carbamazepine was most effective. The diagnosis was clinically made as an atypical trigeminal neuralgia. The term 'atypical' is used when there is something unknown and the problem is not identified. It is thought that an atypical pain may be approached in the perspective of chronic pain, neuropathic pain, and myofascial pain, the mchanisms of which are poorly understood. As the knowledge of pain physiology improves, there needs to be modification and re-evaluation. Pain disorders must be classified on the basis of an understanding of the underlying mechanism and etiology.

• Journal of Oral Medicine and Pain
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• v.33 no.4
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• pp.353-374
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• 2008

The descriptive epidemiology of specific neuropathic pain disorders has not been well-des-cribed, although the burden of neuropathic pain is well recognized. The true incidence of neuro-pathic pain disorder is unknown, but it is believed to be under diagnosed and treated inade-quately, despite the development of various diagnostic system. The purpose of this study was to report the epidemiology of specific neuropathic pain as managed by all kinds of hospital in Korea. A descriptive analysis of the epidemiology of prevalent trigeminal neuralgia(TN)(n-=77,053 27,6%), atypical facial pain(AFP)(n=12,382 4.4%), glossopharyngeal neuralgia(GN)-(n=1,319 0.5%), post-herpetic neuralgia(PHN)-(n=84,598 30.3%), diabetic neuropathy(DN)-(n=85,989 30.8%), atypical odontalgia(AO)-(n=16,001 5.7%) and glossodynia(GD)(n=2,133 0.8%) and treatment departments and treatment durations from computerized Health Insurance Review and Assessment Service(HIRA) of Korea: January 2003 to December 2005, are reported with rates increasing over time for PHN and DN and decreasing for the other neuropathic pain disorders. Most patients were treated at private clinic record for 57.6-72.8% of patients except OA for 10.3%. The percentage of Dept of dentistry for outpatients was 3.2% for TN, 34.7% for AO and 15.4% for GD. Other neuropathic pain patients visited nearly medical clinic.

• Journal of The Korean Dental Society of Anesthesiology
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• v.3 no.1 s.4
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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.

• Journal of Pharmacopuncture
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• v.17 no.1
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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.

• International Journal of Oral Biology
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• v.34 no.3
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• pp.157-164
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• 2009

We recently described a novel animal model of trigeminal neuropathic pain following compression of the trigeminal ganglion (Ahn et al., 2009). In our present study, we adapted this model using male Sprague-Dawley rats weighing between 250-260 g and then analyzed the behavioral responses of these animals following modified chronic compression of the trigeminal ganglion. Under anesthesia, the rats were mounted onto a stereotaxic frame and a 4% agar solution ($10{\mu}L$) was injected in each case on the dorsal surface of the trigeminal ganglion to achieve compression without causing injury. In the control group, the rats received a sham operation without agar injection. Air-puff, acetone, and heat tests were performed at 3 days before and at 3, 7, 10, 14, 17, 21, 24, 30, 40, 55, and 70 days after surgery. Compression of the trigeminal ganglion produced nociceptive behavior in the trigeminal territory. Mechanical allodynia was established within 3 days and recovered to preoperative levels at approximately 60 days following compression. Mechanical hyperalgesia was also observed at 7 days after compression and persisted until the postoperative day 40. Cold hypersensitivity was established within 3 days after compression and lasted beyond postoperative day 55. In contrast, compression of the trigeminal ganglion did not produce any significant thermal hypersensitivity when compared with the sham operated group. These findings suggest that compression of the trigeminal ganglion without any injury produces prolonged nociceptive behavior and that our rat model is a useful system for further analysis of trigeminal neuralgia.

• Journal of Korean Neurosurgical Society
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• v.63 no.6
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• pp.814-820
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• 2020

Objective : Trigeminal neuralgia (TN) is a severe neuropathic condition that affects several elderly patients. It is characterized by uncontrolled pain that significantly impacts the quality of life of patients. Therefore, the condition should be treated as an emergency. In the majority of patients, pain can be controlled with medication; however, other treatment modalities are being explored in those who become refractory to drug treatment. The use of the trigeminal nerve block with a local anesthetic serves as an excellent adjunct to drug treatment. This technique rapidly relieves the patient of pain while medications are being titrated to effective levels. We report the efficacy and safety of percutaneous trigeminal nerve block in elderly patients with TN at our outpatient clinic. Methods : Twenty-one patients older than 65 years with TN received percutaneous nerve block at our outpatient clinic. We used bupivacaine (1 mL/injection site) to block the supraorbital, infraorbital, superior alveolar, mental, and inferior alveolar nerves according to pain sites of patients. Results : All patients reported relief from pain, which decreased by approximately 78% after 2 weeks of nerve block. The effect lasted for more than 4 weeks in 12 patients and for 6 weeks in two patients. There were no complications. Conclusion : Percutaneous nerve block procedure performed at our outpatient clinic provided immediate relief from pain to elderly patients with TN. The procedure is simple, has no serious side effects, and is easy to apply.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.1
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• pp.47-56
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• 2024

Background: Among the various pain-related diseases that can be encountered at the clinic, there is a neuropathic pain that is difficult to treat. Numerous methods have been proposed to treat neuropathic pain, such as taking medication, nerve block with lidocaine, or neurolysis with alcohol or phenol. Recently, a method of perineural injection using dextrose instead of lidocaine was proposed. This study was designed to compare the effects of perineural injection therapy (PIT) with buffered 5% dextrose or 0.5% lidocaine on neuropathic pain. Methods: The data were collected from the database of pain clinic from August 1st, 2019 to December 31st, 2022 without any personal information. The inclusion criteria were patients diagnosed with postherpetic neuralgia (PHN), trigeminal neuralgia (TN), complex regional pain syndrome (CRPS), or peripheral neuropathy (PN), and patients who had undergone PIT with buffered 5% dextrose (Dextrose group) or 0.5% lidocaine (Lidocaine group) for pain control. The data of patients, namely sex, age, and pain score (numerical rating scale, NRS) were collected before PIT. The data of NRS, side effects, and satisfaction grade (excellent, good, fair, or poor) were collected one week after each of the four PIT, and two weeks after the last PIT. Results: Overall, 112 subjects were enrolled. The Dextrose group included 89 and Lidocaine group included 23 patients. Because the number of patients in the Lidocaine group was too small to allow statistical analysis, the trend in Lidocaine group was just observed in each disease. There were no significant side effects except for a few bruise cases on the site of injection in all groups. The NRS in most Dextrose groups except CRPS were reduced significantly; however, the Lidocaine group showed a trend of pain reduction only in PHN. The Dextrose group except CRPS showed increased satisfaction two weeks after the final PIT. Conclusion: From the results, it is suggested that PIT with buffered 5% dextrose may have a good effect for neuropathic pain without any side effect except for patients with CRPS. This may offer a window into a new tool that practitioners can employ in their quest to help patients with neuropathic pain.

• Journal of Yeungnam Medical Science
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• v.35 no.1
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• pp.104-108
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• 2018

Syncope is defined as a transient loss of consciousness and postural tone, characterized by rapid onset, short duration, and spontaneous recovery. Stellate ganglion block (SGB) is a nerve block method that is used for treatment of neuropathic pain in the head, neck and upper extremities, especially trigeminal neuralgia, postherpetic neuralgia and complex regional pain syndrome. SGB can modulate and stabilize the sympathetic nervous system, which prevents it from overexcitation and improves symptoms of syncope. The authors report a patient who was treated for pain and edema of both upper extremities with SGB, then showed improvement in recurrent syncope followed by chest pain and overall quality of life.

• The Korean Journal of Pain
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• v.34 no.1
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• pp.4-18
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• 2021

Except for carbamazepine for trigeminal neuralgia, gabapentinoid anticonvulsants have been the standard for the treatment of neuropathic pain. Pregabalin, which followed gabapentin, was developed with the benefit of rapid peak blood concentration and better bioavailability. Mirogabalin besylate (DS-5565, Tarlige®) shows greater sustained analgesia due to a high affinity to, and slow dissociation from, the α2δ-1 subunits in the dorsal root ganglion (DRG). Additionally, it produces a lower level of central nervous system-specific adverse drug reactions (ADRs), due to a low affinity to, and rapid dissociation from, the α2δ-2 subunits in the cerebellum. Maximum plasma concentration is achieved in less than 1 hour, compared to 1 hour for pregabalin and 3 hours for gabapentin. The plasma protein binding is relatively low, at less than 25%. As with all gabapentinoids, it is also largely excreted via the kidneys in an unchanged form, and so the administration dose should also be adjusted according to renal function. The equianalgesic daily dose for 30 mg of mirogabalin is 600 mg of pregabalin and over 1,200 mg of gabapentin. The initial adult dose starts at 5 mg, given orally twice a day, and is gradually increased by 5 mg at an interval of at least a week, to 15 mg. In conclusion, mirogabalin is anticipated to be a novel, safe gabapentinoid anticonvulsant with a greater therapeutic effect for neuropathic pain in the DRG and lower ADRs in the cerebellum.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.11 no.1
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• pp.9-16
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• 2015

Pain and sensory disorder resulting from injury to peripheral nerves of the face and jaws are a major source of patient dissatisfaction and suffering. The majority of patient who sustain injuries to the peripheral sensory nerves of the face and jaws experience a slow but orderly return of sensation that is functional and tolerable in quality, if not "normal". For many patients, however, the long-term effects are a source of aggravation, and for a few, a significant cause of suffering. Common complaints relate to reduced sensory information causing embarrassing food accumulations or drooling, biting a burning the lip or tongue, and difficulty in performing routine activities such as shaving and apply makeup. For some patients posttraumatic symptoms become pathological and frankly painful. The predominent pain components are (1) numbing anesthesia dolorosa pain, (2) triggered neuralgiaform pain, (3) burning, aching causalgiaform pain, and (4) phantom pain. This is a report of cases about posttraumatic pain syndrome associated with dental treatment in a psychologically disabled patient.