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Allam AK, Larkin MB, Sharma H, Viswanathan A. Trigeminal and Glossopharyngeal Neuralgia. Neurol Clin 2024; 42:585-598. [PMID: 38575268 DOI: 10.1016/j.ncl.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Trigeminal neuralgia and glossopharyngeal neuralgia are craniofacial pain syndromes characterized by recurrent brief shock-like pains in the distributions of their respective cranial nerves. In this article, the authors aim to summarize each condition's characteristics, pathophysiology, and current pharmacotherapeutic and surgical interventions available for managing and treating these conditions.
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Affiliation(s)
- Anthony K Allam
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - M Benjamin Larkin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Himanshu Sharma
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
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2
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Sharav Y, Heiliczer S, Benoliel R, Haviv Y. Pharmacological Topical Therapy for Intra-Oral Post Traumatic Trigeminal Neuropathic Pain: A Comprehensive Review. Pharmaceuticals (Basel) 2024; 17:264. [PMID: 38399479 PMCID: PMC10893422 DOI: 10.3390/ph17020264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
Background: The efficacy of topical treatments in alleviating neuropathic pain is well-established. However, there is a paucity of research on topical interventions designed specifically for intra-oral application, where the tissue composition differs from that of exposed skin. Methods: This comprehensive review endeavors to assess the extant evidence regarding the efficacy of topical treatments in addressing neuropathic pain within the oral cavity. Utilizing combinations of search terms, we conducted a thorough search across standard electronic bibliographic databases-MEDLINE (via PubMed), Embase, Google Scholar, and Up to Date. The variables under scrutiny encompassed topical treatment, local intervention, chronic oral and orofacial pain, and neuropathic pain. All pertinent studies published in the English language between 1992 and 2022 were included in our analysis. Results: Fourteen relevant manuscripts were identified, primarily consisting of expert opinions and case reports. The comprehensive review suggests that topical treatments, especially when applied under a stent, could be effective in mitigating neuropathic pain in the oral area. However, it is crucial to conduct further studies to confirm these preliminary results. The limitations of the reviewed studies, mainly the reliance on expert opinions, small sample sizes, inconsistent study designs, and a lack of long-term follow-up data, highlight the need for more rigorous research. Conclusions: Although initial findings indicate topical treatments may be effective for oral neuropathic pain, the limitations of current studies call for more thorough research. Further comprehensive studies are essential to validate the efficacy of these treatments, standardize procedures, and determine long-term results. This will provide clearer guidance for treating chronic neuropathic pain in the oral cavity.
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Affiliation(s)
- Yair Sharav
- Department of Oral Medicine, Sedation and Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (Y.S.); (S.H.)
| | - Shimrit Heiliczer
- Department of Oral Medicine, Sedation and Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (Y.S.); (S.H.)
- Oral Medicine Unit, Oral and Maxillofacial Surgery Department, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
| | | | - Yaron Haviv
- Department of Oral Medicine, Sedation and Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (Y.S.); (S.H.)
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Mousavi SH, Lindsey JW, Westlund KN, Alles SRA. Trigeminal Neuralgia as a Primary Demyelinating Disease: Potential Multimodal Evidence and Remaining Controversies. THE JOURNAL OF PAIN 2024; 25:302-311. [PMID: 37643657 DOI: 10.1016/j.jpain.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
Trigeminal neuralgia is a heterogeneous disorder with likely multifactorial and complex etiology; however, trigeminal nerve demyelination and injury are observed in almost all patients with trigeminal neuralgia. The current management strategies for trigeminal neuralgia primarily involve anticonvulsants and surgical interventions, neither of which directly address demyelination, the pathological hallmark of trigeminal neuralgia, and treatments targeting demyelination are not available. Demyelination of the trigeminal nerve has been historically considered a secondary effect of vascular compression, and as a result, trigeminal neuralgia is not recognized nor treated as a primary demyelinating disorder. In this article, we review the evolution of our understanding of trigeminal neuralgia and provide evidence to propose its potential categorization, at least in some cases, as a primary demyelinating disease by discussing its course and similarities to multiple sclerosis, the most prevalent central nervous system demyelinating disorder. This proposed categorization may provide a basis in investigating novel treatment modalities beyond the current medical and surgical interventions, emphasizing the need for further research into demyelination of the trigeminal sensory pathway in trigeminal neuralgia. PERSPECTIVE: This article proposes trigeminal neuralgia as a demyelinating disease, supported by histological, clinical, and radiological evidence. Such categorization offers a plausible explanation for controversies surrounding trigeminal neuralgia. This perspective holds potential for future research and developing therapeutics targeting demyelination in the condition.
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Affiliation(s)
- Seyed H Mousavi
- Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - John W Lindsey
- Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Karin N Westlund
- Department of Anesthesiology & Critical Care Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Sascha R A Alles
- Department of Anesthesiology & Critical Care Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Yanko R, Badran Y, Leibovitz S, Sharav Y, Vered Y, Keshet N, Rettman A, Aframian DJ, Haviv Y. Exploring the Effect of Ethnicity on Chronic Orofacial Pain: A Comparative Study of Jewish and Arab Israeli Patients. Healthcare (Basel) 2023; 11:1984. [PMID: 37510424 PMCID: PMC10379038 DOI: 10.3390/healthcare11141984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/18/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
The relationship between ethnicity and chronic pain has been studied worldwide. The population of Israel includes two main ethnic groups, 75% Jews and 21% Arabs. The purpose of this study was to compare orofacial chronic pain characteristics and treatment outcomes between Jewish and Arab Israeli citizens. Two hundred patients admitted to the Orofacial Pain Clinic at Hebrew University-Hadassah School of Dental Medicine between 2017 and 2022 were selected randomly for this historical cohort study. Our cohort included 159 (79.5%) Jews and 41 (20.5%) Arabs. Twenty-six pain-related variables were compared of which only two differed significantly between the two groups, awakening due to pain and mean muscle sensitivity; both indicators were higher in the Arab group (p < 0.05). No differences were found in any of the other variables such as diagnosis, pain severity, onset, and treatment outcome. This minimal difference may be explained by the equal accessibility to medical services for all citizens, and the diversity of our staff that includes Jew as well as Arab service providers. These factors minimize or even eliminate racial bias, language, and cultural barriers, and is reflected in the minor differences in orofacial pain characteristics found between the two main ethnic groups in Israel.
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Affiliation(s)
- Robert Yanko
- Department of Oral Medicine, Sedation & Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Yaara Badran
- In Partial Fulfillment of DMD Requirements, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel
| | - Shirley Leibovitz
- Department of Pediatric Dentistry, Barzilai Medical Center, Ashkelon 78306, Israel
| | - Yair Sharav
- Department of Oral Medicine, Sedation & Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Yuval Vered
- Department of Community Dentistry, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Naama Keshet
- Department of Oral Medicine, Sedation & Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Andra Rettman
- Department of Oral Medicine, Sedation & Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Doron J Aframian
- Department of Oral Medicine, Sedation & Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Yaron Haviv
- Department of Oral Medicine, Sedation & Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
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Haviv Y. Unveiling Neurovascular Orofacial Pain: An Underdiagnosed Form of Chronic Orofacial Pain. Healthcare (Basel) 2023; 11:1722. [PMID: 37372839 DOI: 10.3390/healthcare11121722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
Neurovascular orofacial pain (NVOP) is a relatively rare type of facial pain syndrome that shares similarities with migraine, orofacial migraine, and trigeminal autonomic cephalalgias (TACs) [...].
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Affiliation(s)
- Yaron Haviv
- Faculty of Dental Medicine, Department of Oral Medicine, Sedation and Imaging, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem 91120, Israel
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Allam AK, Sharma H, Larkin MB, Viswanathan A. Trigeminal Neuralgia. Neurol Clin 2023; 41:107-121. [DOI: 10.1016/j.ncl.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Svedung Wettervik T, Snel D, Kristiansson P, Ericson H, Abu Hamdeh S. Incidence of trigeminal neuralgia: A population-based study in Central Sweden. Eur J Pain 2023; 27:580-587. [PMID: 36680398 DOI: 10.1002/ejp.2081] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/27/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The primary aim of this observational study was to determine the incidence of trigeminal neuralgia (TN) in a county in central Sweden. The secondary aim was to investigate TN characteristics including the affected side and nerve branches. METHODS Patients that received the ICD-10 diagnostic codes TN (G50.0), atypical facial pain (G50.1) and other/unspecified disorder of the trigeminal nerve (G50.8 and G50.9) in Uppsala County, between 2009 and 2017, were eligible for inclusion. Case ascertainment was conducted by the authors by review of the medical records. RESULTS The incidence of TN was estimated to be 5.5 (95% confidence interval 4.7-6.4) per 100,000 person-years. The incidence increased with age, from 0.1 in 0- to 19-year-olds to 23.1 per 100,000 person-years in 80+-year-olds. Females exhibited a higher incidence at 7.3 than males at 3.7 per 100,000 person-years. Most of the trigeminal neuralgia cases were diagnosed in the Neurology department (47%). Trigeminal neuralgia was most frequently right sided (59%) and limited to one cranial nerve V-branch, of which V2 was the most common. CONCLUSIONS Trigeminal neuralgia incidence was estimated to be 5.5 per 100,000 person-years. The incidence was higher for females and increased with older age. SIGNIFICANCE There is limited knowledge about the true incidence of trigeminal neuralgia. This manuscript provides an estimate of 5.5 cases per 100,000 person-years, by using a thorough case ascertainment methodology.
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Affiliation(s)
| | - Daniel Snel
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Per Kristiansson
- Department of Public Health and Caring Sciences, Section of Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Hans Ericson
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Sami Abu Hamdeh
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
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Salivary Endocannabinoid Profiles in Chronic Orofacial Pain and Headache Disorders: An Observational Study Using a Novel Tool for Diagnosis and Management. Int J Mol Sci 2022; 23:ijms232113017. [PMID: 36361803 PMCID: PMC9659113 DOI: 10.3390/ijms232113017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/28/2022] Open
Abstract
The endocannabinoid system is involved in physiological and pathological processes, including pain generation, modulation, and sensation. Its role in certain types of chronic orofacial pain (OFP) has not been thoroughly examined. By exploring the profiles of specific salivary endocannabinoids (eCBs) in individuals with different types of OFP, we evaluated their use as biomarkers and the influence of clinical parameters and pain characteristics on eCB levels. The salivary levels of anandamide (AEA), 2-arachidonoyl glycerol (2-AG), and their endogenous breakdown product arachidonic acid (AA), as well as the eCB-like molecules N-palmitoylethanolamide (PEA) and N-oleoylethanolamide (OEA), were assessed in 83 OFP patients and 43 pain-free controls using liquid chromatography/tandem mass spectrometry. Patients were grouped by diagnosis: post-traumatic neuropathy (PTN), trigeminal neuralgia (TN), temporomandibular disorder (TMD), migraine, tension-type headache (TTH), and burning mouth syndrome (BMS). Correlation analyses between a specific diagnosis, pain characteristics, and eCB levels were conducted. Significantly lower levels of 2-AG were found in the TN and TTH groups, while significantly lower PEA levels were found in the migraine group. BMS was the only group with elevated eCBs (AEA) versus the control. Significant correlations were found between levels of specific eCBs and gender, health-related quality of life (HRQoL), BMI, pain duration, and sleep awakenings. In conclusion, salivary samples exhibited signature eCBs profiles for major OFP disorders, especially migraine, TTH, TN, and BMS. This finding may pave the way for using salivary eCBs biomarkers for more accurate diagnoses and management of chronic OFP patients.
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Schott Andersen AS, Maarbjerg S, Noory N, Heinskou TB, Forman JL, Cruccu G, Ashina M, Bendtsen L. Safety and efficacy of erenumab in patients with trigeminal neuralgia in Denmark: a double-blind, randomised, placebo-controlled, proof-of-concept study. Lancet Neurol 2022; 21:994-1003. [DOI: 10.1016/s1474-4422(22)00294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022]
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Haviv Y, Georgiev O, Gaver-Bracha T, Hamad S, Nemirovski A, Hadar R, Sharav Y, Aframian DJ, Brotman Y, Tam J. Reduced Endocannabinoid Tone in Saliva of Chronic Orofacial Pain Patients. Molecules 2022; 27:molecules27144662. [PMID: 35889535 PMCID: PMC9322033 DOI: 10.3390/molecules27144662] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023] Open
Abstract
Background: the endocannabinoid system (ECS) participates in many physiological and pathological processes including pain generation, modulation, and sensation. Its involvement in chronic orofacial pain (OFP) in general, and the reflection of its involvement in OFP in salivary endocannabinoid (eCBs) levels in particular, has not been examined. Objectives: to evaluate the association between salivary (eCBs) levels and chronic OFP. Methods: salivary levels of 2 eCBs, anandamide (AEA), 2-arachidonoylglycerol (2-AG), 2 endocannabinoid-like compoundsN-palmitoylethanolamine (PEA), N-oleoylethanolamine (OEA), and their endogenous precursor and breakdown product, arachidonic acid (AA), were analyzed using liquid chromatography/tandem mass spectrometry in 83 chronic OFP patients and 43 pain-free controls. The chronic OFP patients were divided according to diagnosis into musculoskeletal, neurovascular/migraine, and neuropathic pain types. Results: chronic OFP patients had lower levels of OEA (p = 0.02) and 2-AG (p = 0.01). Analyzing specific pain types revealed lower levels of AEA and OEA in the neurovascular group (p = 0.04, 0.02, respectively), and 2-AG in the neuropathic group compared to controls (p = 0.05). No significant differences were found between the musculoskeletal pain group and controls. Higher pain intensity was accompanied by lower levels of AA (p = 0.028), in neuropathic group. Conclusions: lower levels of eCBs were found in the saliva of chronic OFP patients compared to controls, specifically those with neurovascular/migraine, and neuropathic pain. The detection of changes in salivary endocannabinoids levels related to OFP adds a new dimension to our understanding of OFP mechanisms, and may have diagnostic as well as therapeutic implications for pain.
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Affiliation(s)
- Yaron Haviv
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel; (O.G.); (T.G.-B.); (Y.S.); (D.J.A.); (J.T.)
- Correspondence: ; Tel.: +972-2-677-6140; Fax: +972-2-644-7919
| | - Olga Georgiev
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel; (O.G.); (T.G.-B.); (Y.S.); (D.J.A.); (J.T.)
- In Partial Fulfillment of DMD Requirements, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel
| | - Tal Gaver-Bracha
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel; (O.G.); (T.G.-B.); (Y.S.); (D.J.A.); (J.T.)
- In Partial Fulfillment of DMD Requirements, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel
| | - Sharleen Hamad
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (S.H.); (A.N.); (R.H.)
| | - Alina Nemirovski
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (S.H.); (A.N.); (R.H.)
| | - Rivka Hadar
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (S.H.); (A.N.); (R.H.)
| | - Yair Sharav
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel; (O.G.); (T.G.-B.); (Y.S.); (D.J.A.); (J.T.)
| | - Doron J. Aframian
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel; (O.G.); (T.G.-B.); (Y.S.); (D.J.A.); (J.T.)
| | - Yariv Brotman
- Department of Life Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel;
| | - Joseph Tam
- Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel; (O.G.); (T.G.-B.); (Y.S.); (D.J.A.); (J.T.)
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Huang B, Guo S, Zhang Y, Lin P, Lin C, Chen M, Zhu S, Huang L, He J, Zhang L, Zheng Y, Wen Z. MiR-223-3p alleviates trigeminal neuropathic pain in the male mouse by targeting MKNK2 and MAPK/ERK signaling. Brain Behav 2022; 12:e2634. [PMID: 35608154 PMCID: PMC9304854 DOI: 10.1002/brb3.2634] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/13/2022] [Accepted: 04/28/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a neuropathic pain that occurs in branches of the trigeminal nerve. MicroRNAs (miRNAs) have been considered key mediators of neuropathic pain. This study was aimed to elucidate the pathophysiological function and mechanisms of miR-223-3p in mouse models of TN. METHODS Infraorbital nerve chronic constriction injury (CCI-ION) was applied in male C57BL/6J mice to establish mouse models of TN. Pain responses were assessed utilizing Von Frey method. The expression of miR-223-3p, MKNK2, and MAPK/ERK pathway protein in trigeminal ganglions (TGs) of CCI-ION mice was measured using RT-qPCR and Western blotting. The concentrations of inflammatory cytokines were evaluated using Western blotting. The relationship between miR-223-3p and MKNK2 was tested by a luciferase reporter assay. RESULTS We found that miR-223-3p was downregulated, while MKNK2 was upregulated in TGs of CCI-ION mice. MiR-223-3p overexpression by an intracerebroventricular injection of Lv-miR-223-3p attenuated trigeminal neuropathic pain in CCI-ION mice, as well as reduced the protein levels of pro-inflammatory cytokines in TGs of CCI-ION mice. MKNK2 was verified to be targeted by miR-223-3p. Additionally, miR-223-3p overexpression decreased the phosphorylation levels of ERK1/2, JNK, and p38 protein in TGs of CCI-ION mice to inhibit MAPK/ERK signaling. CONCLUSIONS Overall, miR-223-3p attenuates the development of TN by targeting MKNK2 to suppress MAPK/ERK signaling.
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Affiliation(s)
- Bixia Huang
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, China
| | - Shaoyong Guo
- Department of Stomatology, The First Hospital of Putian City, Putian, China
| | - Yipan Zhang
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, China
| | - Pengxing Lin
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, China
| | - Changgui Lin
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, China
| | - Meixia Chen
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, China
| | - Shengyin Zhu
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, China
| | - Liyu Huang
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, China
| | - Junwei He
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, China
| | - Lingfeng Zhang
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, China
| | - Yanping Zheng
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, China
| | - Zhipeng Wen
- Department of Neurology, The Affiliated Hospital of Putian University, Putian, China
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Chen Q, Yi DI, Perez JNJ, Liu M, Chang SD, Barad MJ, Lim M, Qian X. The Molecular Basis and Pathophysiology of Trigeminal Neuralgia. Int J Mol Sci 2022; 23:ijms23073604. [PMID: 35408959 PMCID: PMC8998776 DOI: 10.3390/ijms23073604] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 02/04/2023] Open
Abstract
Trigeminal neuralgia (TN) is a complex orofacial pain syndrome characterized by the paroxysmal onset of pain attacks in the trigeminal distribution. The underlying mechanism for this debilitating condition is still not clearly understood. Decades of basic and clinical evidence support the demyelination hypothesis, where demyelination along the trigeminal afferent pathway is a major driver for TN pathogenesis and pathophysiology. Such pathological demyelination can be triggered by physical compression of the trigeminal ganglion or another primary demyelinating disease, such as multiple sclerosis. Further examination of TN patients and animal models has revealed significant molecular changes, channelopathies, and electrophysiological abnormalities in the affected trigeminal nerve. Interestingly, recent electrophysiological recordings and advanced functional neuroimaging data have shed new light on the global structural changes and the altered connectivity in the central pain-related circuits in TN patients. The current article aims to review the latest findings on the pathophysiology of TN and cross-examining them with the current surgical and pharmacologic management for TN patients. Understanding the underlying biology of TN could help scientists and clinicians to identify novel targets and improve treatments for this complex, debilitating disease.
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Affiliation(s)
- QiLiang Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (Q.C.); (D.I.Y.); (J.N.J.P.); (M.L.); (M.J.B.)
| | - Dae Ik Yi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (Q.C.); (D.I.Y.); (J.N.J.P.); (M.L.); (M.J.B.)
| | - Josiah Nathan Joco Perez
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (Q.C.); (D.I.Y.); (J.N.J.P.); (M.L.); (M.J.B.)
| | - Monica Liu
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (Q.C.); (D.I.Y.); (J.N.J.P.); (M.L.); (M.J.B.)
| | - Steven D. Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.D.C.); (M.L.)
| | - Meredith J. Barad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (Q.C.); (D.I.Y.); (J.N.J.P.); (M.L.); (M.J.B.)
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.D.C.); (M.L.)
| | - Xiang Qian
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; (Q.C.); (D.I.Y.); (J.N.J.P.); (M.L.); (M.J.B.)
- Correspondence:
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Prasetya M, Adidharma P, Sulistyanto A, Inoue T, Arham A. Characteristics of Patients With Trigeminal Neuralgia Referred to the Indonesian National Brain Center Neurosurgery Clinic. Front Surg 2022; 8:747463. [PMID: 35083268 PMCID: PMC8784373 DOI: 10.3389/fsurg.2021.747463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
Trigeminal neuralgia (TN) is a debilitating neuropathic pain involving the fifth cranial nerve. There has been no study investigating the clinical and socioeconomical characteristics of patients with TN in Indonesia. A total of 100 patients were included in this study. Symptoms indicating a later stage of the illness, namely, involvement of all the trigeminal nerve branches, numbness, and concomitant persistent pain, were the common presentations found in our cohort. Only one TN diagnosis was made by a general practitioner (GP). None were immediately referred to a neurosurgeon following their diagnosis. Access to our clinic took as long as 4.7 ± 5.1 years (mean ± SD) from the onset. Older age was a significant predictor of an increased likelihood of not knowing their illness upon the referral (21.9%, p = 0.008). Upon their first presentation, 25.5% of patients had experienced drug-related side effects due to prolonged medication. Only 50% of patients were compensated by the universal health coverage (UHC) system. Seven patients spent ≥ 50 million rupiahs and eight patients had already lost their jobs. In conclusion, early contact with a neurosurgeon contributes to better management of TN, both for the patients and healthcare system in Indonesia. A refined understanding of TN nature is still needed in this country.
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Affiliation(s)
- Mustaqim Prasetya
- Department of Neurosurgery, National Brain Center Hospital, East Jakarta, Indonesia
| | - Peter Adidharma
- Department of Neurosurgery, National Brain Center Hospital, East Jakarta, Indonesia
- *Correspondence: Peter Adidharma
| | - Adi Sulistyanto
- Department of Neurosurgery, National Brain Center Hospital, East Jakarta, Indonesia
| | - Takuro Inoue
- Department of Neurosurgery, Subarukai Koto Memorial Hospital, Higashiomi, Japan
| | - Abrar Arham
- Department of Neurosurgery, National Brain Center Hospital, East Jakarta, Indonesia
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14
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Jay GW, Barkin RL. Trigeminal neuralgia and persistent idiopathic facial pain (atypical facial pain). Dis Mon 2022; 68:101302. [PMID: 35027171 DOI: 10.1016/j.disamonth.2021.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gary W Jay
- Department of Neurology, Division: Headache/Pain, University of North Carolina, Chapel Hill, USA.
| | - Robert L Barkin
- Departmentts of Anesthesilogy, Family Medicine, Pharrmacology, Rush University Medical College, Chicago Illinois, USA
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15
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Abstract
Trigeminal neuralgia (TN) is a highly disabling disorder characterised by very severe, brief and electric shock like recurrent episodes of facial pain. New diagnostic criteria, which subclassify TN on the basis of presence of trigeminal neurovascular conflict or an underlying neurological disorder, should be used as they allow better characterisation of patients and help in decision-making regarding medical and surgical treatments. MR imaging, including high-resolution trigeminal sequences, should be performed as part of the diagnostic work-up. Carbamazepine and oxcarbazepine are drugs of first choice. Lamotrigine, gabapentin, pregabalin, botulinum toxin type A and baclofen can be used either alone or as add-on therapy. Surgery should be considered if the pain is poorly controlled or the medical treatments are poorly tolerated. Trigeminal microvascular decompression is the first-line surgery in patients with trigeminal neurovascular conflict while neuroablative surgical treatments can be offered if MR imaging does not show any neurovascular contact or where patients are considered too frail for microvascular decompression or do not wish to take the risk.
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Affiliation(s)
- Giorgio Lambru
- The Headache Service, Pain Management and Neuromodulation Centre, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Joanna Zakrzewska
- Facial Pain Clinic, Eastman Dental Hospital, London, UK
- Pain Management Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
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16
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Slettebø H. Is this really trigeminal neuralgia? Diagnostic re-evaluation of patients referred for neurosurgery. Scand J Pain 2021; 21:788-793. [PMID: 34333890 DOI: 10.1515/sjpain-2021-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/14/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Patients with facial pain are sometimes referred for neurosurgical treatment with a poorly documented diagnosis of trigeminal neuralgia. In such cases, neurosurgery will usually not be helpful. We conducted a re-evaluation of the diagnosis in patients referred for neurosurgical treatment of presumed trigeminal neuralgia. Our objective was to find out why and how often misdiagnosis occurred. METHODS A retrospective study was done in consecutive first-time patients referred for trigeminal neuralgia to our outpatient clinic in 2019. We used five ICHD-3-based clinical criteria to verify or exclude the diagnosis. In patients where trigeminal neuralgia was excluded, we established a diagnosis for their facial pain based upon medical history and a physical examination by a neurosurgeon - often supplemented with examination by an oral surgeon. RESULTS Thirty-eight patients were referred for presumed trigeminal neuralgia. Only 17 of them fulfilled the five criteria and were diagnosed with trigeminal neuralgia. In 20 of the remaining 21 patients trigeminal neuralgia could be clearly excluded, while one of the patients had a periodontitis closely mimicking trigeminal neuralgia. In 14 of the 21 patients we diagnosed temporomandibular dysfunction or dental conditions. MRI scans had detected low-grade neurovascular contacts in 13 of the 21 patients, a finding that was clearly overestimated by the referring neurologists in seven patients. CONCLUSIONS Overdiagnosis of trigeminal neuralgia was common in patients referred for neurosurgery, mostly due to insufficient clinical evaluation combined with an overestimation of MRI-detected NVCs. The clinical diagnosis should be critically re-evaluated before recommending neurosurgery to patients referred for presumed trigeminal neuralgia.
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Affiliation(s)
- Haldor Slettebø
- Department of Neurosurgery, Rikshospitalet, Oslo University Hospital, Pb 4950 Nydalen, 0424Oslo, Norway
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17
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Maarbjerg S, Benoliel R. The changing face of trigeminal neuralgia-A narrative review. Headache 2021; 61:817-837. [PMID: 34214179 DOI: 10.1111/head.14144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/11/2021] [Accepted: 04/21/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This narrative review aims to update the reader on the new classification of trigeminal neuralgia (TN), clinical signs, pathophysiologic evidence, and their implications on management. This review is based on the authors' collective experience and knowledge of the literature in addition to a literature search. BACKGROUND In recent years, the phenotype of TN has been intensively studied leading to discrete groups of patients. These include patients with TN with additional continuous pain, and patients with and without neurovascular compression of the trigeminal dorsal root entry zone. A number of associated clinical signs such as tearing and sensory changes need further research. METHODS The literature on TN was searched in PubMed with the aims of providing evidence for the recently published third edition of the International Classification of Headache Disorders (ICHD) and update the clinical phenotype and management of the TN subcategories. RESULTS The ICHD's new classification for TN is based on reliable clinical data, imaging, and neurophysiologic studies. The TN classification reflects current knowledge and has improved the possibility for clinicians to choose adequate management options. However, there is a lack of effective, safe drugs for the management of TN and sparse, robust data on neurosurgical options. CONCLUSION Research into all aspects of TN-diagnosis, pharmacotherapy, surgery, long-term management prognosis, and natural history-is needed. Research should adhere to the ICHD's schema for TN. Improved drugs are needed along with rigorous research into surgical options and their efficacy for different subtypes of TN.
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Affiliation(s)
- Stine Maarbjerg
- Danish Headache Center, Department of Neurology, Rigshospitalet, Glostrup, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Copenhagen, Denmark
| | - Rafael Benoliel
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
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18
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Bendtsen L, Zakrzewska JM, Heinskou TB, Hodaie M, Leal PRL, Nurmikko T, Obermann M, Cruccu G, Maarbjerg S. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol 2020; 19:784-796. [PMID: 32822636 DOI: 10.1016/s1474-4422(20)30233-7] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Abstract
Trigeminal neuralgia is a very painful neurological condition with severe, stimulus-evoked, short-lasting stabbing pain attacks in the face. The past decade has offered new insights into trigeminal neuralgia symptomatology, pathophysiology, and treatment, leading to a change in the classification of the condition. An accurate diagnosis is crucial because neuroimaging interpretation and clinical management differ among the various forms of facial pain. MRI using specific sequences should be a part of the diagnostic workup to detect a possible neurovascular contact and exclude secondary causes. Demonstration of a neurovascular contact should not be used to confirm a diagnosis but rather to facilitate surgical decision making. Carbamazepine and oxcarbazepine are drugs of first choice for long-term treatment, whereas microvascular decompression is the first-line surgery in medically refractory patients. Advances in neuroimaging techniques and animal models will provide further insight into the causes of trigeminal neuralgia and its pathophysiology. Development of more efficacious treatment options is highly warranted.
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Affiliation(s)
- Lars Bendtsen
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark.
| | - Joanna Maria Zakrzewska
- Pain Management Centre, National Hospital for Neurology and Neurosurgery, London, UK; Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | - Tone Bruvik Heinskou
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Krembil Brain Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Paulo Roberto Lacerda Leal
- Department of Neurosurgery, Faculty of Medicine of Sobral, Federal University of Cearà, Sobral, Brazil; University of Lyon, Lyon, France
| | - Turo Nurmikko
- Neuroscience Research Centre, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany
| | - Giorgio Cruccu
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Stine Maarbjerg
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark
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19
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Jani RH, Hughes MA, Gold MS, Branstetter BF, Ligus ZE, Sekula RF. Trigeminal Nerve Compression Without Trigeminal Neuralgia: Intraoperative vs Imaging Evidence. Neurosurgery 2020; 84:60-65. [PMID: 29425330 DOI: 10.1093/neuros/nyx636] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/26/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND While high-resolution imaging is increasingly used in guiding decisions about surgical interventions for the treatment of trigeminal neuralgia, direct assessment of the extent of vascular contact of the trigeminal nerve is still considered the gold standard for the determination of whether nerve decompression is warranted. OBJECTIVE To compare intraoperative and magnetic resonance imaging (MRI) findings of the prevalence and severity of vascular compression of the trigeminal nerve in patients without classical trigeminal neuralgia. METHODS We prospectively recruited 27 patients without facial pain who were undergoing microvascular decompression for hemifacial spasm and had undergone high-resolution preoperative MRI. Neurovascular contact/compression (NVC/C) by artery or vein was assessed both intraoperatively and by MRI, and was stratified into 3 types: simple contact, compression (indentation of the surface of the nerve), and deformity (deviation or distortion of the nerve). RESULTS Intraoperative evidence of NVC/C was detected in 23 patients. MRI evidence of NVC/C was detected in 18 patients, all of whom had intraoperative evidence of NVC/C. Thus, there were 5, or 28% more patients in whom NVC/C was detected intraoperatively than with MRI (Kappa = 0.52); contact was observed in 4 of these patients and compression in 1 patient. In patients where NVC/C was observed by both methods, there was agreement regarding the severity of contact/compression in 83% (15/18) of patients (Kappa = 0.47). No patients exhibited deformity of the nerve by imaging or intraoperatively. CONCLUSION There was moderate agreement between imaging and operative findings with respect to both the presence and severity of NVC/C.
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Affiliation(s)
- Ronak H Jani
- Department of Neurological Surgery, University of Pittsburgh School of Med-icine, Pittsburgh, Pennsylvania
| | - Marion A Hughes
- Department of Neurological Surgery, University of Pittsburgh School of Med-icine, Pittsburgh, Pennsylvania.,Dep-artment of Radiology, University of Pit-tsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Michael S Gold
- Department of Neurological Surgery, University of Pittsburgh School of Med-icine, Pittsburgh, Pennsylvania.,Department of Neurobi-ology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Barton F Branstetter
- Department of Neurological Surgery, University of Pittsburgh School of Med-icine, Pittsburgh, Pennsylvania.,Dep-artment of Radiology, University of Pit-tsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Zachary E Ligus
- Department of Neurological Surgery, University of Pittsburgh School of Med-icine, Pittsburgh, Pennsylvania
| | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh School of Med-icine, Pittsburgh, Pennsylvania.,Department of Neuro-logical Surgery, University of Pitt-sburgh School of Medicine, Pittsburgh, Pennsylvania
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20
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Exposto FG, Arima T, Svensson P. Sleep Disorders and Chronic Orofacial Pain. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00152-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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21
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Callai EMM, Scarabelot VL, Fernandes Medeiros L, Oliveira C, Souza A, Macedo IC, Cioato SG, Finamor F, Caumo W, Quevedo ADS, Torres ILS. Transcranial direct current stimulation (tDCS) and trigeminal pain: A preclinical study. Oral Dis 2019; 25:888-897. [DOI: 10.1111/odi.13038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 12/04/2018] [Accepted: 12/21/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Etiane Micheli Meyer Callai
- Pharmacology of Pain and Neuromodulation Laboratory: Preclinical Researches, Department of Pharmacology, Institute of Basic Health Sciences (ICBS) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
- Animal Experimentation Unit and Graduate Research Group Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
- Graduate Program in Biological Sciences: Physiology ICBS, UFRGS Porto Alegre Brazil
| | - Vanessa Leal Scarabelot
- Pharmacology of Pain and Neuromodulation Laboratory: Preclinical Researches, Department of Pharmacology, Institute of Basic Health Sciences (ICBS) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
- Animal Experimentation Unit and Graduate Research Group Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
| | - Liciane Fernandes Medeiros
- Pharmacology of Pain and Neuromodulation Laboratory: Preclinical Researches, Department of Pharmacology, Institute of Basic Health Sciences (ICBS) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
- Animal Experimentation Unit and Graduate Research Group Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
- Postgraduate Program in Medical Sciences, School of Medicine Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Carla Oliveira
- Pharmacology of Pain and Neuromodulation Laboratory: Preclinical Researches, Department of Pharmacology, Institute of Basic Health Sciences (ICBS) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
- Animal Experimentation Unit and Graduate Research Group Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
- Postgraduate Program in Medical Sciences, School of Medicine Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Andressa Souza
- Pharmacology of Pain and Neuromodulation Laboratory: Preclinical Researches, Department of Pharmacology, Institute of Basic Health Sciences (ICBS) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
- Animal Experimentation Unit and Graduate Research Group Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
- Post‐Graduate Program in Health and Human Development, Centro Universitário Unilasalle Canoas Brazil
| | - Isabel Cristina Macedo
- Pharmacology of Pain and Neuromodulation Laboratory: Preclinical Researches, Department of Pharmacology, Institute of Basic Health Sciences (ICBS) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
- Animal Experimentation Unit and Graduate Research Group Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
| | - Stefania Giotti Cioato
- Pharmacology of Pain and Neuromodulation Laboratory: Preclinical Researches, Department of Pharmacology, Institute of Basic Health Sciences (ICBS) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
- Animal Experimentation Unit and Graduate Research Group Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
- Graduate Program in Biological Sciences: Pharmacology and Therapeutics ICBS, UFRGS Porto Alegre Brazil
| | - Fabrício Finamor
- Pharmacology of Pain and Neuromodulation Laboratory: Preclinical Researches, Department of Pharmacology, Institute of Basic Health Sciences (ICBS) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
- Animal Experimentation Unit and Graduate Research Group Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
- Graduate Program in Biological Sciences: Pharmacology and Therapeutics ICBS, UFRGS Porto Alegre Brazil
| | - Wolnei Caumo
- Postgraduate Program in Medical Sciences, School of Medicine Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | - Alexandre da Silva Quevedo
- Pharmacology of Pain and Neuromodulation Laboratory: Preclinical Researches, Department of Pharmacology, Institute of Basic Health Sciences (ICBS) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
- Graduate Program in Biological Sciences: Pharmacology and Therapeutics ICBS, UFRGS Porto Alegre Brazil
| | - Iraci L. S. Torres
- Pharmacology of Pain and Neuromodulation Laboratory: Preclinical Researches, Department of Pharmacology, Institute of Basic Health Sciences (ICBS) Universidade Federal do Rio Grande do Sul (UFRGS) Porto Alegre Brazil
- Animal Experimentation Unit and Graduate Research Group Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
- Graduate Program in Biological Sciences: Physiology ICBS, UFRGS Porto Alegre Brazil
- Postgraduate Program in Medical Sciences, School of Medicine Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
- Graduate Program in Biological Sciences: Pharmacology and Therapeutics ICBS, UFRGS Porto Alegre Brazil
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22
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Melek LN, Devine M, Renton T. The psychosocial impact of orofacial pain in trigeminal neuralgia patients: a systematic review. Int J Oral Maxillofac Surg 2018. [PMID: 29526561 DOI: 10.1016/j.ijom.2018.02.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Trigeminal neuralgia (TN) is characterized by sharp, electric shock-like pain, which can be triggered by trivial stimuli. Although medical and surgical treatments are available for TN, some patients experience refractory pain, which has a significant impact on their quality of life. The aim of this systematic review was to determine the psychosocial impact of orofacial pain in patients with diagnosed TN. A search was initiated in three electronic databases (Embase, MEDLINE, PubMed) to identify potential studies for inclusion in the review. All types of study published in English that reported psychosocial measures using validated psychometric questionnaires were included. A total of 585 articles were retrieved from the search. These were screened thoroughly, leading to the selection of 13 articles for data extraction and final analysis. The results show the chronic overwhelming nature of TN, with pain levels varying from mild to severe. Psychometric scores indicated mild to moderate depression, moderate to severe anxiety, and moderate to severe functional limitation of daily life activities in TN patients. Therefore, psychological support within a multidisciplinary team is recommended for TN patients to help them cope better with their chronic disorder and to improve the efficacy of treatment.
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Affiliation(s)
- L N Melek
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Egypt.
| | - M Devine
- Department of Oral Surgery, Dental Institute, King's College London, London, UK
| | - T Renton
- Department of Oral Surgery, Dental Institute, King's College London, London, UK
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23
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Abstract
Patients with idiopathic trigeminal neuralgia (TN) were categorised into 3 subtypes (n = 225). Group 1 (n = 155, 68.9%) had TN without concomitant pain, group 2 (n = 32, 14.2%) had TN with intermittent concomitant pain, and group 3 (n = 39, 16.9%) had TN with autonomic symptoms. We tested 2 hypotheses: (1) that different pain profiles would be associated with the different groups; (2) that the severe pain associated with TN would impact negatively on activities of daily living and thereby result in disability as defined by the World Health Organisation. A different pain profile was found across the groups. We obtained unequivocal evidence that TN causes disability with up to 45% of patients being absent from usual daily activities 15 days or more in the past 6 months. On the Hospital Anxiety and Depression Scale, 35.7% patients had mild-to-severe depression and over 50% were anxious. The Pain Catastrophizing Scale showed that 78% of patients had considerable negative thoughts with scores >20 and a mean score of 36.4. Prior to referral, only 54% had been prescribed carbamazepine while opioids had been prescribed in 14.6% of the patients. Prior to referral, over 80% had already been to 1 specialist centre which had not provided appropriate management. Patients with TN report varied characteristics but all result in some degree of psychosocial disability especially before adequate therapy is attained.
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24
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Pareja JA, López-Ruiz P, Mayo D, Villar-Quiles RN, Cárcamo A, Gutiérrez-Viedma Á, Lastarria CP, Romeral M, Yangüela J, Cuadrado ML. Supratrochlear Neuralgia: A Prospective Case Series of 15 Patients. Headache 2017; 57:1433-1442. [PMID: 28833061 DOI: 10.1111/head.13158] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/11/2017] [Accepted: 04/11/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to describe clinical features unique to supratrochlear neuralgia. BACKGROUND The supratrochlear nerve supplies the medial aspect of the forehead. Due to the intricate relationship between supraorbital and supratrochlear nerves, neuralgic pain in this region has been traditionally attributed to supraorbital neuralgia. No cases of supratrochlear neuralgia have been reported so far. METHODS From 2009 through 2016, we prospectively recruited patients with pain confined to the territory of the supratrochlear nerve. RESULTS Fifteen patients (13 women, 2 men; mean age 51.4 years, standard deviation 14.9) presented with pain in the lower paramedian forehead, extending to the eyebrow in two patients and to the internal angle of the orbit in another. Pain was unilateral in 11 patients (six on the right, five on the left), and bilateral in four. Six patients had continuous pain and nine described intermittent pain. Palpation of the supratrochlear nerve at the medial third of the supraorbital rim resulted in hypersensitivity in all cases. All but one patient exhibited sensory disturbances within the painful area. Fourteen patients underwent anesthetic blockades of the supratrochlear nerve, with immediate relief in all cases and long-term remission in three. Six of them had received unsuccessful anesthetic blocks of the supraorbital nerve. Five patients were treated successfully with oral drugs and one patient was treated with radiofrequency. CONCLUSIONS Supratrochlear neuralgia is an uncommon disorder causing pain in the medial region of the forehead. It may be differentiated from supraorbital neuralgia and other similar headaches and neuralgias based on the topography of the pain and the response to anesthetic blockade.
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Affiliation(s)
- Juan A Pareja
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Pedro López-Ruiz
- Department of Neurology, Hospital Universitario Quironsalud Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Diego Mayo
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Rocío-Nur Villar-Quiles
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Alba Cárcamo
- Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.,Pain Clinic, Department of Anesthesiology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Álvaro Gutiérrez-Viedma
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlo P Lastarria
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
| | - María Romeral
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Julio Yangüela
- Department of Ophthalmology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - María-Luz Cuadrado
- Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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25
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Wöber C. Tics in TACs: A Step into an Avalanche? Systematic Literature Review and Conclusions. Headache 2017; 57:1635-1647. [PMID: 28542727 DOI: 10.1111/head.13099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Trigeminal autonomic cephalalgias (TACs) comprise cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua. In some cases, trigeminal neuralgia (TN, "tic douloureux") or TN-like pain may co-occur with TACs. AIM This article will review the co-occurrence and overlap of TACs and tics in order to contribute to a better understanding of the issue and an improved management of the patients. METHODS For performing a systematic literature review Pubmed was searched using a total of ten terms. The articles identified were screened for further articles of relevance. SUMMARY TACs are related to tics in various ways. TN or TN-like paroxysms may co-occur with CH, PH, and HC, labeled as cluster-tic syndrome, PH-tic syndrome, and HC-tic syndrome. Such co-occurrence was not only found in the primary TACs but also in secondary headaches resembling TACs. The initial onset of TAC and tic may be simultaneous or separated by months or years. In acute attacks, tic and TAC may occur concurrently or much more often independently of each other. The term "cluster-tic syndrome" was also used in patients with a single type of pain in a twilight zone between TACs and TN fulfilling none of the relevant diagnostic criteria. Short-lasting neuralgiform headache attacks overlap with TN in terms of clinical features, imaging findings, and therapy.
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Affiliation(s)
- Christian Wöber
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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26
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Benoliel R, Sharav Y, Haviv Y, Almoznino G. Tic, Triggering, and Tearing: From CTN to SUNHA. Headache 2017; 57:997-1009. [DOI: 10.1111/head.13040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 01/03/2023]
Affiliation(s)
- R. Benoliel
- Rutgers School of Dental Medicine; Rutgers State University of New Jersey; Newark NJ USA
| | - Y. Sharav
- Department of Oral Medicine, The Faculty of Dentistry; Hebrew University-Hadassah; Jerusalem Israel
| | - Y. Haviv
- Department of Oral Medicine, The Faculty of Dentistry; Hebrew University-Hadassah; Jerusalem Israel
| | - G. Almoznino
- Department of Oral Medicine, The Faculty of Dentistry; Hebrew University-Hadassah; Jerusalem Israel
- Department of Oral Medicine; Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces; Tel-Hashomer Israel
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Villar-Quiles RN, García-Moreno H, Mayo D, Gutiérrez-Viedma Á, Ramos MI, Casas-Limón J, Cuadrado ML. Infratrochlear neuralgia: A prospective series of seven patients treated with infratrochlear nerve blocks. Cephalalgia 2017; 38:585-591. [PMID: 28114806 DOI: 10.1177/0333102417690493] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Infratrochlear neuralgia is a recently described painful cranial neuropathy that causes pain in the internal angle of the orbit and the medial upper eyelid, the upper bridge of the nose and/or the lacrimal caruncle. We aim to present seven new cases of infratrochlear neuralgia treated with anaesthetic nerve blocks. Methods Over an 18-month period, we prospectively identified seven cases of infratrochlear neuralgia among the patients attending the Headache Unit in a tertiary hospital. Anaesthetic blocks were performed by injecting 0.5 cc of bupivacaine 0.5% at the emergence of the nerve above the internal canthus. Results All patients were women, and the mean age was 49.1 years (standard deviation, 17.9). The pain appeared at the internal angle of the orbit and/or the medial upper eyelid in six cases, and the whole territory of the infratrochlear nerve in one case. Six patients had continuous pain and one had episodes lasting 8-24 hours. All patients showed sensory disturbances within the painful area and tenderness upon palpation of the infratrochlear nerve. Nerve blocks resulted in complete and long-lasting relief in four patients and short-lasting relief in the other three patients. Conclusions Infratrochlear neuralgia should be considered among the neuralgic causes of orbital and periorbital pain. Anaesthetic blocks may assist clinicians in the diagnosis and may also be an effective therapy.
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Affiliation(s)
- Rocío-Nur Villar-Quiles
- 1 Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,2 Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Héctor García-Moreno
- 1 Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,3 Department of Molecular Neuroscience, University College London (UCL), London, UK
| | - Diego Mayo
- 1 Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,2 Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Álvaro Gutiérrez-Viedma
- 1 Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,2 Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | | | - Javier Casas-Limón
- 5 Department of Neurology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - María-Luz Cuadrado
- 1 Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.,2 Department of Medicine, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
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de Coo I, van Dijk JMC, Metzemaekers JD, Haan J. A Case Report About Cluster-Tic Syndrome Due to Venous Compression of the Trigeminal Nerve. Headache 2016; 57:654-657. [DOI: 10.1111/head.12990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Ilse de Coo
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
| | - J. Marc C. van Dijk
- Department of Neurosurgery; University Medical Center Groningen; Groningen The Netherlands
| | | | - Joost Haan
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
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Evaluation of sphenopalatine ganglion blockade via intra oral route for the management of atypical trigeminal neuralgia. SPRINGERPLUS 2016; 5:906. [PMID: 27386351 PMCID: PMC4923019 DOI: 10.1186/s40064-016-2612-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 06/17/2016] [Indexed: 01/03/2023]
Abstract
Background The sphenopalatine ganglion (SPG) may be involved in persistent idiopathic facial pain and unilateral headaches. The role of SPG blockade via intra oral route in the management of trigeminal neuralgia (TN) is worthy of study. Methods In this retrospective study, patient records included patients with atypical TN (type 2) that persisted in spite of conservative treatment for at least 2 years, and an average pain intensity from the craniofacial region visual analogue scale (VAS) before examination. In group I the patients received carmapazepin 800 mg a day for at least 2 years. In group II 3 ml of local anesthetic agent consisting 2 ml bupivacaine and 1 ml prilocain in addition to 1 ml fentanyl, 0.5 ml betametasone disodium phosphate and 0.5 ml opaque was injected by the intraoral route. In this group, injection procedures were performed under local anesthesia with fluoroscopic guidance. The Kruskal–Wallis and Mann–Whitney U tests with Bonferroni correction were used for intergroup analysis. Age and sex differences were evaluated with one-way ANOVA and Fisher’s exact tests, respectively. Results Significant differences were found between pre-op and 3rd day VAS values and also pre-op and 1st month VAS values. No significant differences were found between pre-op and 6th month VAS values. Conclusion The SPG blockade improves the quality of life of patients and a minimally-invasive procedure to management of TN, when compared to other methods.
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