ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

There are no satisfactory animal models of trigeminal neuralgia, and it is difficult to obtain essential data from patients. However, trigeminal neuralgia presents with such idiosyncratic signs and symptoms, and responds to so distinctive a set of therapeutic modalities, that scientific deduction can be used to generate likely hypotheses. The ignition hypothesis of trigeminal neuralgia is based on recent advances in the understanding of abnormal electrical behavior in injured sensory neurons, and new histopathologic observations of biopsy specimens from patients with trigeminal neuralgia who are undergoing microvascular decompression surgery. According to the hypothesis, trigeminal neuralgia results from specific abnormalities of trigeminal afferent neurons in the trigeminal root or ganglion. Injury renders axons and axotomized somata hyperexcitable. The hyperexcitable afferents, in turn, give rise to pain paroxysms as a result of synchronized afterdischarge activity. The ignition hypothesis accounts for the major positive and negative signs and symptoms of trigeminal neuralgia, for its pathogenesis, and for the efficacy of treatment modalities. Proof, however, awaits the availability of key experimental data that can only be obtained from patients with trigeminal neuralgia.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Trigeminal neuralgiais a chronic facial pain classified as a neuropathic pain. There is widespread agreement regarding the International Association for the Study of Pain definition of classical idiopathic trigeminal neuralgia as “a sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve.” However, there are variations in presentation that are less easy to diagnose and an erroneous diagnosis of trigeminal neuralgia is occasionally made. In patients with tumors or multiple sclerosis, trigeminal neuralgia is termed secondary. Currently, clinical manifestations are the mainstay for diagnosis because there are no objective tests to validate the diagnosis. The sensitivity and specificity of these clinical manifestations is reviewed. Magnetic resonance imaging (MRI) and three-dimensional fast-in-flow with steady-state precession MRI are performed to determine the presence of tumors or plaques of multiple sclerosis and to assess possible compressions and deformations of the trigeminal nerve. Their specificity and sensitivity regarding compressions found at the time of surgery is reviewed. Other differential diagnoses for chronic unilateral orofacial pain are discussed.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The efficacy of the anticonvulsant drug carbamazepine in the management of trigeminal neuralgia is evidenced in several controlled trials, and the numbers needed to treat to obtain one patient with at least 50% pain relief (NNT) is 1.7. Single small trials have shown that baclofen alone provides pain relief (NNT = 1.4) and that lamotrigine has an additional effect in patients with insufficient relief using carbamazepine or phenytoin (NNT = 2.1). Uncontrolled observations and clinical practice indicate that phenytoin, clonazepam, sodium valproate, gabapentin, and lidocaine will also relieve trigeminal neuralgia. In case of lacking effect of a single drug, combination of two or more drugs may be used, but with the exception of the lamotrigine-carbamazepine combination, this is not evidence-based medicine. Acute exacerbation has successfully been treated with intravenous loading with phenytoin or lidocaine, but again these procedures have not been tested in controlled trials. In conclusion, carbamazepine is the mainstay of pharmacotherapy of trigeminal neuralgia, and secondary drug choices are baclofen, lamotrigine, oxcarbazepine, phenytoin, gabapentin, and sodium valproate. Controlled trials testing the effect of some of these drugs, new drugs, and drug combinations are needed.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This review discusses the various peripheral and ganglion-level procedures available for treating trigeminal neuralgia and summarizes specific success and complication rates for each technique.MethodA review of the available literature.ResultsIt appears that expertly performed ganglion-level procedures (radiofrequency thermocoagulation, balloon compression, and glycerolysis) are more effective than peripheral procedures but neither approach can be relied on to produce long-term pain relief. All of these procedures are neurodestructive and can cause sensory loss and dysesthesia. Effective drug therapy may not be acceptable to some patients as adverse cognitive side effects are increasingly recognized.ConclusionsEach patient should receive an informed and impartial account of the available surgical options. There is a need for prospective randomized controlled studies in procedure-naïve subjects to determine the optimal surgical management of trigeminal neuralgia.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Microvascular decompression (MVD) remains the only treatment of trigeminal neuralgia that directly addresses the presumed pathogenesis. It is a proven therapy, associated with the longest duration of pain relief while preserving facial sensation. The authors' premise for advocating early MVD is the belief that the disease's natural progression, in the absence of treatment, is toward the development of more atypical features that are refractory to treatment, signifying ongoing neuropathic injury. In an effort to more successfully select candidates for MVD, the authors have incorporated high-resolution magnetic resonance imaging into our preoperative algorithm, since it has proven extremely accurate in defining the neurovascular relations at the trigminal nerve complex. Microvascular decompression can only be recommended when it is performed with low rates of morbidity.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Stereotactic radiosurgery is an increasingly used and the least invasive surgical option for patients with medically refractory trigeminal neuralgia (TN). The authors began use of this technique at our center in 1992 and have evaluated outcomes serially. Independently acquired data from 220 patients with idiopathic TN that had Gamma Knife radiosurgery was reviewed. The median radiosurgery dose was 80 Gy with a range of 60 to 90 Gy. Most patients had features of typical TN, although 16 (7.3%) described additional atypical features. One hundred thirty-five patients (61.4%) had prior surgery. Patients were followed to a maximum of 6.5 years (median, 2 years). Complete or partial pain relief was achieved in 85.6% of patients at 1 year. Complete pain relief was achieved in 64.9 % of patients at 6 months, 70.3% at 1 year, and 75.4% patients at 33 months. Patients with an atypical pain component had a lower rate of achieving pain relief (p= 0.025). Due to recurrences, 55.8% of patients had complete or partial pain relief at 5 years. The absence of preoperative sensory disturbance or prior surgery correlated with an increased proportion of patients in complete or partial pain relief over time. Ten percent of patients developed new or increased subjective facial paresthesia or facial numbness. Radiosurgery for idiopathic TN was safe and effective, and provided benefit to a patient population with a high frequency of prior surgical intervention. It is an important addition to the surgical armamentarium for TN.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveExtradural cortical stimulation is a recent addition to the armamentarium of functional neurosurgery. This article reviews results of treatment of chronic central and neuropathic pain.ConclusionsIt is concluded that extradural cortical stimulation may be effective in several refractory cases.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe assumption that individuals are capable of accurately recalling past painful experiences has been a fundamental tenet of a number of cognitive–behavioral theories of pain, including the gate control theory. However, there has been very little research on the topic in the past, and the results have often been contradictory. A general conclusion that can be drawn is that memory for pain is variable, and there is need to identify what factors contribute to this variability in memory for pain. The current study examined the relation of catastrophizing to the recall of persistent pain associated with rheumatoid arthritis.MethodsParticipants in this study were 45 individuals with persistent pain due to rheumatoid arthritis. Each participant was asked to complete a daily pain diary for a period of 30 days. Participants were subsequently asked to recall the pain they experienced over the entire period of time rather than provide a single, average rating.ResultsThe results of a series of hierarchical regression analyses indicated that level of catastrophizing was related to the recall of both pain intensity and pain variability. This relation was statistically significant even after controlling for actual pain and variability and other background variables.ConclusionsParticipants who scored higher on catastrophizing demonstrated better accuracy in the recall of general pain intensity and pattern over a 30-day diary period. The results of the study are discussed in terms of future studies as well as their potential clinical importance.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesThe aims of this study were to (1) identify behaviors that occur in noncommunicative nursing home residents that are perceived by nurses to be indicators of pain, (2) determine factors affecting the differentiation of pain behaviors from similar behaviors due to other causes, and (3) assess nurses' perceptions of the prevalence and importance of specific indicators of pain as well as barriers to the detection of pain in this population.Setting and PatientsSeventy-two staff members of three nursing homes were interviewed and surveyed about specific behaviors associated with pain. Focus groups were conducted with staff to validate pain indicators and investigate perceptions of their own ability to identify pain.ResultsNursing staff members agreed on a core group of behaviors that they perceive as pain indicators in elderly persons suffering from dementia. These indicators include specific physical repetitive movements, vocal repetitive behaviors, physical signs of pain, and changes in behavior from the norm for that person. The nursing staff members' level of familiarity with the residents was reported to have a significant effect on staff members' ability to identify and differentiate pain behaviors from other behaviors of impaired residents. Barriers to the detection of pain pertain to staff issues, resident behaviors, and resident–staff relationships.ConclusionsThe study of pain among the noncommunicative elderly and, in particular, the development of a tool that can be used to assess their pain may greatly improve the quality of life of the estimated 20% to 35% of nursing home residents who cannot adequately express their needs.

ISSN:0749-8047    

出版商:OVID    

年代:2002

数据来源: OVID