I. Signs and symptoms
The abrupt onset of short pains in the face or in a part of the face, including
1. Stabbing
2. Lightning
3. Electric shocks(3).
4. Autonomic symptoms can occur in association with the facial pain of trigeminal neuralgia (TN).the most common autonomic symptoms were conjunctival injection, ptosis, and excessive tearing (4).
5. In the study to evaluate a total of 30 patients with TN and chronic facial pain (group A, 25 women and 5 men; mean age, 64.2±3.2 years) and 30 with atypical facial pain (group B, 26 women and 4 men; mean age, 64.8±1.9 years, researchers at the Lithuanian University of Health Sciences, showed that patients with TN and chronic facial pain had a significantly higher level of pain perception, and they presented the higher level for anxiety and depression than those with atypical facial pain(5).
6. Etc.
II. Causes and Risk factors
A. Causes
1. Neurovascular compression (NC)
Neurovascular compression (NC) seems to have been confirmed as the major cause of classical trigeminal neuralgia (TN)(6).
2. Tumor in the brain
There are a reprot of three cases of contralateral trigeminal neuralgia as a false localizing sign in intracranial tumors. In all cases, tumors were large and firm. The tumor was supratentorial in two cases. In one case, a cortically mediated mechanism may have caused the neuralgia, whereas in the remaining two cases distortion and displacement of the brain stem and compression of the contralateral Meckel's cave would explain the trigeminal nerve signs(7).
3. Multiple sclerosis
Multiple Sclerosis is an inflammation of central nervous system disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are deteriorated, leading to impair of proper conduction of nerve impulse. In a multicentre controlled study of 130 patients with MS: 50 patients with TN, 30 patients with trigeminal sensory disturbances other than TN (ongoing pain, dysaesthesia, or hypoesthesia), and 50 control patients, found that the most likely cause of MS-related TN is a pontine plaque damaging the primary afferents. Nevertheless, in some patients a neurovascular contact may act as a concurring mechanism. The other sensory disturbances, including ongoing pain and dysaesthesia, may arise from damage to the second-order neurons in the spinal trigeminal complex(8).
4. Shingles
Shingles also known as herpes zoster or zona is defined as a viral disease with condition of a painful, blistering skin rash on one side of the body of that can continue to be painful even after the rash have long disappeared(1), as a result of varicella-zoster viral causes of a nerve and skin inflammation. There is a report of a case of reactivation of herpes zoster along the trigeminal nerve with intractable pain after facial trauma(9).
5. Etc.
B. Risk factors
1. Age
If you are 50 or older, you are at increased risk to develop Trigeminal neuralgia.
2. Sex
If you are female, your risk of develop TN are increased.
3. Familial risks
In the study of familial risks for siblings who were hospitalised for nerve, nerve root and plexus disorders in Sweden, showed that 29,686 patients, 43% men and 57% women, were diagnosed at a mean age of 37.5 years. 191 siblings were hospitalised for these disorders, giving an overall SIR of 2.59 (95% CI 1.58 to 4.22), with no sex difference(10).
3. Certain conditions
a. Hypertension
Increased risk of trigeminal neuralgia after hypertension. In the hypertension group, 121 patients developed TN during follow-up, while, in the nonhypertension group, 167 subjects developed TN. The crude hazard ratio for the hypertension group was 1.52 (95% confidence interval [CI] 1.20-1.92; p = 0.0005), while, after adjustment for demographic characteristics and medical comorbidities, the adjusted hazard ratio was 1.51 (95% CI 1.19-1.90; p = 0.0006)(11).
b. Multiple sclerosis
Multiple sclerosis are associated with the increased risk of Trigeminal neuralgia.
c. Etc.
III. Diagnosis and Misdiagosis
A. Misdiagosis
1. Acute dental pain
Pre-trigeminal and atypical neuralgias are amongst the possible differential diagnoses of acute dental pain. * In a patient with nonodontogenic pain, simultaneous dental pain in the same area could be overlooked. * Dentists should consider a nonodontogenic origin as a possible explanation for burning, lancinating or atypical pain. In such cases, an appropriate medical specialist should be consulted, according to Dr. Sanner F.(12)
2. Paroxysmal orofacial pains
Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either be located in a healthy tooth or in the temporomandibular joint. Neuralgic pain is distinguished into trigeminal neuralgia, glossopharyngeal neuralgia, Horton's neuralgia, cluster headache and paroxysmal hemicrania, according to Dr. de Bont LG. at the Universitair Medisch Centrum, Groningen(13).
3. Trigeminal neuralgia and other facial pain
Attacks of facial pain are often triggered by cutaneous stimuli to the face or the oral cavity, which may be such minor activities as talking, chewing, brushing the teeth, or even wind blowing on the face. As a result, facial hygiene as well as a good diet may be neglected. Although 1% of the patients may eventually develop the disorder bilaterally, pain does not cross the midline during any single episode. The clinical course is characterized by exacerbations and remissions, but as the disorder progresses, remissions become shorter and exacerbations more severe. If the trigeminal neuralgia may be considered as a nerve irritation, like the glossopharyngeal neuralgia and the nasociliary neuralgia, nerve lesion may elicit neurogenic or neuropathic pain, characterized by chronic burning pain; post-zoster pain, iatrogenic and posttraumatic pain illustrate this condition. Cluster headache (Horton neuralgia), Sluder's neuralgia and auriculotemporal neuralgia may be related to a dysfunction of the autonomous nervous system(14).
4. Leprosy
There is a report of healthy without any overt features suggestive of infection patient who had migrated to Australia from India 24 years previously, but a review of the literature revealed that the trigeminal nerve is frequently involved in leprosy, usually associated with sensory loss rather than neuropathic pain(15).
5 Etc.
B. Diagnosis
The diagnosis is typically determined clinically, although imaging studies or referral for specialized testing may be necessary to rule out other diseases. Accurate and prompt diagnosis is important because the pain of trigeminal neuralgia can be severe(16).
According to International Headache Society diagnostic criteria for trigeminal neuralgia, Trigeminal neuralgia is diagnosed depending to
Classical
- Paroxysmal attacks of pain lasting from a fraction of a second to 2 min, affecting one or more divisions of the trigeminal nerve, and fulfilling criteria B and C
- Pain has at least one of the following characteristics:
- Intense, sharp, superficial, or stabbing
- Precipitated from trigger zones or by trigger factors
- Attacks are sterotyped in the individual patient
- There is no clinically evident neurologic deficit
- Not attributed to another disorder
- Paroxysmal attacks of pain lasting from a fraction of a second to 2 min, with or without persistence of aching between paroxysms, affecting one or more divisions of the trigeminal nerve, and fulfilling criteria B and C
- Pain has at least one of the following characteristics:
- Intense, sharp, superficial, or stabbing
- Precipitated from trigger zones or by trigger factors
- Attacks are sterotyped in the individual patient
- A causative lesion, other than vascular compression, has been demonstrated by special investigations and/or posterior fossa exploration(17)
MRI is particularly useful in planning the management of those conditions where surgical or medical intervention can result in improvement or resolution of symptoms and to exclude the symptomatic TN due to multiple sclerosis and tumors.
Risk of stroke increases after Trigeminal neuralgia, according to the study of population-based follow-up study to investigate whether the occurrence of TN is associated with a higher risk of developing stroke(18).
V. Treatment
V.1. Treatment in conventional medicine perspective
A. Medication
1. Carbamazepine
Carbamazepine is currently the drug of first choice in the treatment of trigeminal neuralgia. However, it is reported as efficacious in only 70-80% of patients, and can be associated with adverse effects such as drowsiness, confusion, nausea, ataxia, nystagmus and hypersensitivity, which may necessitate discontinuation of medication(19).
2. Topiramate
In the trials comparing topiramate with carbamazepine are all poor in methodological quality. A meta-analysis of these studies showed that the overall effectiveness and tolerability of topiramate did not seem to differ from carbamazepine in the treatment of classical trigeminal neuralgia. However, the meta-analysis yielded a favourable effect of topiramate compared with carbamazepine after a treatment duration of 2 months. Results were limited due to the poor methodological quality and the geographic localization of the randomized controlled trials identified. Therefore, large, international, well conducted, randomized controlled trials are needed to further assess the relative efficacy and tolerability of topiramate and carbamazepine in this indication(20)
Side effects include Loss of appetite, dizziness, and tingling sensations, etc.
3. Lamotrigine
In the study of 21e patients with TN administered with LTG in comparison to CBZ. in the clinical trials comprised two phases of 40 days each, with an intervening three-day washout period, showed that oth on VAS and VRS assessments, in terms of proportion of patients, CBZ benefitted 90.5% (19/21) of the patients with pain relief (p < 0.05), in contrast to 62% (13/21) from LTG. On VAS assessment, of the 13 patients who gained pain relief from LTG and 19 from CBZ, 77% (10/13) obtained a "complete" degree of pain relief from LTG, as compared with 21% (4/19) from CBZ. On VRS assessment, with LTG, 84% (11/13) of the patients accomplished "much better" degree of pain relief, as compared with 26% (5/19) with CBZ. On LTG, 67% (14/21) of patients endured general pharmacological side effects, as compared with 57% (12/21) of patients on CBZ (p > 0.05). Meanwhile, LTG inflicted 14% (3/21) of the patients with haematological, hepatic and renal derangements, as compared with 48% (10/21) on CBZ(21).
Side effects include nausea, dizziness, headaches, coordination problems, etc.
4. Etc.
B. Surgical treatments
1. Peripheral neurectomies, a minimally invasive treatment for trigeminal neuralgia
In the study to investigate the efficacy of peripheral neurectomy as a surgical procedure in the treatment of trigeminal neuralgia and to evaluate the results obtained by this procedure and their recurrences in a period of three years followup, researchers at the Modern Dental Collage & Research Centre, showed that peripheral neurectomy is one of the oldest, minimal invasive forms of surgery, well tolerated by the patient and can be done under local anesthesia(22)
Others suggested that peripheral neurectomy is thus a safe and effective procedure for elderly patients, for those patients living in remote and rural places that cannot avail major neurosurgical facilities, and for those patients who are reluctant for major neurosurgical procedures(23).
According to the study by Dr. Freemont AJ, and DR. Millac P. Of 49 patients ultimately maintained pain-free by non-medical means, 26 underwent peripheral neurectomy. Twenty of these achieved excellent pain control in the longer term and 5 of the remaining 6 became more responsive to carbamazepine after operation. Seven patients required repeat neurectomies(24).
2. Trigeminal Root Compression of trigeminal nerve
In the study of the Efficacy and safety of root compression of trigeminal nerve for trigeminal neuralgia with out evidence of vascular compression, found that all patients were pain free after the procedure; there was a 27% relapse in a mean time of 10 months, but 83% of these patients were adequately controled by medical treatment, and only 17% needed a complementary procedure for pain relief. Also we found that 63% of the patients complained of a partial loss of facial sensitivity, but only one patient presented with a corneal ulcer. There were a 6.7% rate of significant complications. We concluded that Trigeminal Root Compression is a safe and effective option for patients with primary trigeminal neuralgia without vascular compression(25).
TN is frequently associated with nerve root entry zone demyelination in MS and patients with nerve root vascular compression. The characteristics of the TN and response to PSR are similar in both groups. Persistent vascular compression increases the risk of recurrent TN after PSR(26).
3. Microvascular decompression (MVD)
In the study to evaluate the long-term efficacy of microvascular decompression (MVD) and to identify the factors affecting outcome in patients treated for primary trigeminal neuralgia (TN), researchers at the
Hôpital Neurologique Pierre Wertheimer, University of Lyon, found that Pure MVD can offer patients affected by a primary TN a 73.38% probability of long-term (15 years) cure of neuralgia. The presence of a clear-cut and marked vascular compression at surgery (and possibly-although not yet reliably--on preoperative magnetic resonance imaging) is the guarantee of a higher than 90% success rate(27).
In Microvascular decompression (MVD), the Complete pain relief (off medication) achieved in 71% of patients at 10 years. Overall 84% of responders to questionnaires expressed satisfaction with the operative outcome, the mean duration of TGN was 80 months and mean post-operative follow-up of 7 years. No mortality reported in this series(28).
4. Gamma Knife surgery
In the comparison of data across previous reports hampered by differences in treatment protocols, lengths of follow-up, and outcome criteria, researchers at the Sint Elisabeth Hospital, Tilburg found that
in the idiopathic TN group, rates of adequate pain relief, defined as BNI Pain Scores I-IIIB, were 75%, 60%, and 58% at 1, 3, and 5 years, respectively. In the multiple sclerosis (MS)-related TN group the rates of adequate pain relief were 56%, 30%, and 20% at 1, 3, and 5 years, respectively. Repeated GKS was as successful as the first. An analysis of our treatment strategy of repeated GKS showed rates of adequate pain relief of 75% at 5 years in the idiopathic TN and 46% in the MS-related TN group. Somewhat bothersome numbness was reported by 6% of patients after the first treatment and by 24% after repeated GKS. Very bothersome numbness was reported in 0.5% after the first GKS and in 2% after the second treatment(29).
During the radiosurgical procedure, 19 patients (2%) suffered anxiety or syncopal episodes, and 2 patients suffered acute coronary events. Treatments were incompletely administered in 12 patients (1.2%). Severe pain was a delayed complication: 8 patients suffered unexpected headaches, and 9 patients developed severe facial pain. New motor deficits developed in 11 patients, including edema-induced ataxia in 4 and one case of facial weakness after treatment of a vestibular schwannoma. Four patients required shunt placement for symptomatic hydrocephalus, and 16 patients suffered delayed seizures(30).
5. Radiofrequency
Only Patients with a good to excellent pain relief
with a diagnostic trigeminal ganglion block and if the pain relief is of a
short duration may be suitable candidates
for percutaneous RF rhizotomy. It is performed by destruction of the trigeminal
ganglion or roots using RF. RF is the most common percutaneous procedure used to treat TN, especially in elderly patients(31).
According to the study of an analysis of 16 346 treated nodules in 13 283 patients, between January 1999 and November 2010. Five patients (0.038%) died: two
from intraperitoneal hemorrhage, and one each from hemothorax, severe
acute pancreatitis and perforation of the colon. In 16 346 treated
nodules, 579 complications
(3.54%) were observed, including 78 hemorrhages (0.477%), 276 hepatic
injuries (1.69%), 113 extrahepatic organ injuries (0.691%) and 27 tumor
progressions (0.17%). The centers that treated a large number of nodules
and performed RFA modifications, such as use of artificial ascites,
artificial pleural effusion and bile duct cooling, had low complication
rates(32).
6. Balloon compression
In the retrospective study of 121 patients treated with balloon compression of the rootlets behind the Gasser ganglion from 1995 to 2007 showed that balloon compression is considered in the literature to be a safer procedure than other percutaneous surgeries, especially for postoperative sensitive disorders. The best indications seem to be trigeminal neuralgia in older patients or pain due to multiple sclerosis and neuralgia involving the V1 territory(33).
According to researches at the University Clinical Centre Maribor, pain relief was reported in 25 (93%) patients. In two patients, the pain remained the same. The pain free period ranged from 2 to 74 months (median 15 months). A mean duration of analgesia was longer in patients with ideal pear shape of balloon at the time of the procedure compared to nonideal shape (P = 0.01). No major complications occurred in our group of patients(34).
In the retrospective study of 121 patients treated with balloon compression of the rootlets behind the Gasser ganglion from 1995 to 2007 showed that balloon compression is considered in the literature to be a safer procedure than other percutaneous surgeries, especially for postoperative sensitive disorders. The best indications seem to be trigeminal neuralgia in older patients or pain due to multiple sclerosis and neuralgia involving the V1 territory(33).
According to researches at the University Clinical Centre Maribor, pain relief was reported in 25 (93%) patients. In two patients, the pain remained the same. The pain free period ranged from 2 to 74 months (median 15 months). A mean duration of analgesia was longer in patients with ideal pear shape of balloon at the time of the procedure compared to nonideal shape (P = 0.01). No major complications occurred in our group of patients(34).
7. Glycerol rhizolysis
In the study to examine the pathophysiological mechanisms of trigeminal neuralgia and the mechanisms underlying pain relief after percutaneous retrogasserian glycerol rhizolysis (PRGR), indicated that relief of pain after PRGR depends on the normalization of abnormal temporal summation of pain, which is independent of general impairment of sensory perception. Assessment of the temporal summation of pain may serve as an important tool to record central neuronal hyperexcitability, which may play a key role in the pathophysiological changes in trigeminal neuralgia(35).
According to researchers at the All India Institute of Medical Sciences, seventy-nine patients underwent either PRGR (n = 40) or RF thermocoagulation (n = 39). A total of 23 patients (58.9%) in the PRGR group and 33 patients (84.6%) in the RF group experienced excellent pain relief. The mean duration of excellent pain relief in the PRGR and RF groups was comparable. By the end of the study period, 39.1% patients in the PRGR group and 51.5% patients in the RF group experienced recurrence of pain(36).
In the study to examine the pathophysiological mechanisms of trigeminal neuralgia and the mechanisms underlying pain relief after percutaneous retrogasserian glycerol rhizolysis (PRGR), indicated that relief of pain after PRGR depends on the normalization of abnormal temporal summation of pain, which is independent of general impairment of sensory perception. Assessment of the temporal summation of pain may serve as an important tool to record central neuronal hyperexcitability, which may play a key role in the pathophysiological changes in trigeminal neuralgia(35).
According to researchers at the All India Institute of Medical Sciences, seventy-nine patients underwent either PRGR (n = 40) or RF thermocoagulation (n = 39). A total of 23 patients (58.9%) in the PRGR group and 33 patients (84.6%) in the RF group experienced excellent pain relief. The mean duration of excellent pain relief in the PRGR and RF groups was comparable. By the end of the study period, 39.1% patients in the PRGR group and 51.5% patients in the RF group experienced recurrence of pain(36).
8. Radiofrequency rhizotomy
In the reevaluate the results of radiofrequency rhizotomy and review the effectiveness of other surgical procedures for the treatment of trigeminal neuralgia, Dr. Taha JM, and Dr. Tew JM Jr. at the University of Cincinnati College of Medicine, found that
1) percutaneous techniques and posterior fossa exploration offer advantages and disadvantages,
2) radiofrequency rhizotomy is the procedure of choice for most patients undergoing first surgical treatments, and
3) MVD is recommended for healthy patients who have isolated pain in the first ophthalmic trigeminal division or in all three trigeminal divisions and patients who desire no sensory deficit(37)
Fifty-four of the 89 patients underwent 146 RF-TR procedures for both sides and 35 underwent 40 RF-TR procedures for one side. Complete pain relief or partial satisfactory pain relief was achieved on the medically treated side in 35 patients. During follow-up, 36 patients required the second procedure and 7 required the third procedure. Acute pain relief was reported in 86 (96.6%) patients. Early (<6 months) pain recurrence was observed in 11 (12.3%) and late (>6 months) recurrence in 25 (28.0%) patients. Complications included diminished corneal reflex in four (2.1%) patients, keratitis in two (1.1%), masseter dysfunction in four (2.1%), dysesthesia in two (1.1%), and anesthesia dolorosa in one (0.5%), according to the study of Ankara University, Faculty of Medicine(38).
9. Etc.
Unfortunately, all neurosurgical interventions are helpful in relieving pain but with certain side effects. In the study to assess the efficacy of neurosurgical interventions for classical trigeminal neuralgia in terms of pain relief, quality of life and any harms and to determine if there are defined subgroups of patients more likely to benefit, showed that there is very low quality evidence for the efficacy of most neurosurgical procedures for trigeminal neuralgia because of the poor quality of the trials. All procedures produced variable pain relief, but many resulted in sensory side effects. There were no studies of microvascular decompression which observational data suggests gives the longest pain relief. There is little evidence to help comparative decision making about the best surgical procedure. Well designed studies are urgently needed(39) and various surgical procedures have been reported for the treatment of this condition, but there is no agreement on the best management of these patients. There are no differences in the short term results among different procedures for TN in MS patients. Each technique demonstrate advantages and limits in terms of long term pain, recurrence rate and complication rate(40).
In the reevaluate the results of radiofrequency rhizotomy and review the effectiveness of other surgical procedures for the treatment of trigeminal neuralgia, Dr. Taha JM, and Dr. Tew JM Jr. at the University of Cincinnati College of Medicine, found that
1) percutaneous techniques and posterior fossa exploration offer advantages and disadvantages,
2) radiofrequency rhizotomy is the procedure of choice for most patients undergoing first surgical treatments, and
3) MVD is recommended for healthy patients who have isolated pain in the first ophthalmic trigeminal division or in all three trigeminal divisions and patients who desire no sensory deficit(37)
Fifty-four of the 89 patients underwent 146 RF-TR procedures for both sides and 35 underwent 40 RF-TR procedures for one side. Complete pain relief or partial satisfactory pain relief was achieved on the medically treated side in 35 patients. During follow-up, 36 patients required the second procedure and 7 required the third procedure. Acute pain relief was reported in 86 (96.6%) patients. Early (<6 months) pain recurrence was observed in 11 (12.3%) and late (>6 months) recurrence in 25 (28.0%) patients. Complications included diminished corneal reflex in four (2.1%) patients, keratitis in two (1.1%), masseter dysfunction in four (2.1%), dysesthesia in two (1.1%), and anesthesia dolorosa in one (0.5%), according to the study of Ankara University, Faculty of Medicine(38).
9. Etc.
Unfortunately, all neurosurgical interventions are helpful in relieving pain but with certain side effects. In the study to assess the efficacy of neurosurgical interventions for classical trigeminal neuralgia in terms of pain relief, quality of life and any harms and to determine if there are defined subgroups of patients more likely to benefit, showed that there is very low quality evidence for the efficacy of most neurosurgical procedures for trigeminal neuralgia because of the poor quality of the trials. All procedures produced variable pain relief, but many resulted in sensory side effects. There were no studies of microvascular decompression which observational data suggests gives the longest pain relief. There is little evidence to help comparative decision making about the best surgical procedure. Well designed studies are urgently needed(39) and various surgical procedures have been reported for the treatment of this condition, but there is no agreement on the best management of these patients. There are no differences in the short term results among different procedures for TN in MS patients. Each technique demonstrate advantages and limits in terms of long term pain, recurrence rate and complication rate(40).
V.2. Treatment in herbal medicine perspective
The aim of herbal treatment is to relieve pain or discomfort and support the function of the peripheral nerves.
1. Corydalis yanhusuo
In the study to evaluate the analgesic effect of Corydalis yanhusuo on trigeminal neuropathic pain.in a rat mode suggested that the analgesic effect of Yanhusuo involves the participation of CB1 receptors, suggesting that Yanhusuo may offer a useful therapeutic approach for trigeminal neuropathic pain(41).
2. Uyakujunkisan (UJS)
There is a report of a 65-year-old female who developed right-sided trigeminal neuralgia that was partially responsive to carbamazepine (CZ). The pain gradually increased in intensity and at 72 years of age she presented for herbal medicine therapy. Cranial MRI demonstrated vascular compression of the right trigeminal nerve at the cerebellopontine angle by the anterior inferior cerebellar artery. Although microvascular decompression was considered, UJS was prescribed after informed consent. After 3 weeks of treatment with UJS, dramatic improvement of symptoms permitted a decrease in CZ dose(42).
3. Saiko-Keishi-To (TJ-10)
In the study to verify the effectiveness of TJ-10, Wistar rats with chronic neuralgia of the mandibular nerve were prepared and TJ-10 was administered to them for 4 weeks following the manifestation of pain in the mandibular region. The result reveals that the rise in the pain threshold in the mandibular region is more significant in the rats administered TJ-10 than in those in the control group. However, in the tail flick test, no significant change was observed in the pain threshold. These findings suggest that TJ-10 is effective for controlling the manifestation of pain in ligatured nerves, by local effect, not by general analgesic effect(43).
4. Herbal formula containing Ganoderma lucidum, WTMCGEPP
Administration of hot water extracts of a herbal formula containing Ganoderma lucidum, WTMCGEPP (Wisteria floribunda 0.38, Trapa natans 0.38, Miristica agrans 0.38, Coix lachryma-jobi 0.75, cultivated Ganoderma lucidum 0.75, Elfuinga applanata 0.38, tissue cultured Panax ginseng 0.3, and Punica granatum 0.38: numerals designate dry weight gram/dose), decreased herpes zoster pain for five Japanese patients suffering from shingles. Pain relief started within a few days of intake and was almost complete within 10 days. Two acute herpes zoster with manifestations including trigeminal nerve ophthalmia (both 74 years old), lower body zoster (70 years old), herpes zoster oticus (17 years old), and leg herpes (28 years old), responded quickly to treatment and no patient developed post-herpetic neuralgia (PHN) after more than one year of follow-up(44)
5. Etc.
V.3. Treatment in traditional Chinese perspective
1. Siwei Shaoyao Decoction
Siwei Shaoyao Decoction possesses a marked effect on the alleviation of trigeminal neuralgia in rats caused by penicillin G potassium injection. As shown from the hot-plate test, it also has an obvious analgesic effect on mice. To some extent, the decoction has a significant anti-inflammatory effect on the acute edema in hind paws of rats and the effect is believed to be related to the reduction of capillary permeability, according to the study by Guiyang College of Traditional Chinese Medicine(45)
2. Sanchaning
In an experimental study and the comparision of the effect of Sanchaning with that of distilled water as well as carbamazepine, a common Western medicine for curing PTN, Sanchaning differed significantly from distilled water in treating PTN (P < 0.01), but slightly differed from that of carbamazepine (P < 0.05). The sequential trial has identified that Sanchaning could be used effectively to inhibit PTN and has the same effect as carbamazepine. But further study should be carried out to investigate the mechanism of its function in relieving PTN(46).
3. Yokukansan (Yi-Gan San)
According to the report of Juntendo University School of Medicine, the efficacy of Yokukansan in patients with neuropathic pain, including acute herpetic pain, postherpetic neuralgia, central poststroke pain, post-traumatic spinal cord injury pain, thalamic syndrome, complex regional pain syndrome and symptomatic trigeminal neuralgia. Yokukansan was more effective compared with traditional medicines, such as tricyclic antidepressants, carbamazepine, gabapentin, and opioids etc., which are recommended to treat neuropathic pain(47).
4. Etc.
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Sources
(1) http://www.neurosurgery.ufl.edu/clinical-specialties/images/trigeminal_neuralgia_brochure_for_web.pdf
(2) http://www.ncbi.nlm.nih.gov/pubmed/18540495
(3) http://www.ncbi.nlm.nih.gov/pubmed/9139410
(4) http://www.ncbi.nlm.nih.gov/pubmed/21568653
(5) http://www.ncbi.nlm.nih.gov/pubmed/22112988
(6) http://www.ncbi.nlm.nih.gov/pubmed/16472332
(7) http://www.ncbi.nlm.nih.gov/pubmed/3808248
(8) http://www.ncbi.nlm.nih.gov/pubmed/19171430
(9) http://www.ncbi.nlm.nih.gov/pubmed/21686763
(10) http://www.ncbi.nlm.nih.gov/pubmed/17183020
(11) http://www.ncbi.nlm.nih.gov/pubmed/21998318
(12) http://www.ncbi.nlm.nih.gov/pubmed/20078705
(13) http://www.ncbi.nlm.nih.gov/pubmed/17147031
(14) http://www.ncbi.nlm.nih.gov/pubmed/9139410
(15) http://www.ncbi.nlm.nih.gov/pubmed/22558614
(16) http://www.ncbi.nlm.nih.gov/pubmed/18540495
(17) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033033/table/t1-jpr-3-249/
(18) http://www.ncbi.nlm.nih.gov/pubmed/21511953
(19) http://www.ncbi.nlm.nih.gov/pubmed/21936587
(20) http://www.ncbi.nlm.nih.gov/pubmed/21936587
(21) http://www.ncbi.nlm.nih.gov/pubmed/21621166
(22) http://www.ncbi.nlm.nih.gov/pubmed/22865967
(23) http://www.ncbi.nlm.nih.gov/pubmed/22865967
(24) http://www.ncbi.nlm.nih.gov/pubmed/7267511
(25) http://www.ncbi.nlm.nih.gov/pubmed/22889619
(26) http://www.ncbi.nlm.nih.gov/pubmed/22130049
(27) http://www.ncbi.nlm.nih.gov/pubmed/18077952
(28) http://www.ncbi.nlm.nih.gov/pubmed/20158348
(29) http://www.ncbi.nlm.nih.gov/pubmed/21121797
(30) http://www.ncbi.nlm.nih.gov/pubmed/19123881
(31) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033033/
(32) http://www.ncbi.nlm.nih.gov/pubmed/22583706
(33) http://www.ncbi.nlm.nih.gov/pubmed/19298979
(34) http://www.ncbi.nlm.nih.gov/pubmed/22545013
(35) http://www.ncbi.nlm.nih.gov/pubmed/9733301
(36) http://www.ncbi.nlm.nih.gov/pubmed/21866065
(37) http://www.ncbi.nlm.nih.gov/pubmed/8727810
(38) http://www.ncbi.nlm.nih.gov/pubmed/22392016
(39) http://www.ncbi.nlm.nih.gov/pubmed/21901707
(40) http://www.ncbi.nlm.nih.gov/pubmed/22840414
(41) http://www.ncbi.nlm.nih.gov/pubmed/20855279
(42) http://www.ncbi.nlm.nih.gov/pubmed/18694452
(43) http://www.ncbi.nlm.nih.gov/pubmed/11424461
(44) http://www.ncbi.nlm.nih.gov/pubmed/16173526
(45) http://www.ncbi.nlm.nih.gov/pubmed/9208559
(46) http://www.ncbi.nlm.nih.gov/pubmed/7640504
(47) http://www.ncbi.nlm.nih.gov/pubmed/19860227
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