Trigeminal neuralgia (TN) is defined as a chronic, severe, electrifying and burning pain in one side of the face. The attacks are initiated by tactile irritations in a so-called trigger area of the trigeminal nerve and are perceived within the borders of this nerve's innervation. TN is a chronic condition which initially goes into spontaneous remission but these become fewer as the condition progresses. TN is classified as symptomatic when the etiology is known and as idiopathic when the etiology is unknown. There are various forms of treatment: drugs such as anticonvulsants, local ganglionic opioid analgesia (GLOA) at the superior cervical ganglion or sphenopalatine ganglion, percutaneous intervention at the trigeminal ganglion as well as neurosurgery. None of these various procedures has been found to be the most suited and best method. A retrospective analysis of the data of 39 patients who had sought treatment for TN at our pain and acupuncture outpatients' department from 1993 to 1994 was undertaken. Group A (n = 17) had received carbamazepine and acupuncture therapy, group B (n = 11) carbamazepine and GLOA + acupuncture, whereas group C (n = 11) had received carbamazepine and GLOA without acupuncture. All subjects had taken carbamazepine for at least 4 weeks and their plasma levels were within the therapeutic range. Acupuncture therapy was carried out once a week and the number recorded. GLOA was carried out with 0.045 mg buprenorphine at the superior cervical ganglion or the sphenopalatine ganglion as a series of at least 5 injections. The number of attacks of pain and the degree of pain (visual analogue scale [VAS]) were documented. The reduction in pain was categorized in 4 groups: I = pain free, II = reduction of at least 50% on the VAS, III = reduction of less than 50% on the VAS, and IV = no improvement. The statistical analysis was carried out using the chi 2-text, p<0.05 was considered as significant. Of the groups who received acupuncture as an additive, 8 of the 17 subjects of group A, and 5 of the 11 subjects of group B were pain free, but only 2 of the 11 subjects of group C (no acupuncture). The results of the patients with marked pain reduction (category II) were similar. The most patients with no improvement were from the group which did not receive acupuncture (C). The statistical analysis showed significant differences in the categories I, II, and IV between groups A and C. These results show that the combined use of acupuncture and carbamazepine with/without GLOA achieves an additional therapeutic effect in the treatment of trigeminal neuralgia. The addition of acupuncture seems to have a superior effect to the addition of GLOA. These results support the use of acupuncture as an additional form of therapy for the treatment of trigeminal neuralgia.

Trigeminal neuralgia (TN) is defined as a chronic, severe, electrifying and burning pain in one side of the face. The attacks are initiated by tactile irritations in a so-called trigger area of the trigeminal nerve and are perceived within the borders of this nerve's innervation. TN is a chronic condition which initially goes into spontaneous remission but these become fewer as the condition progresses. TN is classified as symptomatic when the etiology is known and as idiopathic when the etiology is unknown. There are various forms of treatment: drugs such as anticonvulsants, local ganglionic opioid analgesia (GLOA) at the superior cervical ganglion or sphenopalatine ganglion, percutaneous intervention at the trigeminal ganglion as well as neurosurgery. None of these various procedures has been found to be the most suited and best method. A retrospective analysis of the data of 39 patients who had sought treatment for TN at our pain and acupuncture outpatients' department from 1993 to 1994 was undertaken. Group A (n = 17) had received carbamazepine and acupuncture therapy, group B (n = 11) carbamazepine and GLOA + acupuncture, whereas group C (n = 11) had received carbamazepine and GLOA without acupuncture. All subjects had taken carbamazepine for at least 4 weeks and their plasma levels were within the therapeutic range. Acupuncture therapy was carried out once a week and the number recorded. GLOA was carried out with 0.045 mg buprenorphine at the superior cervical ganglion or the sphenopalatine ganglion as a series of at least 5 injections. The number of attacks of pain and the degree of pain (visual analogue scale [VAS]) were documented. The reduction in pain was categorized in 4 groups: I = pain free, II = reduction of at least 50% on the VAS, III = reduction of less than 50% on the VAS, and IV = no improvement. The statistical analysis was carried out using the chi 2-text, p<0.05 was considered as significant. Of the groups who received acupuncture as an additive, 8 of the 17 subjects of group A, and 5 of the 11 subjects of group B were pain free, but only 2 of the 11 subjects of group C (no acupuncture). The results of the patients with marked pain reduction (category II) were similar. The most patients with no improvement were from the group which did not receive acupuncture (C). The statistical analysis showed significant differences in the categories I, II, and IV between groups A and C. These results show that the combined use of acupuncture and carbamazepine with/without GLOA achieves an additional therapeutic effect in the treatment of trigeminal neuralgia. The addition of acupuncture seems to have a superior effect to the addition of GLOA. These results support the use of acupuncture as an additional form of therapy for the treatment of trigeminal neuralgia.

OBJECTIVE: To probe a better method for treatment of trigeminal neuralgia. Methods One hundred and four cases of trigeminal neuralgia were randomly divided into a treatment group (n=57) and a control group (n=47). The treatment group were treated witb acupoint injection of 2000 microg of VitB12, with Xiaguan (ST 7) selected as main point, and the control group witb oral administration of Carbamazepine. The therapeutic effect were analyzed after 3 tberapeutic courses. RESULTS: Tbe cured and markedly effective rate and the effective rate were 82.5% and 98.2% in the treatment group, and 57.4% and 8O.9% in the control group, with a very significant difference between the two groups (P<0.01). After treatment, there was a very significant difference in the cumulative score of pain between the two groups (P<0.01). CONCLUSION: Acupoint injection of VitB12 has a better therapeutic effect than that of oral administration of Carbamazepine.

OBJECTIVE: To probe into a better therapy for primary trigeminal neuralgia. METHODS: Eighty-six cases were randomly divided into an observation group (n = 46) and a control group (n = 40). The observation group were treated with the three-combination needling method, i. e. acupuncture, acupoint-injection and fire-needle therapy, and the control group with acupuncture and acupoint-injection. After treatment of 2 courses, their therapeutic effects were assessed. RESULTS: The total effective rate of 93.5% and the cured rate of 60.9% in the observation group were better than 65.0% and 22.5% in the control group, with significant differences (both P<0.01). CONCLUSION: The three-combination needling method has obvious clinical therapeutic effect on primary trigeminal neuralgia.

OBJECTIVE: To probe into a better therapy for primary trigeminal neuralgia. METHODS: Eighty-six cases were randomly divided into an observation group (n = 46) and a control group (n = 40). The observation group were treated with the three-combination needling method, i. e. acupuncture, acupoint-injection and fire-needle therapy, and the control group with acupuncture and acupoint-injection. After treatment of 2 courses, their therapeutic effects were assessed. RESULTS: The total effective rate of 93.5% and the cured rate of 60.9% in the observation group were better than 65.0% and 22.5% in the control group, with significant differences (both P<0.01). CONCLUSION: The three-combination needling method has obvious clinical therapeutic effect on primary trigeminal neuralgia.

In this paper the treatment of patients with chronic, intractable trigeminal neuralgia by invasive electrical stimulation of the Gasserion ganglion is reviewed. Two different surgical techniques are employed in this treatment. Most frequently, a method similar to the traditional technique for percutaneous glycerol and radiofrequency trigeminal rhizolysis is used: a small percutaneous stimulation electrode is advanced under fluoroscopic control through a thin needle via the foramen ovale to the Gasserian cistern. Some neurosurgeons use an open surgical technique by which the Gasserian ganglion is approached subtemporally and extradurally, and the bipolar pad electrode is sutured to the dura. When percutaneous test stimulation is successful (at least 50% pain relief) the electrode is internalized and connected to a subcutaneous pulse generator or RF-receiver. Data from 8 clinical studies, including 267 patients have been reviewed. Of all 233 patients with medication-resistant atypical trigeminal neuralgia 48% had at least 50% long term pain relief. The result of test stimulation is a good predictor of the long term effect, because 83% of all patients with successful test stimulation had at least 50% long term relief, and 70% had at least 75% long term relief. Patients generally preferred this invasive method over TENS. The success rate in patients with postherpetic trigeminal neuralgia was very low (less than 10%). It is suggested that the likelihood of pain relief by electrical stimulation is inversely related to the degree of sensory loss. It is concluded that invasive stimulation of the Gasserian ganglion is a promising treatment modality for patients with chronic, intractable, atypical trigeminal neuralgia.

OBJECTIVE: To evaluate individualized classical homeopathy in the treatment of idiopathic trigeminal neuralgia (ITN) METHOD: 15 patients with physician-confirmed trigeminal neuralgia were treated with homeopathy. Patients received individualized homeopathic medicines as oral liquid 30C once per month and were followed-up at the end of first, second, third and fourth month. Visual analogue scale (VAS) was used for the evaluation of pain intensity and descriptive criteria were used for evaluation of attack frequency. RESULT: All 15 patients completed treatment. The results for both the reduction of pain intensity and attack frequency were statistically significant (P<0.001) during the four-month evaluation. We observed overall reductions of more than 60% in pain intensity using homeopathic treatment. CONCLUSION: The results suggest that homeopathic treatment is an effective and safe method in the treatment of ITN.

In the present paper, 45 cases of acute trigeminal neuralgia were treated and observed by comparative method. Results showed no significant difference in transient analgesic effect (P>0.05) but a significant difference in therapeutic effect (P<0.01) between the treatment and control groups. This indicates that blood-letting puncture with cupping is an effective therapy for the disease.

In the present paper, 45 cases of acute trigeminal neuralgia were treated and observed by comparative method. Results showed no significant difference in transient analgesic effect (P>0.05) but a significant difference in therapeutic effect (P<0.01) between the treatment and control groups. This indicates that blood-letting puncture with cupping is an effective therapy for the disease.

This report evaluates the effect of meridian acupuncture treatment on trigeminal neuralgia. Ten patients aged 26 to 67 years (mean 55.4 years) who visited the outpatient Dental Anesthesiology Clinic at Tsurumi University Dental Hospital from 1985 to 1990 were studied. Five of the patients suffered from idiopathic and five from symptomatic trigeminal neuralgia. The patients underwent meridian treatment by acupuncture alone or acupuncture combined with moxibustion. The acupuncture method used was primarily basic treatment employing only needles without electrical stimulation. Meridian acupuncture treatments were repeated from two to four times a month. Five patients were restored to a pain-free state. The other five patients noted a decrease in pain, but with some level of pain remaining (significant pain in one patient). It is concluded that meridian acupuncture treatment is useful and can be one therapeutic approach in the management of trigeminal neuralgia.

This report evaluates the effect of meridian acupuncture treatment on trigeminal neuralgia. Ten patients aged 26 to 67 years (mean 55.4 years) who visited the outpatient Dental Anesthesiology Clinic at Tsurumi University Dental Hospital from 1985 to 1990 were studied. Five of the patients suffered from idiopathic and five from symptomatic trigeminal neuralgia. The patients underwent meridian treatment by acupuncture alone or acupuncture combined with moxibustion. The acupuncture method used was primarily basic treatment employing only needles without electrical stimulation. Meridian acupuncture treatments were repeated from two to four times a month. Five patients were restored to a pain-free state. The other five patients noted a decrease in pain, but with some level of pain remaining (significant pain in one patient). It is concluded that meridian acupuncture treatment is useful and can be one therapeutic approach in the management of trigeminal neuralgia.

Rhino-cerebral fungal infections are rare and difficult disorders to cure. We report the case of a woman presenting a left trigeminal neuralgia complicated by ophthalmoplegia and blindness. MRI demonstrated a lesion of the left orbital apex with extension into the cavernous sinus. Fungal infiltration (aspergillosis or mucormycosis), was seen on biopsy. High-dose liposomal Amphotericin B (5mg/kg/day) for six weeks was unsuccessful. Adjunctant hyperbaric oxygen therapy led to clinical and radiological improvement. Hyperbaric oxygen therapy is discussed in the medical management of rhino-cerebral yeast abscesses.

OBJECTIVE: To search for an effective method for increasing therapeutic effect on trigeminal neuralgia. METHODS: Ninety cases of primary trigeminal neuralgia were randomly divided into a deep needling group and a routine needling group, 45 cases in each group. The routine needling group were treated by shallow acupuncture at local acupoints and distal acupoints along the Hand and Foot-Yangming Channels, and the deep needling group were treated by acupuncture at the above acupoints and deeply needling at the local acupoints to nerve stem for 3 courses. RESULTS: In the deep needling group 12 cases were clinically cured, 24 cases were markedly effective, 7 cases improved and 2 cases were ineffective, with a total effective rate of 95.6%; and in the routine needling group, the corresponding figures were 7, 15, 12, 11, 75.6%. The therapeutic effect in the deep needling group was better than that in the routine needling group (P<0.05). CONCLUSION: Deeply needling local acupoints plus acupuncture at distal acupoints along the Hand and Foot-Yangming Channels can increase significantly the therapeutic effect on trigeminal neuralgia.

OBJECTIVE: To search for an effective method for increasing therapeutic effect on trigeminal neuralgia. METHODS: Ninety cases of primary trigeminal neuralgia were randomly divided into a deep needling group and a routine needling group, 45 cases in each group. The routine needling group were treated by shallow acupuncture at local acupoints and distal acupoints along the Hand and Foot-Yangming Channels, and the deep needling group were treated by acupuncture at the above acupoints and deeply needling at the local acupoints to nerve stem for 3 courses. RESULTS: In the deep needling group 12 cases were clinically cured, 24 cases were markedly effective, 7 cases improved and 2 cases were ineffective, with a total effective rate of 95.6%; and in the routine needling group, the corresponding figures were 7, 15, 12, 11, 75.6%. The therapeutic effect in the deep needling group was better than that in the routine needling group (P<0.05). CONCLUSION: Deeply needling local acupoints plus acupuncture at distal acupoints along the Hand and Foot-Yangming Channels can increase significantly the therapeutic effect on trigeminal neuralgia.

The essential or secondary trigeminal neuralgia is a very frequent and invalidant disease. In this forms, the medical or surgical conventional therapies are often inadequate. In this study we evaluated the effects of the acupunctural therapy on 104 patients (mean age 52.3 +/- 13 years) with idiopathic or secondary trigeminal neuralgia. Utilizing cycles of twelve sessions, the acupunctural treatment was performed with an electrostimulator on local points and a distance or on aching points, in the secondary forms. The results was evaluated on the basis of three parameters (reappearance of the symptomatology, absence of pain in months and preceding treatments) and was defined using this scale: very well, well, fair and null. In conclusion we can say that acupuncture is an elective treatment in all kinds of secondary tregeminal neuralgia, while, in the idiopathic form, its validity is conditioned by preceding medical treatments and by beginning of the disease.

The following case describes a 68 year-old woman with a 7(1/2) year history of worsening head and neck pain diagnosed as trigeminal neuralgia following surgical resection of a brain tumor. After years of unsuccessful management with medication and physical therapies, a therapeutic trial of chiropractic was carried out. Chiropractic care included ultrasound, manual therapies (manipulation and mobilization), soft tissue therapies, and home stretching exercises. After an initial treatment period followed by 18 months of supportive care the patient reported satisfactory improvement. It became evident that there were at least three sources of her symptoms: mechanical and/or degenerative neck pain, temporomandibular joint syndrome, and trigeminal neuralgia. While never completely pain-free, the patient continued to report that her pains reduced to minimal at times. At the most recent follow-up, the pain had not returned to pre-treatment intractable levels. This case study demonstrates the importance of diagnosing and treating multiple sources of pain and the positive role chiropractic care can have in the management of patients with these clinical conditions. The potential for convergence of sensory input from the upper three cervical segments and the trigeminal nerve via the trigeminocervical nucleus is discussed.

OBJECTIVE: To discuss a case of trigeminal neuralgia that responded to an accidental high-intensity discharge of electrical current delivered by a transcutaneous electrical nerve stimulator (TENS). CLINICAL FEATURES: A 36-yr-old man suffering from a 5-month history of worsening paroxysmal pain of the left facial and temporal regions was referred to a neurologist by his family physician. A clinical diagnosis of trigeminal neuralgia was made; before committing to pharmaceutical treatment, however, the patient sought chiropractic consultation. INTERVENTION AND OUTCOME: A trial of self-applied TENS was recommended for pain control. Initial application to patient tolerance provided transient pain relief until an accidental, intense discharge resulted in immediate remission of symptoms, lasting now for three years. CONCLUSION: As an initial treatment of choice, TENS can be a safe and effective therapy for trigeminal neuralgia. The unique effect of this accidental application leads us to speculate that diffuse noxious inhibitory controls may have been the pain inhibitory pathway responsible for the resolution of symptoms in this case. Although firm conclusions are difficult to draw from one incident, using TENS at an intense, noxious level may improve its therapeutic efficacy by decreasing treatment time and frequency and eliciting long-lasting effects. This case suggests the need for further investigation of TENS in the treatment of trigeminal neuralgia and related pain syndromes.