Primary trigeminal neuralgia is a common condition that we encounter in our daily lives and is characterized by persistent and severe pain. Many patients suffer from the disease for years to decades, with long-lasting pain of a lightning-like nature and paroxysmal. Once the pain occurs it is unbearable. It may sometimes flare up when eating, talking, washing the face or blowing cold air. The most important feature of this disease is that conventional analgesics are ineffective. There are many treatment methods: ① drug therapy: phenytoin sodium and carbamazepine with slow and poor efficacy and many side effects; ② nerve block therapy: there are trigeminal nerve branch block, semilunar ganglion block, trigeminal nerve pool block, these three methods have a certain degree of efficacy, but the operator’s operation requirements and high accuracy, the type, concentration and dose of drugs required to be high and appropriate, the recurrence rate is relatively high; ③ electrocoagulation (3) electrocoagulation and radiofrequency thermal coagulation therapy: this method has poor efficacy and complications such as sensory abnormalities and keratitis, complicated operation and the need for appropriate equipment, the patient is in considerable pain during treatment, and the recurrence rate is high; (4) surgical treatment: surgical methods continue to improve, but it is still difficult to avoid serious complications, and the recurrence rate is high, and it is difficult to give new treatment after recurrence. All of the above methods are effective but have many drawbacks. Sun Yanbin, Department of Acupuncture and Tuina, Tieling City Hospital of Traditional Chinese Medicine
1 Clinical data
1.1 General data 20 cases of patients all outpatient treatment. Among them, 12 cases were male and 8 cases were female; the youngest was 18 years old and the oldest was 68 years old, the shortest duration of the disease was half a year and the longest was 8 years, 13 cases were on the right side and 7 cases were on the left side; the pain was distributed in the Ⅰ branch in 3 cases, the Ⅱ branch in 7 cases, the Ⅲ branch in 5 cases, and the Ⅱ and Ⅲ were concurrent in 5 cases. 18 cases had “trigger points”, and most of the above cases were treated repeatedly by several hospitals. Most of the above cases were treated repeatedly by several hospitals without improvement.
1.2 The clinical manifestations are mostly over 40 years old, characterized by sudden onset of severe and transient pain in the distribution area of one or several branches of the facial trigeminal nerve. It may be fixed in one branch for a long time, especially in the second and third branches, or both branches may be involved at the same time. The pain is most obvious in the cheek, upper and lower jaw or tongue; the corners of the mouth, nose, cheek and tongue are the most sensitive and can be triggered by light touch, so it is called “trigger point” or “trigger point”. Pain can cause reflex facial muscle twitching, with the corners of the mouth pulling to the affected side, and redness, lacrimation and salivation, called painful twitching. In severe cases, washing the face, brushing the teeth, talking and chewing can be induced, so that these actions cannot be done. Each attack lasts only a few seconds to 2 minutes, with sudden onset and stop. The intervals are completely normal, with a low number of pains, which increase and worsen later. The course of the disease may be cyclic, with each attack lasting several days, weeks or months. The remission period may vary from several days to several years. There are usually no positive neurological signs.
2 Treatment methods
2.1 Acupuncture treatment is performed at the pressure points or hard nodes on the affected side of the cervical spine, mainly at the cervical occipital region, cervical 1, cervical 2, cervical 4 and cervical 5 interspinous transverse processes. The next sites for release are at the mastoid foramen, the outlet of the auricular nerve, the branch travel area, and the trigger point.
2.2 Needle knife method Homemade small needle knife routine preoperative preparation, needle knife site with iodine alcohol routine disinfection. Take the needle knife and apply it at the trigger point and the lesion site. The blade is perpendicular to the pain radiating line; when the needle knife is cut on the orbit and the inferior foramen, the blade is parallel to the eye fissure. The right hand thumb and index finger pinch the needle handle, the remaining three fingers hold the needle body, gradually pressurize to have a hard feeling without piercing the skin, into the needle point at the formation of depression, and then a little pressure, you can pass through the skin. After entering the needle first longitudinal cutting and peeling, and then horizontal cutting and peeling, layer by layer deep, to reach the bone surface and do not penetrate the oral cavity as degree. After the needle comes out, squeeze the bleeding several drops by hand, disinfect the needle hole and then apply a band-aid externally. 3 days once, each trigger point is taken. 5 times can be basically cured.
3 Results
In the treated nearly 20 cases of trigeminal neuralgia patients cure rate reached 80%. The effectiveness rate was 100%.
4 Discussion and experience
About 30% to 50% of patients with trigeminal neuralgia have one or more “trigger points” on the face. They are located on the eyebrows, nose and lips, upper and lower lips, etc., and the upper and lower lips at the corners of the mouth are common. The causes are rarely discussed in books. The author believes that cervical spondylosis or neuropathy is the main cause of this disease. On the one hand, cervical spondylosis causes spasm of the vertebral artery due to sympathetic nerve stimulation, and on the other hand, direct compression of the vertebral artery causes narrowing of the blood vessels, which leads to poor blood supply to the spinal cord, resulting in lack of nutrition to the trigeminal nerve and muscle dysfunction, followed by tissue malnutrition and increased local metabolism, while blood flow is relatively reduced, resulting in muscle These local reactions cause muscle bundle tension and painful areas through central or sympathetic reflexes. Therefore, needle knife cutting of trigger points and other areas can effectively serve to relax tense muscles; dilate blood vessels and dilute accumulated metabolic substances; and block pain transmission, thus relieving or eliminating trigeminal neuralgia.
Small needle knife stripping cervical spine and trigger point-based treatment methods, the needle knife site are on or near the branches of the trigeminal nerve, the needle knife site, in essence, is the use of the needle end of the micro knife to apply the actual trigeminal nerve peripheral branch stripping loosening surgery, so as to effectively block the transmission of pain. The method is simple but more effective than medication, sealant and surgical treatment.
Trigeminal neuralgia is an episodic, severe throbbing, stabbing, radiating, burning, cutting or clicking pain in one or more branches of the trigeminal nerve distribution. Trigeminal neuralgia needs to be differentiated from the following diseases.
①Secondary trigeminal neuralgia: manifesting persistent facial pain and hyperalgesia, retarded corneal reflex, etc., often combined with other cerebral nerve paralysis.
②Toothache: usually toothache is persistent and dull, mostly confined to the gum area, and can be aggravated by cold or hot food.
③Sinusitis: local persistent dull pain, local pressure pain, fever, leukocytosis, runny nose and other inflammatory manifestations, nasal examination and X-ray film can confirm the diagnosis.
④Temporomandibular arthropathy is mainly pain and limitation of movement when chewing, popping sound and local pressure pain in the temporomandibular joint on the diseased side when opening the mouth.
⑤ Glossopharyngeal neuralgia: It is a severe pain confined to the tonsils, root of the tongue, pharynx and deep part of the ear canal in the distribution area of the glossopharyngeal nerve, and can often be triggered by tongue and throat, speech, yawning and coughing. There may be painful trigger points in the pharynx, root of tongue and tonsillar fossa.
(6) Pterygopalatine neuralgia: distributed in the posterior part of the nasal root, maxilla, palate and gingival area. During the attack, the nasal mucosa of the diseased side is congested, nasal congestion and lacrimation, and the pain is discharged to the ipsilateral orbit, to the frontal, temporal, occipital and ear areas, without trigger points.
(7) Atypical facial pain: the pain site is variable, deep in or diffuse, located on one side of the face, or can be bilateral, no tenderness point, and emotion makes the pain worse.