Background: Active unilateral condylar hyperplasia (UCH) is a progressive mandibular growth disorder characterized by facial asymmetry, occlusal alteration, and mandibular deviation. Although single-photon emission computed tomography/computed tomog-raphy (SPECT/CT) is widely used to assess condylar hyperactivity, little is known about the clinical and neuromuscular adaptations occurring during the observation period before definitive treatment. This study evaluated whether conservative functional stabilization is associated with adaptive clinical and neuromuscular changes during this period. Methods: This prospective comparative observational cohort study included 49 patients with active unilateral condylar hyperplasia confirmed by SPECT/CT. Thirty-seven patients received full-time orthopedic stabilization with a rigid mandibular intraoral orthosis, whereas 12 were managed by observation alone. Clinical outcomes included pain intensity, maximum mouth opening, and mandibular midline deviation. Surface electromyography (sEMG) was performed at baseline and after approximately 3 months. SPECT/CT examinations were obtained at baseline and follow-up (mean, approximately 14 months). Within-group and between-group comparisons, effect sizes, percentage changes, and 95% confidence intervals were calculated. Results: Orthopedic stabilization significantly improved mandibular midline deviation, maximum mouth opening, and neuromuscular function. Composite resting sEMG activity decreased, whereas functional muscle recruitment increased in the treated cohort. In contrast, the observation cohort demonstrated increased resting muscle activity with minimal functional changes. Significant between-group differences were observed for resting and functional sEMG outcomes. SPECT/CT metabolic changes were also detected, but were less consistent and clinically informative than the documented clinical and neuromuscular adaptations. Conclusions: Full-time orthopedic stabilization was associated with measurable clinical and neuromuscular adaptation during the observation period preceding definitive treatment. These findings support functional stabilization as a conservative approach that may promote a more favorable neuromuscular and biomechanical environment while treatment decisions are being made. SPECT/CT findings should be interpreted as complementary semiquantitative observations rather than definitive indicators of growth modification.
Background: Herpetic trigeminal neuralgia (HTN) is a neuropathic pain disorder caused by varicella-zoster virus invasion of the trigeminal nerve, but its mechanisms remain poorly elucidated. Accumulating evidence implicates gut microbiota dysbiosis and metabolic perturbations in modulating chronic pain via the gut-brain axis, yet their roles in HTN have not been systematically explored. Methods: Integrated multi-omics analysis was performed on 19 patients with HTN and 18 healthy controls. Fecal metagenomic sequencing characterized gut microbial composition and function. Untargeted metabolomics profiled metabolic signatures in fecal and circulating samples. Weighted gene co-expression network analysis (WGCNA) and random forest modeling screened pivotal microbial and metabolic features associated with HTN. Correlation analysis between differential metabolites and clinical pain scores validated the translational potential of identified alterations. Results: HTN patients showed significantly reduced gut microbial diversity, with enriched Proteobacteria, depleted butyrate-producing bacteria (including Faecalibacterium, Roseburia, and Lachnospira), and expanded opportunistic pathogens (Escherichia coli and [Ruminococcus] gnavus). Microbial pathways for pH homeostasis and oxidative stress defense were downregulated. Metabolomic analysis identified differential metabolites, primarily involving nicotinate/nicotinamide metabolism and retrograde endocannabinoid signaling. WGCNA and random forest analyses suggested fecal metabolites as potential candidate features, with associations between gut microbial dysregulation and systemic metabolic changes. Furthermore, screened metabolites correlated significantly with pain scores. Conclusions: This study provides multi-omics evidence of gut microbial and metabolic dysregulation in HTN, generating hypotheses for further mechanistic research. Large-scale, multicenter prospective cohorts with standardized metadata collection are needed to validate these findings.
Background: The study aimed to identify clinical predictors associated with treatment success following Gasserian ganglion conventional radiofrequency (CRF) in patients with trigeminal neuralgia (TN), with particular focus on the predictive value of early clinical response. Methods: This retrospective secondary cohort analysis included 37 patients with classical TN who underwent Gasserian ganglion CRF at a tertiary pain clinic. Treatment success was defined as a >= 50% reduction in Numerical Rating Scale (NRS) score at 6 months compared with baseline. Demographic characteristics, baseline pain severity, trigeminal branch involvement, early post-procedural pain response, complications, additional treatment requirements, and patient satisfaction scores were analyzed. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive performance of early pain reduction for 6-month treatment success. Results: Twenty-nine patients (78.4%) achieved treatment success at 6 months. The success group demonstrated significantly higher median age (67 vs. 54.5 years, p = 0.006) and baseline pain intensity (NRS0: 10 vs. 8, p = 0.007) compared with the non-success group. Early treatment response at 1 month was strongly associated with 6-month success. Median percentage reduction in NRS score at 1 month was significantly greater in the success group (60% vs. 31.25%, p = 0.008). Achieving >= 50% pain reduction at 1 month was significantly associated with treatment success at 6 months (p = 0.0005). ROC analysis demonstrated good predictive performance for early pain reduction (area under the curve (AUC) = 0.804), with a sensitivity of 82.8% and specificity of 87.5% for the >= 50% cutoff. Patient satisfaction scores were higher among patients with treatment success (p < 0.001). Conclusions: Early post-procedural pain reduction appears to be a clinically useful marker of sustained mid-term treatment success after Gasserian ganglion CRF in TN. In particular, a >= 50% reduction in NRS score at 1 month may help identify patients likely to maintain meaningful pain relief at 6 months.
Background: To observe the real-world association of Five Element Acupuncture (FEA) with symptom improvement when used for the preventive treatment of primary headache disorders. Methods: This prospective case series study was conducted across multiple centers in China. Patients diagnosed with migraine, tension-type headache (TTH), or trigeminal autonomic cephalalgias (TACs) according to the International Classification of Headache Disorders, Third Edition (ICHD-3), received standardized FEA treatment once every 1-2 weeks for 12 weeks, followed by a 12-week follow-up. Outcomes included headache days per 4 weeks, headache frequency, headache intensity (visual analog scale, VAS), total analgesic units, and headache-related quality of life (Headache Impact Test-6, HIT-6). Safety was assessed by recording acupuncture-related adverse events (AEs). Linear mixed models were used for analysis. Results: Ninetythree participants were included in the intention-to-treat analysis. Headache days were significantly reduced from baseline to the 12-week treatment (p < 0.001, d = -2.01, 95% Confidence Intervals (CI) (-2.37, -1.65)) and 12-week follow-up (p < 0.001, d = -2.50, 95% CI (-2.99, -2.01)) time points. Significant improvements were also noted in headache frequency, VAS scores, total analgesic units, and HIT-6 scores (all p <0.001). Headache days and HIT-6 scores showed further significant improvement during the follow-up period compared to the end of treatment (p = 0.009 and p <0.001, respectively). No acupuncture-related AEs were reported. Conclusions: This realworld exploratory observational study suggests that FEA is associated with significant improvements in headache days, headache frequency, headache intensity, analgesic use, and quality of life, with sustained effects noted during follow-up. These findings provide preliminary observational evidence that may inform the design of future randomized controlled trials. Clinical Trial Registration: Registration No.: ChiCTR2200061878.
Background: Burning mouth syndrome (BMS) is a chronic condition characterized by a burning sensation in the mouth without observable lesions, lasting over two hours daily for more than three months. In this study, we aimed to examine whether central sensitization inventory (CSI) scores differ between primary and secondary BMS (SBMS), arising from identifiable causes, and to explore their associations with taste thresholds and pain characteristics. Methods: This study was conducted between February 2022 and September 2025 and included 30 patients with BMS, 30 patients with SBMS, and 30 healthy controls. Taste assessments, including sweet, salty, sour, and bitter solutions and CSI evaluations, were performed. Statistical analyses, including correlation and comparison tests, were performed using the SPSS software. Results: Patients with BMS exhibited significantly larger pain visual analog scale (VAS) and CSI scores than those with SBMS. There were no significant differences in taste perception thresholds for the four flavors among the three groups. CSI scores showed significant positive correlations with taste thresholds for sweetness, saltiness, and bitterness in the BMS group, whereas no such correlations were observed in the SBMS group. The pain VAS scores in the BMS group were positively correlated with age and CSI scores. Receiver operating characteristic analysis revealed acceptable CSI discrimination for distinguishing BMS from SBMS (Area under the curve = 0.76). A cutoff of 27 yielded 70% sensitivity and 77% specificity, with an overall accuracy of 73%. Conclusions: Although no significant differences in taste thresholds were observed among the three groups, significant associations between the CSI scores and taste thresholds were identified exclusively in patients with BMS. While CSI scores do not directly assess central sensitization, they might reflect clinical features associated with central sensitization-related symptom burden in BMS, as observed for taste thresholds, pain intensity, and age. These findings suggest that taste alterations in BMS might be associated with central sensitization-related clinical features.
