BackgroundCervicogenic orofacial pain (COFP) is frequently misdiagnosed or undiagnosed, particularly in patients with refractory orofacial pain. When conventional treatments for conditions such as trigeminal neuralgia, dental pathologies, or oncologic pain fail to provide relief, a cervical spondylotic etiology should be considered. We present two cases of COFP secondary to cervical spondylosis successfully managed with minimally invasive intervention.Case presentationBoth patients present with 3-year histories of unilateral, persistent orofacial pain and dental discomfort. Despite multimodal therapeutic interventions, no significant improvement was observed. Physical examination of the neck and cervical spine MRI both confirmed the diagnosis of cervical spondylosis. After receiving ultrasound-guided low-temperature plasma ablation targeting the C2 dorsal root ganglion and the periarterial region of the vertebral artery V3 segment, both patients experienced immediate and substantial relief from refractory dental and facial pain. Postoperatively, the visual analog scale scores for both patients decreased from 8 to 1. The Jaw Functional Limitation Scale-8 scores improved from 65 to 11 in Patient 1 and from 60 to 8 in Patient 2. Similarly, the Oral Health Impact Profile scores decreased from 45 to 6 in Patient 1 and from 48 to 8 in Patient 2. No recurrence or complications were observed during the 8-month follow-up period.ConclusionsCOFP often manifests with subtle symptoms overlapping trigeminal neuralgia and dental disorders, leading to diagnostic delays. Comprehensive neuroanatomical differential diagnosis is critical. Precision-guided minimally invasive cervical interventions can provide effective symptom control, as demonstrated by this dual-target low-temperature plasma ablation approach.

Cervicogenic angina is a frequently overlooked non-cardiac chest pain syndrome whose clinical manifestations closely resemble those of true cardiac angina, and conventional anti-anginal medications as well as coronary interventions often yield unsatisfactory results. This report describes a 61-year-old male patient who presented with recurrent precordial pain, chest tightness, dyspnea, and numbness of the neck, shoulders and upper extremities for one year. The patient was initially diagnosed with coronary artery disease and underwent coronary intervention, but symptoms recurred shortly after the procedure and sublingual nitroglycerin was ineffective. After cardiac causes were ruled out through specialized cardiac examinations, physical examination revealed positive paravertebral tenderness and signs of nerve root compression. Cervical magnetic resonance imaging demonstrated disc herniation at C5-C7 with nerve root compression, leading to a final diagnosis of cervicogenic angina. The patient underwent ultrasound-guided pulsed radiofrequency of the cervical nerve roots and cervical sympathetic nerve combined with low-temperature plasma ablation of the cervical facet joints, followed by postoperative adjunctive treatment with duloxetine. Neck-shoulder pain and precordial discomfort improved markedly, with the visual analog scale score decreasing from 7 preoperatively to 0 at the 3-month follow-up; Cervical range of motion markedly improved; precordial pain, chest tightness, and dyspnea resolved completely without recurrence, and sleep quality improved significantly. This case suggests that cervicogenic angina should be strongly suspected in patients with recurrent chest pain after a standard cardiac work-up has excluded a cardiac origin. Ultrasound-guided radiofrequency intervention is safe and effective, providing a reliable minimally invasive treatment strategy for this easily missed condition and deserves wider clinical application.

IntroductionGiven the intricate nature and varied symptoms of cervicogenic headache, its treatment can be challenging, potentially leading to refractory cervicogenic headache. We aimed to identify risk factors that could help predict the development of refractory cervicogenic headache in patients with cervicogenic headache.MethodsThis is a retrospective cohort study of patients diagnosed with cervicogenic headache between January 1, 2022 and March 1, 2024 who underwent greater occipital nerve block. Data were collected by reviewing patients’ medical records and pain questionnaires. Covariates were selected using univariate and multivariate logistic regression analyses. A predictive nomogram model was developed to predict the unresponsiveness of the greater occipital nerves to anesthetic blockade.ResultsOf the 82 patients studied, 46 experienced relief from headache following greater occipital nerve blocks, whereas 36 did not. In a multivariate analysis of patients with refractory cervicogenic headache, factors such as C2–C3 sensory loss [odds ratio (OR) = 13.10, 95% confidence interval (CI): 1.45–118.54], bilateral headache (OR = 7.99, 95% CI: 1.36–47.07), having two or more types of pain sources (OR = 5.51, 95% CI: 1.01–30.16), and limited cervical range of motion (>1) (OR = 13.05, 95% CI: 2.28–74.59) were identified as major prognostic indicators of unresponsiveness to greater occipital nerve blocks in cases of large occipital and cervical spine-related factors.ConclusionPatients with severely limited cervical spine mobility, bilateral headaches, and C2–C3 sensory loss may not respond well to greater and lesser occipital nerve block therapy. Pain originating from multiple sources is typically associated with less favorable outcomes.

颈源性头痛(cervicogenic headache, CGH)是一种继发于颈部结构病变的头痛综合征,通常单侧发病,病因可能是神经血管、骨骼、软组织等方面损伤,由枕下肌群、椎前和颈椎肌肉激痛点导致的肌筋膜疼痛,常累及胸锁乳突肌、斜方肌和头半棘肌等 [1].

We investigated the function and molecular mechanism of long non-coding RNA (lncRNA) small nucleolar RNA host gene 16 (Snhg16) in modifying ozone treatment for neuropathic pain (NP) in a mouse model of chronic constriction injury (CCI). Pain-related behavioral responses were evaluated using paw withdrawal threshold (PWT), paw lifting number (PLN), and paw withdrawal latency (PWL) tests. Interleukin (IL)-1β, IL-10, IL-6, and tumor necrosis factor-alpha (TNF-α) were measured by ELISA and qRT-PCR to evaluate neuroinflammation. qRT-PCR was performed to detect expressions of Snhg16, microRNA (miR)-719, sodium voltage-gated channel alpha subunit 1 (SCN1A), and inflammatory factors. Bioinformatics, dual-luciferase reporter assay, and RNA pull-down verified the underlying molecular mechanisms. Snhg16 expression increased in CCI mice. Snhg16 overexpression retarded the curative effect of ozone and induced NP. miR-719 was sponged by Snhg16. SCN1A was a target of miR-719. Inhibition of miR-719 markedly reversed the effects of Snhg16 on pain-related behavioral responses and neuroinflammation. Upregulation of SCN1A partly abrogated the effects of elevated miR-719 levels on the occurrence of NP. The findings demonstrate that lncRNA Snhg16 promotes NP progression in CCI mice by binding to miR-719 to increase SCN1A expression. The Snhg16/miR-719/SCN1A axis may influence the curative effects of ozone therapy in treating NP.

目的 探讨超声引导锁骨上入路锁骨下静脉(SCV)穿刺在颅脑手术中的应用效果.方法 选择80例需要中心静脉置管的颅脑手术患者,随机分为锁骨下入路组(n=40)和锁骨上入路组(n=40).记录2组SCV长轴图像超声定位时间;测量2组SCV长轴图像与探头的垂直距离;测量2组SCV的平均内径;记录2组穿刺时间、总穿刺次数、一次穿刺成功率、总穿刺成功率;记录2组误穿动脉、气胸等并发症的发生情况.结果 与锁骨下入路组相比,锁骨上入路组SCV长轴图像超声定位时间更短(P<0.05),SCV长轴图像与探头的垂直距离更短(P<0.05),SCV的平均内径明显较长(P<0.05),穿刺时间明显较短(P<0.05),总穿刺次数明显较少(P<0.05),一次穿刺成功率明显较高(P<0.05).2组总穿刺成功率及并发症发生率比较差异无统计学意义(P>0.05).结论 超声引导锁骨上入路SCV穿刺具有定位时间短、穿刺时间短、穿刺成功率高等优势,值得在颅脑手术中推广应用.

Animals display stereotyped behavioral modifications during development, but little is known about how genes and neural circuits are regulated to turn on/off behaviors. Here we report that Drosophila neuropeptide F (dNPF), a human NPY homolog, coordinates larval behavioral changes during development. The brain expression of npf is high in larvae attracted to food, whereas its downregulation coincides with the onset of behaviors of older larvae, including food aversion, hypermobility, and cooperative burrowing. Loss of dNPF signaling in young transgenic larvae led to the premature display of behavioral phenotypes associated with older larvae. Conversely, dNPF overexpression in older larvae prolonged feeding, and suppressed hypermobility and cooperative burrowing behaviors. The dNPF system provides a new paradigm for studying the central control of cooperative behavior.

腹股沟疝术后慢性疼痛 (chronic postoperative inguinal pain, CPIP) 是腹股沟疝术后并发症之一,国内文献报道发生率为4.1％～12％ [1],国外报道的发生率为0％～63％.术后慢性疼痛已成为腹股沟疝术后最常见的并发症,很大程度上阻碍了术后康复的进程 [2].CPIP治疗手段包括口服药物、局部理疗、针灸、痛点注射、外科手术治疗与周围神经阻滞治疗等,其中周围神经阻滞治疗因创伤小、对机体生理干扰小、效果确切等优点,受到广大医师的关注.尤其是超声引导的周围神经阻滞,可引导穿刺针准确穿刺到位,并可实时显示穿刺针的位置并观察药物扩散情况,操作精准,安全性好,成功率高 [3].本研究采用超声引导环腹股沟管药物注射,针对腹股沟管周围神经,实施神经阻滞及消炎镇痛液注射水分离治疗CPIP,并观察临床效果,为治疗CPIP提供临床参考.

OBJECTIVE To explore the clinical value of ultrasound combined with C-arm guiding selective semilunar ganglion radiofrequency thermocoagulation via the foramen ovale for trigeminal neuralgia. METHODS This study enrolled 48 patients diagnosed with trigeminal neuralgia between January 2021 and December 2021 in the department of pain management at Xuanwu Hospital. Patients were randomly and equally divided into the C-arm group and ultrasound combined with the C-arm group, according to a random number table. After exclusions, 42 patients were analyzed. Among them, 21 cases underwent selective semilunar ganglion radiofrequency thermocoagulation via the foramen ovale guided by the C-arm, whereas 21 cases underwent the same guided by ultrasound combined with C-arm. The number and time of punctures, the accumulative doses for radiation exposure, and puncture-related complications were recorded during the operation. Numerical rating scale scores and radiofrequency thermocoagulation-related complications were evaluated preoperatively, at 1 day, 3 days, 7 days, 1 month, and 3 months after surgery. RESULTS The number and time of punctures and the accumulative doses for radiation exposure in the ultrasound-guided combined with the C-arm group were all lower than that in the C-arm-guided group (all P < 0.05). No significant difference was found in numerical rating scale scores and radiofrequency thermocoagulation -related complications between the two groups (P > 0.05). No puncture-related complications occurred in none of the groups. CONCLUSION Ultrasound guidance combined with C-arm in puncturing semilunar ganglion via foramen ovale could be safely used with more efficiency than C-arm guidance alone and less radiation exposure. CLINICAL TRIALS REGISTRATION This study was registered on the Chinese Clinical Trial Registry (NO. ChiCTR2100042124; http://www.chictr.org.cn/listbycreater.aspx), and the first patient enrollment began on January 18, 2021.

Objective:To explore the feasibility of ultrasound guidance combined with C-arm verification selective semilunar ganglion radiofrequency thermocoagulation via foramen ovale (FO) for the treatment of trigeminal neuralgia.Methods:Sixty-eight patients diagnosed with trigeminal neuralgia between September 2019 and June 2021 in the Department of Pain Management in Xuanwu Hospital were collected, regardless of sex and age, with the numerical rating scale (NRS)≥4. The patients were divided into two groups randomly according to an allocation ratio of 1∶1. Among them, 34 cases underwent selective semilunar ganglion radiofrequency thermocoagulation via foramen ovale guided by C-arm, while 34 cases underwent selective semilunar ganglion radiofrequency thermocoagulation via foramen ovale guided by ultrasound combined with C-arm. The number of FO puncture, the number and time of target area of semilunar ganglion, the number of fluoroscopy and complications involved with puncture during the operation were all record. And NRS was evaluated preoperatively, and 1 day, 3 days, 7 days, 1 month and 3 months after the operation.Results:The number of FO puncture during the operation in ultrasound-guided combined with C-arm group (2.7±1.1) times was lower than that in C-arm-guided group (4.4±1.2) times [95% CI (1.18-2.29), t=6.20, P<0.001]. The number of target area of semilunar ganglion during the operation in ultrasound-guided combined with C-arm group (3.8±2.5) times was lower than that in C-arm-guided group (6.7±2.6) times [95% CI (1.65-4.12), t=4.66, P<0.001]. The time of target area of semilunar ganglion puncture during the operation in ultrasound-guided combined with C-arm group (189.4±83.3) s was lower than that in C-arm-guided group (301.7±91.5) s [95% CI (69.86-154.55), t=5.29, P<0.001]. The number of fluoroscopy during the operation was lower in ultrasound-guided combined with C-arm group (3.2±1.4) times than that in C-arm-guided group (5.7±1.6) times [95% CI(1.73-3.21), t=6.69, P<0.001]. The incidence of facial swelling was lower in ultrasound-guided combined with C-arm group than that in C-arm-guided group ( P<0.05). There was no significant difference in NRS between the two groups at all time points (all P>0.05). Conclusion:Ultrasound guidance combined with C-arm verification in puncturing semilunar ganglion via FO to treat trigeminal neuralgia with radiofrequency thermocoagulation can be safely used in clinic, with more efficiency than traditional C-arm guidance and less radiation exposure to patients.

Background While there is an extensive body of research regarding pain and its treatment in developed countries, little research on this topic has been performed in developing countries. This study aimed to investigate the diagnosis, treatment, and treatment satisfaction in individuals with pain in urban China using real-world data. Methods All respondents from the 2013, 2015, and 2017 China National Health and Wellness Survey were included in the analysis and were classified into diagnosed and undiagnosed groups according to their self-reported physician diagnosis or experience in the past month. The following five categories of pain were analysed: headache, cancer-associated pain, musculoskeletal pain, neuropathic pain, and fibromyalgia. Rates for diagnosis, treatment, and satisfaction with medication were calculated overall and for each pain type. Results A total of 3802 respondents reported experience of at least one type of pain in the past month. Among those, 61.2% were diagnosed with a pain-related condition, the majority of which (84.0%) were receiving treatment. For diagnosed respondents taking over-the-counter and/or prescription medication, 70.3% were satisfied with their treatment. Comparing between pain types, the diagnosis rates for cancer-associated pain (32.7%) and fibromyalgia (22.8%) were relatively low, whereas respondents with musculoskeletal pain has the highest diagnosis rate (61.1%). Respondents with cancer-associated pain had the lowest satisfaction (30.0%) with over-the-counter and prescription medication, while respondents with headache (76.2%) had the highest satisfaction rate with such medications. Conclusion Our study highlights the importance of raising awareness for pain management as well as education and training for healthcare providers and patients.

目的 比较低温等离子消融术和射频热凝术治疗三叉神经痛的有效性和安全性.方法 收集2020年5-12月首都医科大学宣武医院疼痛科收治的行三叉神经外周支毁损治疗三叉神经痛患者的临床资料行回顾性分析.其中52例接受超声引导下三叉神经外周支低温等离子消融术治疗(A组),38例接受超声引导下射频热凝术治疗(B组).对比2组术前及术后3、6个月疼痛数字评分法(NRS)评分、面部麻木评分、面部浅感觉分级及并发症发生情况.结果 2组术后3、6个月NRS评分均明显低于术前(均P＜0.05),但是2组间术前及术后各时点NRS评分差异均无统计学意义(均P＞0.05).A组术后3、6个月面部麻木评分及术后6个月面部浅感觉中重度感觉障碍发生率明显低于B组[(3.6±2.1)分比(5.2±2.7)分、(2.7±1.6)分比(4.2±2.1)分,32.7％(17/52)比63.2％(24/38)],差异均有统计学意义(均P＜0.05).2组患者术后均无严重并发症发生.结论 超声引导下三叉神经外周支低温等离子消融术和射频热凝术治疗三叉神经痛均有效,但前者术后面部麻木及中重度面部浅感觉障碍的发生率明显较低.

Spinal pain (SP) is a common condition that has a major negative impact on a patient's quality of life. Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice. This clinical expert consensus describes the purpose, significance, implementation methods, indications, contraindications, and techniques of ultrasound-guided injections. This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.

Introduction: The nerve fibers innervating the annulus fibrosus are the major origin of degeneration-associated discogenic pain. Coblation is a tissue-dissociating technique in which the nerve fibers in the degenerative disc tissue are ablated. We hypothesized that coblation annuloplasty would be an effective maneuver for cervical discogenic pain without radiculopathy. Aim: To observe the therapeutic efficacy of coblation annuloplasty in patients with cervical discogenic pain without radiculopathy. Material and methods: Forty patients diagnosed with cervical discogenic pain without radiculopathy were screened for coblation annuloplasty therapy. The patient-rated visual analog scale (VAS) score for pain, significant pain relief rate, and Modified MacNab pain-relieving effect were adopted to evaluate the therapeutic effect within a 1-year follow-up period. Results: Thirty-three patients eventually completed the study. The average pain duration was 4.6 +/- 1.6 years (range: 0.5-8 years). The mean VAS pain score decreased from preoperative 6.8 +/- 0.9 to postoperative 2.5 +/- 1.3 (p < 0.01). For all participants, the immediate pain relief rate was 78.7% (26/33), which continued to postoperative 6 months. One year later, 22 (66.6%) subjects reported that their pain was significantly alleviated. According to the Modified MacNab criteria, 63.6-82.1% considered the effect of surgery for their pain therapy as "excellent" during the 1-year follow-up period. No significant complications such as hemorrhage, paresthesia, or infection were observed. Conclusions: This study is the first to demonstrate that coblation annuloplasty is an effective intervention providing significant alleviation of neck pain from cervical discogenic injury without radiculopathy.

目的 观察高能量激光联合综合康复治疗颈源性头痛的临床疗效与安全性.方法 于2017年5月—2019年10月选取诊断为颈源性头痛患者40例为研究对象.将患者按随机区组设计原则分为Ⅰ组(n=20)和Ⅱ组(n=20).两组均口服用药,Ⅰ组辅助假激光照射作为安慰剂组,Ⅱ组辅助高能量激光照射及综合康复为观察组.记录两组患者治疗前(T0)、治疗后4周(T1)、治疗后12周(T2)的视觉模拟评分(VAS)、颈部残疾指数(NDI)、不良反应发生率.结果 (1)VAS评分组间比较,差异有统计学意义(P<0.05);VAS组内各时点比较,差异有统计学意义(P<0.05).(2)NDI组间比较,差异有统计学意义(P<0.05);NDI组内各时点比较,差异有统计学意义(P<0.05).(3)两组患者总体不良反应发生率比较,差异无统计学意义(P>0.05).结论 高能量激光联合综合康复治疗颈源性头痛安全、有效.

疼痛是一种常见的临床症状与疾病,常常被一部分患者和临床医生被认为是无关紧要的疾病或可以伴随其他疾病解除即消失的症状,但这些认识是不全面且不正确的.许多慢性疼痛不仅给患者带来身体与精神上的折磨,还会严重影响到患者的工作、生活,甚至还会摧毁患者生存的信心,导致患者自杀,增加社会不稳定因素.疼痛的临床干预越早,患者的预后越好,即使有些癌症患者顽固性的神经病理性疼痛,采纳综合干预也可以提高患者的生存质量.2007年7月16日卫生部227号文件决定我国二级以上医院成立临床科室"疼痛科",这是我国疼痛医学发展的里程碑.该举措充分体现了我国政府部门对广大患者的人文关怀,标志着我国疼痛医学进入了新时代[1].