Introduction Trigeminal neuralgia is a debilitating condition that can significantly impair the quality of life of affected individuals. Percutaneous balloon compression (PBC) has been established as an effective treatment for this condition. However, the use of general anesthesia during the procedure poses challenges to achieving the desired degree of nerve damage without causing excessive numbness. In this study, we aimed to evaluate the feasibility and efficacy of performing PBC under conscious sedation of local anesthesia. Methods We improved the surgical procedure for PBC by administering intraganglionic lidocaine 0.2% with fine needle aspiration to achieve conscious sedation. This allowed the operator to determine the degree of nerve damage in real time through the tactile test. We conducted a clinical observation of 87 patients who underwent PBC under conscious sedation of local anesthesia. We evaluated the intraoperative blood pressure and heart rate changes, postoperative facial pain relief, and occurrence of complications such as severe facial numbness, irreversible keratitis, vision loss, and masticatory muscle weakness. Results All 87 patients achieved immediate relief of facial pain after undergoing PBC under conscious sedation of local anesthesia. The intraoperative blood pressure and heart rate changes were <20% of the baseline value. No patient experienced severe facial numbness or developed irreversible keratitis, vision loss, or masticatory muscle weakness. Discussion Our findings suggest that PBC under wide-awake local anesthesia is a safe and effective treatment for trigeminal neuralgia. The use of conscious sedation of local anesthesia during the procedure allows the operator to achieve the desired degree of nerve damage without causing excessive numbness. This can lead to long-term pain relief and improved quality of life for patients with trigeminal neuralgia.

Facial nerve block (injection) therapy is an effective clinical treatment method on some diseases, but this method needs to be standardized. This consensus is jointly prepared by pain experts in relevant fields in China. It summarizes and guides the indications, contraindications, operation methods and efficacy evaluation of facial nerve block (injection) therapy, in order to help clinicians for standardizing the application of this method.

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.

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.

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.

目的 分析低温等离子消融术治疗带状疱疹后遗神经痛(PHN)术后效果不佳的影响因素.方法 选择2016年1月—2018年12月首都医科大学宣武医院疼痛科收治的150例PHN患者作为研究对象,根据术后效果将患者分为试验组(术后效果优良,102例)和对照组(术后效果不佳,48例).所有患者均进行低温等离子消融术,将年龄、性别、术前视觉模拟评分(VAS)、病程、体重指数、吸烟、痛觉过敏、糖尿病、高血压、前驱症状、疼痛部位列为自变量,建立logistic回归模型筛选出有统计学意义的变量.结果 两组患者年龄、病程、术前VAS、痛觉过敏以及糖尿病史比较,差异有统计学意义(P<0.05).年龄(OR=2.675,95％CI:2.296～4.992)、术前VAS≥7分(OR=1.112,95％CI:1.101～1.253)、病程≥1年(OR=2.201,95％CI:1.342～2.223)、合并痛觉过敏(OR=1.984,95％CI:1.426～2.376)和糖尿病病史(OR=2.569,95％CI:1.673～3.721)为PHN术后效果的危险因素(P<0.05).结论 治疗过程中需要着重关注高龄糖尿病患者、病程较长、术前痛觉过敏以及VAS较高的患者.

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.

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].

INTRODUCTION:Although the sphenopalatine ganglion (SPG) has been considered a site of therapeutic potential for cluster headache (CH), the optimal technique of SPG is still to be determined. Low-temperature plasma radiofrequency ablation (LTPRA) has been proposed as an alternative treatment for several neuropathic pain diseases.AIM:To evaluate the effect of LTPRA of SPG in treating chronic and episodic CH.MATERIAL AND METHODS:The patients with CH, who achieved temporary pain relief following SPG block, treated using LTPRA between January 2015 and October 2017 were reviewed. Seventy-six patients were included: 50 patients suffered from episodic CH and the remaining 26 patients from chronic CH. The primary outcomes were clinical improvement rate, defined as the percentage of partial and complete pain relief results at 1 day, 12 months, and 24 months of follow-up after the operation.RESULTS:Clinical improvement rates were 92.3%, 92.3% and 73.1% in chronic CH and 73.1%, 84% and 68% in episodic CH at each follow-up time point, respectively. 3 chronic CH patients and 7 episodic CH patients showed no pain relief after the operation. Drooping eyelids were found in 2 cases, one recovered at the 3-month follow-up but another one did not in the 24-month follow-up. No serious complications occurred intraoperatively or postoperatively.CONCLUSIONS:LTPRA can be considered an effective and alternative surgical modality in treating patients with chronic and episodic CH, based on SPG block.

Background： Herpes zoster is a common disease mainly affect sensory nerves, but in this report sphenopalatine ganglion (SPG), mainly a parasympathetic ganglion was infected by the vesicular-zoster virus, with the performance of cluster headache. Case presentation: The patient underwent headache on left side orbit, supraorbital and temporal regions after infection of herpes zoster for 8 months, with lacrimation, conjunctival injection and nasal discharge. Pulsed radiofrequency of the SPG under ultrasound guidance was performed, we applied 2 cycles of PRF at 42℃for 120 seconds each time. Partial response lasted 1 month and the pain had recover to its baseline level. Low-temperature plasma radiofrequency ablation (coblation) technology is a relatively new technology that has shown promise in treating neuropathic pain. Then a CT-guided coblation of SPG was performed, used three of intensity for coblation (lasting for 30s, repeat twice) and six of intensity for coagulation (lasting for 30s, once). After coblation, the patient reported completed pain relief and autonomic symptoms disappeared without any side effects. The patient was satisfied with the effect on post-operative telephone follow-up performed on day 7, month 1 and month 3, pain VAS score remained on 0/10. Conclusions: Our report demonstrates that coblation technology is succeseful treatment for cluster headache in this case, but this finding still needs additional studies for confirmation. Key words: cluster headache, coblation, herpes zoster

目的 探讨触觉反馈对下腰痛(Low back pain,LBP)患者多裂肌活动的影响.方法 纳入20名健康成人(对照组)和20名慢性LBP患者(LBP组),在L5节段将两个肌电图(EMG)电极放置于两侧多裂肌位置.施术者将手与参与者的多裂肌部位进行直接、连续的接触,以施加触觉反馈,分别在有、无触觉反馈的情况下,记录以下体位时的EMG信号:①参与者静息状态时,记录EMG活动信号3次;②参与者对侧臂抬起期间,记录EMG信号5次.将对照组右侧和LBP组患侧的相对EMG值进行统计学分析.结果 ①在静息状态期间,两组有、无触觉反馈时的相对EMG值均无显著组间差异(P=0.829),但总体而言,触觉反馈条件下EMG值显著降低(P=0.013).②在对侧臂抬高期间,两组间有、无触觉反馈时的相对EMG值均无显著组间差异(P=0.878),但总体而言,触觉反馈条件下EMG值显著降低(P=0.010).结论 无论是常人抑或LBP患者,触觉反馈对其腰椎多裂肌活动均具有抑制作用,甚至可能降低预期的治疗效果.

目的 探讨大鼠自体退变髓核注射导致椎间盘源性内脏痛的发生机制.方法 将24只雄性SD大鼠按照随机数字表法分为空白对照组、假手术组、髓核注射组,每组8只.髓核注射组大鼠在X线下行右侧腰交感干自体退变髓核悬液注射,假手术组注射同等剂量生理盐水,空白对照组不做任何处理.注射后14 d收集各组大鼠L1-3脊髓节段,采用免疫印迹法半定量分析P物质(SP)和细胞外调节蛋白激酶1/2 (ERK1/2)、p-ERK1/2和cAMP反应元件蛋白(CREB)、p-CREB表达的变化.结果 髓核注射组大鼠脊髓SP及p-ERK1、p-CREB表达较假手术组及空白对照组明显增多(P＜0.05),三组p-ERK2表达比较,差异无统计学意义(P＞0.05).结论 大鼠自体退变髓核注射导致椎间盘源性内脏痛的产生可能与相应脊髓节段SP释放及ERK1/CREB磷酸化信号传导通路的激活有关.

Background: Low-temperature plasma radiofrequency ablation (coblation) is a relatively novel technique with promising applications in neuropathic pain.A nerve stimulator was modified and connected to a plasma knife head to solve the problem of accessing the Gasserian ganglion for treatment of trigeminal neuralgia (TN).Objective: To compare the therapeutic effects and short-term outcomes of coblation vs radiofrequency thermocoagulation for the treatment of primary TN.Methods: This was a retrospective cohort study of 217 inpatients who had undergone surgical treatment for primary TN between September 2017 and June 2018 at the Xuanwu Hospital, Capital Medical University.The patients were grouped according to the procedure they selected after an informed comprehensive discussion with their surgeon: the coblation group and the radiofrequency group.Pain, numbness, and muscle atrophy were evaluated before surgery, on the day of surgery, and at 3 days, 5 days, and 3 months after surgery.Results: In the coblation and radiofrequency groups, the pain relief rates were 74.7% and 85.5% on day 1 (P=0.066),85.3% and 97.3% on day 3 (P=0.003),and 97.7% and 88.2% at 3 months (P=0.134).At 3 months after surgery, 69.3% of the patients in the coblation group and 42.7% in the radiofrequency group had no pain (P<0.001).The multivariable analysis showed that the risk of numbness in the coblation group was independently lower than in the radiofrequency group at 3 months after surgery and (OR=0.243,95%CI: 0.122-0.484,P<0.001).Three months after the surgery, no recurrence was found in both of the coblation group and the radiofrequency group.Postoperative pain score ≥4 points was considered as a sign of failure this series at 3 months after surgery.The failure rate in coblation group is 2.7% (n=2) and a radiofrequency group is 4.5% (n=5), but there was no statistical difference between the two groups (P=0.703).Conclusion: Coblation could reduce the risk of postoperative numbness in patients with primary TN.

目的 通过低温等离子技术气化消融神经诱发疼痛的方法,探讨颈椎盘源性疼痛的分布规律.方法 选择2018年6～11月首都医科大学宣武医院疼痛科行CT引导下低温等离子椎间盘气化消融术的30例颈椎盘源性疼痛患者作为研究对象.术中,采用人体数字编码区域示意图记录诱发疼痛区域.结果 低温等离子气化消融术的椎间盘节段包括14例C4～C5、17例C5～C6和5例C6～C7,其中C4～C5、C5～C6和C6～C7间盘均可诱发的疼痛区域包括颈肩交界、斜方肌后上方、肩胛骨、肩胛间、胸前、肩后.C4～C5间盘诱发的疼痛区域偏向头侧,包括前额、耳、枕后、枕下、颈后区域;C5～C6间盘诱发的疼痛区域包括颈后、颈前、颈肩交界、斜方肌后上方、肩胛骨、肩胛间、胸前、肩后、上臂、前臂、胸背;C6～C7间盘诱发的疼痛区域偏向足侧,包括上臂、前臂、胸背区域.结论 颈椎盘源性疼痛的分布呈一定规律分布,具有重叠性、局限性、方向性和顺序性.

目的 探讨腰椎管狭窄症(Lumbar spinal stenosis,LSS)患者的腰痛加重情况与其步态中脊柱和骨盆运动的相关性.方法 对29例LSS患者开展6 min步态负荷试验,通过三维运动分析系统记录其脊柱、骨盆运动参数,分别于试验前后进行下肢和腰痛的疼痛VAS评分.根据测试后下肢痛和腰痛的加重程度,将患者分为A组(下肢和腰痛明显加重)8例、B组(仅下肢痛明显加重)12例和C组(下肢和腰痛未加重)9例.对三组步态前后的脊柱、骨盆倾斜度进行比较,并将之与腰痛加重程度进行相关性分析.结果 与试验前相比,A组试验后的腰椎前倾度和骨盆前倾度均显著增大(P<0.05),而B和C组仅腰椎前倾度显著大于试验前(P<0.05).相关性分析显示,腰椎前倾度与腰痛加重呈负相关关系,骨盆前倾度增加与腰痛加重呈正相关关系.结论 LSS患者在步态负荷时,腰椎前倾度减小和骨盆前倾增加,均可能会引起腰痛加剧,腰椎前凸增加可能是导致其腰背痛的因素之一.

目的 研究CT引导下三叉神经半月节低温等离子消融术治疗原发性三叉神经痛的临床疗效及其并发症.方法 选取2017年9月～2018年4月于首都医科大学宣武医院疼痛科行原发性三叉神经低温等离子消融术的原发性三叉神经痛患者48例,分别记录患者术前(T0)、术后即刻(T1)、术后1周(T2),术后1个月(T3)及术后3个月(T4)的疼痛视觉模拟评分(VAS)、麻木评分、并发症及患者满意度.结果 48例患者T1、T2、T3、T4时刻VAS评分均较T0时刻VAS评分有明显降低,差异有统计学意义(P＜ 0.05);48例患者T1、T2、T3、T4均出现不同程度的面部麻木,均为轻、中度麻木,且随时间推后明显好转,不影响日常生活;主要并发症包括咀嚼肌力下降27例(56.25％),角膜感觉减退1例(2.08％),耳鸣3例(6.25％),流清鼻涕1例(2.08％).术后各时间点,患者均未出现视力障碍、颅内感染、低颅压头痛、晕厥等严重并发症.结论 CT引导下三叉神经半月节低温等离子消融术治疗原发性三叉神经痛是一种疗效好且安全的方法.

目的 探讨CT引导下蝶腭神经节低温等离子射频消融术治疗蝶腭神经痛的有效性和安全性.方法 选择2015年1月～2016年8月在宣武医院疼痛科接受蝶腭神经节低温等离子射频消融术治疗的原发性蝶腭神经痛患者61例,对其术前及术后1 d、3 d、1周、1个月、3个月、半年、1年、2年的视觉疼痛模拟评分(VAS)进行比较,采集术后1周和术后1年患者的主观满意度(MacNab)评分,同时观察患者术后麻木及并发症的发生情况.结果 患者术后各时点的VAS评分较术前均显著降低(P<0.05).术后1周和术后1年的MacNab评分比较,差异无统计学意义(P>0.05);术后1周和术后1年的优良率分别为91.8％和83.6％.术后1周面部轻度麻木的发生率为31.1％,术后1年无一例麻木患者.所有患者均无严重手术并发症发生.结论 CT引导下蝶腭神经节低温等离子射频消融术治疗原发性蝶腭神经痛,患者可获得满意的临床疗效,不良反应轻微,值得在临床推广.

目的:分析带状疱疹(HZ)急性期患者后遗神经痛的相关因素.方法:65例HZ患者根据治愈3个月内是否发生遗留神经痛分为HZ后遗神经痛组(PHN组,n=30)及单纯HN组(HN组,n=35),选取同期健康体检者35例作为对照组;分别采集PHN组、HN组入院后急性期及对照组体检时空腹静脉血,采用酶联免疫吸附法(ELISA)测定其血清肿瘤坏死因子-α(TNF-α)、γ干扰素(IFN-γ)、神经元特异性烯醇化酶(NSE)、S100B蛋白(S100B)、白细胞介素-6(IL-6)、IL-17、β-内啡肽(β-EP)、降钙素基因相关肽(CGRP)、P物质(SP)、5羟色胺(5-HT)、神经生长因子诱导蛋白(VGF)及免疫球蛋白(IgA、IgG、IgM)水平,采用流式细胞分析仪测定其外周血T细胞亚群(CD3+、CD4+、CD8+).结果:3组受试者血清TNF-α、IFN-γ、NSE、S100B、IL-6及IL-17、CGRP、SP、5-HT、VGF水平比较,PHN组＞HN组＞对照组,血清β-EP水平比较,PHN组＜HN组＜对照组,血清IgA、IgG、IgM比较,HN组＞PHN组＞对照组,差异有统计学意义(P＜0.05);HN组、PHN组患者CD3+、CD4+、CD8+显著低于对照组,CD4+/CD8+显著高于对照组(P＜0.05),但两患者组比较,差异无统计学意义(P＞0.05).结论:HZ急性期患者血清炎性因子、疼痛介质及机体免疫状态的异常,与PHN的发生有关.