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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There continues a significant debate over the best contemporary method for treating trigeminal neuralgia. Glycerol injection into the trigeminal cistern has been used in a consecutive series of 200 patients. A total of 80% of the patients have had good or excellent pain relief. Side effects have been a mild and usually transient numbness and tingling or mild objective sensory deficit to pin and touch in approximately 1/2 of the patients. Complications have been extremely infrequent and have resolved in time. A recurrence rate of 24% has been the single largest disadvantage of the procedure. Reinjection is usually successful in treatment of recurrence. The combination of efficacy, minimal and temporary neurologic dysfunction, and low complication rate make this procedure, in our opinion, the procedure of choice for the first step, when surgical treatment is required.
Clin J Pain 1989 Jun
PMID:Percutaneous injection of glycerol for the treatment of trigeminal neuralgia. 252 Apr 3

A systematic review of the 14 relevant controlled trials was conducted because there is no agreement about the choice of material and technique for repair of perineal trauma sustained during childbirth. Derivatives of polyglycolic acid (marketed as Dexon and Vicryl) appear to be the absorbable material of choice for both deep and skin closure. Compared with catgut their use is associated with about a 40% reduction in short-term pain and need for analgesia. The main drawback is that some material often needs removal during the puerperium. Glycerol-impregnated catgut is ruled out because of its link with long-term dyspareunia. Compared with the non-absorbable materials (silk and nylon) polyglycolic acid skin sutures were associated with less short-term perineal pain, and had no clear disadvantages. Continuous, subcuticular stitching appears preferable to interrupted, transcutaneous suturing, particularly in terms of perineal pain in the early puerperium.
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PMID:The choice of suture materials and techniques for repair of perineal trauma: an overview of the evidence from controlled trials. 255 6

Nineteen patients with tic douloureux were treated with glycerol injection in the trigeminal cistern. Facial sensibility was measured with an electrical stimulator one day before and one day after the glycerol treatment. The thresholds for perception and pain, and the maximal pain tolerance rose by about 50% (p less than 0.01, 0.01, and 0.001, respectively). The hypaesthesia and hypalgesia were most marked just below the eye, whereas the mandibular division showed only slight sensory impairment. In 13 patients a follow-up sensimetry study was done 1-7 months after surgery. Thirteen patients became completely free of pain and one almost completely free from pain (74%). Two had no pain relief. Twelve patients had no subjective complaints of the treatment. Three reported on dysaesthesiae (16%) over the previously painful area. Seven patients (37%) had subjective sensations of diminished or altered sensibility: numbness and hypalgesia in the face. Corneal hypaesthesia was recorded in ten patients (53%). Glycerol has a non-specific neurotoxic effect which is equal for tactile and nociceptive fibres. Sensory impairment may be a conditio sine qua non for a good clinical result.
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PMID:Sensory disturbance following percutaneous retrogasserian glycerol rhizotomy. 267 89

Fifty patients complaining of trigeminal neuralgia have been treated by Percutaneous Retrogasserian Glycerol Rhizotomy (PRGR) from September 1983 to December 1985. In 94% of cases the procedure was successful in relieving pain with minor facial sensory loss, in 29 cases confined to the affected divisions, in 13 cases extending in an adjacent division. A herpes eruption occurred in 39 patients. A partial relapse (not requiring re-operation) verified in 12 patients. Even it firm conclusions cannot be reached as to the efficacy of this therapy, till when longer duration follow-up studies will not available, it seems to offer a manageable and very efficient way of treating trigeminal pain, constituting a valid alternative to other percutaneous techniques of trigeminal rhizolysis.
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PMID:Percutaneous retrogasserian glycerol rhizolysis. Observations and results about 50 cases. 350 16

Glycerol-impregnated chromic catgut and untreated chromic catgut were compared in a randomized controlled trial involving 737 consecutive women who required repair of perineal trauma following spontaneous vaginal delivery. Medical staff preference was equally divided between the two materials. More untreated chromic catgut sutures required removal both by 10 days and by 3 months postpartum. Women whose perineal trauma was repaired with glycerol-impregnated chromic catgut were 10% more likely to have perineal pain at 10 days and 33% more likely to suffer from dyspareunia in the 3 months following delivery. The high rates of maternal morbidity associated with glycerol-impregnated chromic catgut appear to preclude its use for perineal repair.
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PMID:A randomized comparison of glycerol-impregnated chromic catgut with untreated chromic catgut for the repair of perineal trauma. 351 87

The mechanism by which glycerol abolishes the pain of tic douloureux with minimal trigeminal deafferentation remains unknown. To study the action of glycerol, ten cats underwent unilateral retrogasserian injection of anhydrous glycerol. The contralateral (control) side was injected with saline. Glycerol injection increased the average latencies and reduced the average amplitudes of trigeminal brain-stem evoked potentials. Histopathologic examination disclosed focal demyelination, axonal swelling, endoneurial fibrosis, and neuronal loss. Evoked potentials were severely altered or abolished in cats with axonal damage in the maxillary portion of the postganglionic nerve. Glycerol injection into the trigeminal nerve damages axons and myelin sheaths. We believe that relief of tic douloureux after glycerol injection most likely results from further destruction of the abnormally myelinated fibers implicated in the etiology of trigeminal neuralgia.
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PMID:Experimental trigeminal glycerol injection. Electrophysiologic and morphologic effects. 397 42

Percutaneous retrogasserian glycerol rhizolysis (PRGR) became a diffuse and valuable method for treatment of trigeminal neuralgia, following its introduction by Hakanson in 1981. Its main advantages are: a) mild postoperative facial sensory loss, b) simplification of the technique, c) reduction of costs. Our results in a series of 191 patients treated between September 1983 and September 1990 are reported. The procedure was performed according to Hakanson's method with minor modifications. In 11 cases (5.7%) we failed to pierce the foramen ovale; the procedure was successfully repeated a week or two later. In 17 cases it was impossible to obtain CSF from the needle. Complete relief of pain was achieved in 177 patients (92.7%), in 124 (64.9%) immediately, in 53 (27.8%) within 6 days; the operation was unsuccessful in 14 (7.3%). Postoperative sensory evaluation showed: no sensory loss in 33 cases (17.3%); hypalgesia in 8 (4.2%); mild hypesthesia in 88 cases (46.1%), confined to the affected divisions in 45 (23.6%), exceeding it in 43 (22.5%); moderate hypesthesia in 62 cases (32.4%), restricted to the target divisions in 36 (18.8%), exceeding them in 26 (13.6%). No case of anesthesia occurred. Complications of PRGR were: circum-oral ipsilateral herpetic eruption (herpes simplex type), spontaneously and completely regressing: 63 cases (33%); minor dysesthesia, seldom reported as painful: 33 cases (17.3%); impairment of corneal reflex: 19 cases (9.9%), the first branch being the target of the treatment in 11; regressive masticatory weakness; 11 patients (5.7%); aseptic meningitis, promptly regressed: 2 cases (1.0%). Follow-up ranges from 1 to 7 years (Sept. 1983-Sept. 1990). A recurrence was observed in 44 cases (23%): in 15 patients (7.8%) a partial relapse occurred, well controlled by drug therapy and not requiring further surgical treatment; in 29 cases (15.2%) a new percutaneous procedure was required. The mean time of recurrence was 30.5 months. The recurrence rate in the patients of our series at the end of the follow-up period was 23%. Glycerol produces a weak neurolytic lesion, that generates minor post-operative facial deafferentation; it is the best technique, in our opinion, for treatment of tic douloreux.
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PMID:Percutaneous retrogasserian glycerol rhizolysis for treatment of trigeminal neuralgia. Technique and results in 191 patients. 856 54

In this study, we reevaluate the results of radiofrequency rhizotomy and review the effectiveness of other surgical procedures for the treatment of trigeminal neuralgia. Five hundred patients with trigeminal neuralgia underwent radiofrequency rhizotomy at the University of Cincinnati Medical Center, Cincinnati, OH, between 1981 and 1986. Their results are compared with those of patients reported in the literature who underwent radiofrequency rhizotomy (6205 patients), glycerol rhizotomy (1217 patients), balloon compression (759 patients), microvascular decompression (MVD) (1417 patients), and partial trigeminal rhizotomy (250 patients). Comparisons were based on the following outcome parameters: technical success, pain relief and recurrence, facial numbness, dysesthesia, corneal anesthesia, keratitis, trigeminal motor dysfunction, permanent cranial nerve deficit, intracranial hemorrhage or infarction, perioperative morbidity, and perioperative mortality. We found that MVD had the lowest rate of technical success. Radiofrequency rhizotomy and MVD had the highest rates of initial pain relief and the lowest rates of pain recurrence. Glycerol rhizotomy had the highest rate of pain recurrence. Balloon compression had the highest rate of trigeminal motor dysfunction. Balloon compression and MVD had the lowest rates of corneal anesthesia or keratitis. MVD had the lowest rates of facial numbness and dysesthesia. All percutaneous procedures had similar rates of dysesthesia. Posterior fossa exploration had the highest rates of permanent cranial nerve deficit, intracranial hemorrhage or infarction, and perioperative morbidity and mortality. On the basis of our experience and a review of the literature, we conclude the following: 1) percutaneous techniques and posterior fossa exploration offer advantages and disadvantages, 2) radiofrequency rhizotomy is the procedure of choice for most patients undergoing first surgical treatments, and 3) MVD is recommended for healthy patients who have isolated pain in the first ophthalmic trigeminal division or in all three trigeminal divisions and patients who desire no sensory deficit.
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PMID:Comparison of surgical treatments for trigeminal neuralgia: reevaluation of radiofrequency rhizotomy. 914 78

Glycerol is a known agent in the therapy of chronic tic douloureux. It has been used for about 20 years in percutaneous, retrogasserian minimal-invasive rhizotomy, although the pharmacological mechanism of the pain relief involved remains unclear. To investigate glycerol treatment as a possible replacement for invasive approaches in the therapy of chronic cervicogenic headaches, we performed an experimental study on the pathomorphologic action of anhydrous glycerol injection into the second upper cervical dorsal root ganglion (DRG) of rats. Glycerol injections into the second cervical ganglion were investigated light- and electron-microscopically in a series of 40 rats for survival times of up to 30 days. We detected an unspecific overall effect on sensory neurons and satellite cells, as well as on myelinated and unmyelinated axons and Schwann cells. This could be detected after 5 days and sometimes led to degeneration of most of the neurons. Contralateral saline injections as a control showed no morphological effects. The loss of afferent fiber connections to the posterior horn of the myelon could be detected by immunohistochemical labeling of reactive astrocytes. Our results show a glycerol-induced deterioration of the cytoarchitecture of the neurons and their glial satellite cells. The effects on the ganglion cells appear to have been mediated by membrane disturbances and loss of glial integrity. These observations are contrary to previously reported results indicating the specific effect of glycerol on thin myelinated sensory axons.
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PMID:Glycerol gangliotomy of the second dorsal cervical root in rats: an experimental study to evaluate a minimal invasive approach for the treatment of the chronic cervicogenic headache. 987 84

Glycerol (an atoxic alcohol) and phenol (a toxic monohydroxybenzene) are currently used as neurolytic blocking agents to relieve pain or spasticity. In the present study we compared the endoneurial response of anhydrous glycerol and 7% phenol-aqua after intraneural injection into rat sciatic nerve, using electron microscopy and immunohistochemical stainings. Despite the wide use of these drugs, a systematic morphological study of their action has not been done. Electron microscope studies showed different patterns of nerve damage for glycerol and phenol. Glycerol injection resulted in gross sciatic nerve injury, with myelin fragments widely dispersed in the endoneurium 1-2 weeks after the injury. Phenol-aqua injection resulted in gross sciatic nerve injury with focal haemorrhagic necrosis; nerve fibres were segmentally dissolved 1-2 weeks after the injury. In both groups the first axonal sprouts appeared in the area of the lesion 2 weeks after the injury and the sprouts became myelinated in both groups by 4 weeks. Immunohistochemical staining showed that in the glycerol-treated nerves macrophages were widely scattered in the endoneurium by day 3; the number of macrophages proximal to the lesion site and at the lesion site was significantly higher in the glycerol-treated nerves than in the phenol-treated nerves both at days 3 and 7. In the phenol-treated nerves, macrophages appeared after 1 week and they exceeded the number of macrophages in the glycerol-treated nerves at 2 weeks. The number of Schwann cells remained low until 4 weeks in both groups. The results show that glycerol-induced nerve fibre damage with breaching of myelin fragments is followed by invasion of macrophages into the endoneurium after 3 days. The delayed invasion of macrophages after phenol injection may be due to occluded vessels or may be related to the denaturing effect of phenol on the proteins needed for macrophage attraction. Despite the rapid invasion of macrophages after glycerol injection axonal regeneration was delayed when compared to that seen after traumatic axotomy, but the axonal regeneration occurred at the same time in both experimental groups. Thus, the results suggest that after chemical axonotmesis the axonal regeneration rate is not dependent on the macrophage invasion rate alone and that other endoneurial changes also play a role.
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PMID:Same axonal regeneration rate after different endoneurial response to intraneural glycerol and phenol injection. 1154 50


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