Son Byung-Chul, Lee Changik
Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Korean J Neurotrauma. 2022 Apr 1;18(1):116-125. doi: 10.13004/kjnt.2022.18.e18. eCollection 2022 Apr.
Chronic pain in painful post-traumatic trigeminal neuropathy, formerly called trigeminal deafferentation pain (TDP) or anesthesia dolorosa, is virtually incurable neuropathic pain. In severe cases, no effective method has yet been established. A 58-year-old woman presented with chronic dysesthetic pain in the right side of her face that had persisted for 8 years. It was caused by percutaneous balloon compression for an unexplained, persistent right gingival pain. The TDP did not respond to any medications or radiosurgery. Considering the typical occipital neuralgia that occurred later, the incomprehensible gum pain was interpreted as referred trigeminal pain from occipital neuralgia. Decompression of the greater occipital nerve improved occipital neuralgia; however, TDP did not respond to internal neurolysis or invasive brain stimulation. The last attempt was made to administer an intrathecal opioid because of pain sufficiently severe to cause suicidal ideation. Trial administration of intrathecal opioids had some effect on pain relief. Although incomplete, the effects of intrathecal morphine infusion were maintained up to 1 year later. Invasive neurosurgical interventions should be cautiously performed for continuous pain in persistent idiopathic facial pain and referred facial pain cases that do not show typical neuralgic pain in primary trigeminal neuralgia because of the risk of TDP.
创伤后三叉神经痛性慢性疼痛，以前称为三叉神经传入阻滞性疼痛（TDP）或痛性麻木，实际上是无法治愈的神经性疼痛。在严重病例中，尚未确立有效的治疗方法。一名58岁女性，右侧面部慢性感觉异常性疼痛持续8年。这是由经皮球囊压迫术治疗不明原因的持续性右侧牙龈疼痛引起的。该TDP对任何药物或放射外科治疗均无反应。考虑到后来出现的典型枕神经痛，难以理解的牙龈疼痛被解释为枕神经痛引起的牵涉性三叉神经痛。枕大神经减压改善了枕神经痛；然而，TDP对神经内松解术或侵入性脑刺激无反应。由于疼痛严重到足以导致自杀念头，最后尝试鞘内注射阿片类药物。鞘内注射阿片类药物试验给药对缓解疼痛有一定效果。尽管不完全，但鞘内注射吗啡的效果一直维持到1年后。对于持续性特发性面部疼痛和牵涉性面部疼痛病例中持续存在的疼痛，由于存在TDP风险，对于原发性三叉神经痛中未表现出典型神经痛的情况，应谨慎进行侵入性神经外科干预。
