Five Cases of Thalamic Pain Effectively Treated with Keishikaryukotsuboreito / 日本東洋医学雑誌

Thalamic pain is an intractable central pain caused by thalamic hemorrhage and infarction. Unfortunately, there is no established method for its treatment. We report five cases of thalamic pain effectively treated with keishikaryukotsuboreito. Case 1 was a 63-year-old man who complained of pain in the right side of his body for three years after thalamic infarction. Case 2 was a 68-year-old-man who complained of pain in the right side of his body for 13 years after left thalamic hemorrhage. Case 3 was a 74-year-old woman who complained of left limb pain for three years after right thalamic hemorrhage. Case 4 was a 67-year-old woman who complained of pain in the upper and lower right limbs for two years after right thalamic infarction. Case 5 was an 82-year-old man who complained of pain in the right lower limb for two months after left putaminal hemorrhage including left thalamus. All cases were treated with keishikaryukotsuboreito and their symptoms improved. However, in Case 5, thalamic pain recurred after three months and the effect was not sustained with keishikaryukotsuboreito alone, but it was effective when combined with keishibukuryogan. From the imaging findings, keishikaryukotsuboreito would be a useful option for the treatment of thalamic pain with localized lateral thalamic lesions.

Clinical Observation of Flupirtine Maleate Combined with Amitriptyline in the Treatment of Thalamic Pain after Stroke / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of flupirtine maleate combined with amitriptyline in the treatment of thalamic pain after stroke. METHODS:A total of 70 patients with thalamic pain after stroke in our hospital during Jan. 2016-Aug. 2017 were divided into control group(34 cases)and observation group(36 cases)according to random number table. Both groups received secondary prevention therapy of stroke. Based on it,control group was given Amitriptyline hydrochloride tablet 25 mg/time orally,tid. Observation group was additionally given Flupirtine maleate capsule 0.1 g/time orally,tid,on the basis of control group. Treatment course of 2 groups lasted for 4 weeks. VAS,HAMD17 and HAMA14 scores of 2 groups evaluated before treatment,after 1,2,3,4 weeks of treatment Clinical efficacies and the occurrence of ADR were observed in 2 groups. RESULTS:Before treatment,there was no statistical significance in the scores of VAS,HAMD17 or HAMA14 between 2 groups(P>0.05). VAS score and HAMD17 score of observation group after 1,2,3,4 weeks of treatment,those of control group after 2,3 and 4 weeks of treatment were significantly lower than before treatment;the observation group was significantly lower than the control group at different time periods(P<0.05 or P<0.01). HAMA14 score of 2 groups after 2,3,4 weeks of treatment were significantly lower than before treatment;the observation group was significantly lower than the control group at different time periods(P<0.05 or P<0.01). Total efficiency rate(91.67%)of observation group were significantly higher than that(67.65%)of control group(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups (11.76% vs. 11.11%)(P>0.05). CONCLUSIONS:Flupirtine maleate combined with amitriptyline can effectively relieve thalamic pain after stroke,and improve post-stroke,anxiety depression,which are better than control group,and the incidence of ADR is familar to control group.

Resuscitation acupuncture for thalamic pain:a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To compare the effects between resuscitation acupuncture and pregabalin for thalamic pain and their impacts on plasma P substance (SP) and β-endorphin (β-EP).</p><p><b>METHODS</b>Sixty-four patients were randomly assigned into an acupuncture group and a western medication group, 32 cases in each one. Based on conventional western methods, pregabalin capsule was used orally in the western medication group, 75 mg a time,twice a day; resuscitation acupuncture was applied in the acupuncture group. The main acupoints were Shuigou (GV 26), Neiguan (PC 6), Sanyinjiao (SP 6). Patients with upper limb pain were attached affected Jiquan (HT 1), Chize (LU 5), and Hegu (LI 4); lower limb pain, affected Weizhong (BL 40), Zusanli (ST 36); hea-dache, bilateral Fengchi (GB 20), Wangu (GB 12), and Yifeng (TE 17), twice a day. Treatment was given 6 d a week for 8 weeks in the two groups. The changes of simplified McGill pain questionnaire (SF-MPQ), plasma SP and β-EP were observed before and after 4-week, 8-week treatment, as well as at follow-up, namely, 3 months after treatment. Also, clinical effects were evaluated.</p><p><b>RESULTS</b>The total effective rate of the acupuncture group was 50.0% (16/32) after 4-week treatment, which was similar to 46.9% (15/32) in the western medication group (>0.05). While after 8-week treatment and at follow-up, the total effective rates of the acupuncture group were 90.6% (29/32) and 84.4% (27/32), which were better than 65.6% (21/32) and 40.6% (13/32) of the western medication group correspondingly (both<0.05). After 4-week, 8-week treatment and at follow-up, the pain scores of the acupuncture group were lower than that before treatment (all<0.05). After 4-week and 8-week treatment, the pain scores of the western medication group were lower than that before treatment (both<0.05). After 8-week treatment and at follow-up, the pain scores of the acupuncture group were superior to thoseof the western medication group (both<0.05). After 4-week and 8-week treatment,the contents of plasma SP reduced compared with those before treatment in the two groups (all<0.05), and plasma β-EP increased (all<0.05). After 8-week treatment, SP content of the acupuncture group was apparently lower than that of the western medication group (<0.05), and β-EP increased more obviously (<0.05).</p><p><b>CONCLUSIONS</b>Resuscitation acupuncture can effectively relieve the symptoms of thalamic pain with stable and long-term effect, and it is better than pregabalin. Meanwhile, the acupuncture can increase β-EP and reduce SP.</p>

Therapeutic Observation of Eye Acupuncture plus Body Acupuncture for Thalamic Pain / 上海针灸杂志

Objective To observe the clinical efficacy of eye acupuncture plus body acupuncture in treating thalamic pain. Method Sixty patients with thalamic pain were randomized into group A, group B, and group C, 20 cases in each group. Group A was intervened by eye acupuncture plus body acupuncture, group B was by eye acupuncture alone, and group C was by body acupuncture alone. The Visual Analogue Scale (VAS) was observed before and after treatment, and the clinical efficacies were compared.ResultThe total effective rate and recovery rate were respectively 100.0% and 85.0% in group A, versus 100.0% and 50.0% in group B and 80.0% and 15.0% in group C. There were no significant inter-group differences in comparing the total effective rate (P>0.05). The recovery rate of group A was significantly different from that of group B and C (P<0.05). The recovery rate of group B was significantly different from that of group C (P<0.05). The VAS scores were significantly changed after treatment in the three groups (P<0.05). After treatment, the VAS score of group A was significantly different from that of group B and C (P<0.05).Conclusion Eye acupuncture plus body acupuncture is an effective approach in treating thalamic pain.

Thalamic Pain Misdiagnosed as Cervical Disc Herniation

Thalamic pain is a primary cause of central post-stroke pain (CPSP). Clinical symptoms vary depending on the location of the infarction and frequently accompany several pain symptoms. Therefore, correct diagnosis and proper examination are not easy. We report a case of CPSP due to a left acute thalamic infarction with central disc protrusion at C5-6. A 45-year-old-male patient experiencing a tingling sensation in his right arm was referred to our pain clinic under the diagnosis of cervical disc herniation. This patient also complained of right cramp-like abdominal pain. After further evaluations, he was diagnosed with an acute thalamic infarction. Therefore detailed history taking should be performed and examiners should always be aware of other symptoms that could suggest a more dangerous disease.

Thalamic Pain Syndrome Due to Cytomegalovirus Vasculitis in an HIV- Positive Child.

Dejerine-Roussy syndrome, also known as the ‘thalamic pain syndrome’ is a condition in which the body becomes hypersensitive to pain as a result of damage to the thalamus, a part of the brain that affects sensation. Association of this syndrome with HIV is rare with few case reports described in adults. We report a 10-year-old male child who was HIV positive and had developed this syndrome due to cytomegalovirus vasculitis.

Trial of the Treatment of Kampo Medicines for Thalamic Pain / 日本東洋医学雑誌

Thalamic pain is known as intractable central pain caused by thalamic bleeding and infarction. Although some physical and surgical therapies have been tried, there is no established method for its improvement. We attempted the treatment of 6 cases of thalamic pain, and 4 of them showed improvements in their symptoms. Our patients were aged 27-70 years, 4 men and 2 women. Their diagnoses were 3 cases of right thalamic bleedings, 1case of left thalamic bleeding, and 2 cases of right thalamic infarctions. The periods from onset to consulting our department were from6months to 12 years. In the 4 cases whose symptoms improved, the symptoms had almost disappeared or were decreased by at least 40%. These improved cases used formulas containing uzu or bushi. Yokukansankachimpihange was effective for two cases with mental disturbances. One case showing major improvement was treated by only the formula against oketsu. The cases whose symptoms had continued for a long time were more intractable, with the symptoms remaining to some degree in spite of their decreasing tendency. Finally, in intractable cases, their symptoms remained fixed and they had severe paralysis.

Epidural Motor Cortex Stimulation for Intractable Thalamic Pain: A case report

Motor cortex stimulation is a new technique for post-stroke central pain. The authors reported a case of epidural motor cortex stimulation for thalamic pain after right thalamic intracerebral hematoma. The patient was a 52 year old female who had presented with neuropathic pain on left upper and lower extremity. The authors performed epidural motor cortex stimulation via a small craniotomy site by use of navigation system. Good relief of the pain was achieved. Postoperative visual analogue scale pain score decreased from 9 to 3. The epidural trial of motor cortex stimulation was an effective method in treating refractory thalamic pain as our case.

A Case of Thalamic Pain Syndrome after Meningoencephalitis / 대한소아신경학회지

Thalamic pain syndrome is a type of central pain caused by damage to both thalami and produces persistent and intractable pain; extreme burning or aching sensation by light touch, even without external stimuli. In adults, thalamic pain syndrome occurred in vascular diseases such as a stroke, but in children, it was reported that infectious diseases-upper respiratory infection or meningitis-were usually preceded by development of central pain syndrome. This paper reports on a 12 year old boy with meningoencephalitis followed by evolving to thalamic pain syndrome 10 days later, who suffered from hypersensitivity and severe generalized pain on his whole body. On the brain MRI, both medial temporal lobes showed increased signal intensity, worse on the right side. A combination therapy of intravenous ketamine, amitriptyline and gabapentine for intensive pain control markedly reduced the pain and hypersensitivity in about 1 month. On the following brain SPECT, a strong focal perfusion at the right temporo-parietal cortex area was nearly normalized compared to previous one.

Studies on the sensory changes and somatosensory evoked potential in thalamic stroke

BACKGROUND: The thalamus is a subcortical gray-matter composed of several groups of nuclei. Though there are some characteristic clinical findings in thalamic stroke syndrome, it is not easy to identify their own function in each nuclei. We demonstrated this study to figure out the relationships between anatomic nucleus, sensory symptoms, and electrophysiologic findings in thalamic stroke. METHODS: Sixteen thalamic stroke patients were studied. Fifteen cases showed thalamic lacunar infarction by magnetic resonance imaging and one case showed thalamic hemorrhage by computed tomography. We compared their sensory symptoms and signs, somatosensory evoked potentials(SSEP), the size of lesions, and the location of lesions on imaging studies. RESULTS: There were 12 cases of a lesion on ventroposterolateral(VPL) nucleus(Group I) and 4 cases of a lesion on the other nuclei(Group II). All 8 cases which had a sensory deficit in Group I, and 2 cases - one with sensory deficit and the other without in Group II, showed abnormal SSEP findings. There were 9 cases in Group I and 3 cases in Group II with thalamic pain and there was no relationship between SSEP and thalamic pain. Five were pure sensory strokes in 6 patients with a small lesion(less than 0.5 cm), and pure sensory strokes were only 3 in 10 patients with relatively a large lesion (between 0.5 and 1.5 cm). CONCLUSION: There was significant relationship between sensory deficit and SSEP. SSEP can be used as a objective method in estimating the sensory deficit of thalamic stroke. We could ascertain the fact that other nuclei as well as VPL nucleus were associated with the development of pain in thalamic stroke, and there was significant relationship between the size of lesion and the clinical feature of stroke.