Reflex sympathetic dystrophy of the face. Report of two cases and a review of the literature.

Reflex sympathetic dystrophy of the face is an infrequently reported cause of chronic facial pain. We report the cases of two patients who were diagnosed and treated by sympathetic blockade of the stellate ganglion. Pathophysiologic mechanisms and rationale for treatment are discussed.

A controlled trial of real and simulated acupuncture in the management of chronic asthma.

In 25 patients with moderate to severe asthma, we compared the therapeutic effectiveness of classic Chinese acupuncture with that of "placebo" acupuncture administered in a randomly ordered, subject- and evaluator-blind, crossover fashion twice weekly for 4 weeks. Real and placebo acupuncture periods were each preceded and followed by 3- to 4-week periods during which no acupuncture was administered. Outcome variables consisted of the following: daily symptoms and medication use self-scored on patient diaries, spirometry and whole body plethysmography performed once weekly during the entire course of the study and repeated serially during 3 hours after real and placebo acupuncture treatment, patients' self-assessment of acute efficacy of acupuncture therapy, and physician's physical findings before and after acupuncture treatment. Two-way analysis of variance failed to reveal a significant effect of either form of acupuncture on symptoms, medication use, or lung function measurements. Similarly, no significant acute effect of acupuncture on lung function, self-ratings of efficacy, or physician's physical findings was found by covariance analysis or the Wilcoxon signed-rank test. When data during the entire course of the study were examined on an individual basis by analysis of variance with repeated measures, only two subjects demonstrated significantly favorable responses to real versus placebo acupuncture, but one subject demonstrated the reverse, suggesting that these responses were not specifically related to acupuncture therapy. Thus, our findings failed to demonstrate any short- or long-term benefit of acupuncture therapy in the management of moderate to severe asthma.

Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients.

Myofascial pain syndrome (MPS) is a common but misunderstood muscular pain disorder involving pain referred from small, tender trigger points within myofascial structures in or distant from the area of pain. Misdiagnosis or inadequate management of this disorder after onset may lead to development of a complex chronic pain syndrome. A review of the clinical characteristics of 164 patients whose chief complaints led to the diagnosis of MPS revealed that these patients had (1) tenderness at points in firm bands of skeletal muscle that were consistent with past reports, (2) specific patterns of pain referral associated with each trigger point, (3) frequent emotional, postural, and behavioral contributing factors, and (4) frequent associated symptoms and concomitant diagnoses.

Rapid narcotic detoxification in chronic pain patients treated with auricular electroacupuncture and naloxone.

Severe withdrawal signs which accompany the detoxification of narcotic addicts from opiate drugs are also a serious problem for chronic pain patients taking high levels of analgesic medications. A rapid narcotic detoxification procedure utilizing auricular electroacupuncture was applied to 14 chronic pain patients to be withdrawn from their opiate medications. All patients were first switched to oral methadone. They were then given bilateral electrical stimulation to needles inserted in the "lung" and "shen men" acupuncture points on the ear, followed by periodic intravenous injections of low doses of naloxone. Twelve of the patients, 85.7%, were completely withdrawn from narcotic medications within 2-7 days, and they experienced no to minimal side effects. These results are explained by the relationship of electroacupuncture to the release of endorphins.

Electrical stimulation of the brain in treatment of chronic pain. Experience over 5 years.

Forty-eight patients underwent electrical stimulation of the brain for treatment of chronic pain between 1978 and 1983. Average pain duration prior to treatment was 4.5 years. Before selection for this procedure patients underwent pain treatment in a multidisciplinary pain center, intensive psychological and psychiatric evaluation, and assessment of pain responsiveness to intravenous administration of placebo, morphine, and naloxone. A total of 71 electrodes were placed in the 48 patients at a variety of stimulating targets, including the periaqueductal gray matter, periventricular gray matter, thalamus, and internal capsule. Seventy-two percent of patients experienced complete or partial pain relief. In addition, 59% of patients were able to discontinue narcotic usage. Twenty-five percent of patients returned to normal physical activities and another 33% showed marked improvement in functional capacity. Follow-up periods ranged from 2 to 60 months; with a mean follow-up period of 20 months. A variety of relatively minor complications occurred, but no mortality or permanent sequelae were experienced. No patient's pain was made worse as a result of electrical stimulation. Electrical stimulation of the brain offers a safe and relatively effective method for the treatment of chronic pain in appropriately selected patients, who are unresponsive to other forms of therapy.

Practical differential diagnosis of chronic craniofacial pain.

Chronic craniofacial pain afflicts more than one in every ten persons in the United States and Europe. Successful management of chronic craniofacial pain closely follows the thorough evaluation and understanding of the patient and the problem and, subsequently, a correct diagnosis or diagnoses. Evaluation of the patient includes a complete medical, dental, and personal history, physical examination, and appropriate diagnostic studies and consultations. Special consideration should be given the possibility of multiple diagnoses as well as complicating emotional, behavioral, or perceptual factors common in persons with chronic pain. Differential diagnosis is simplified by the use of a practical classification of chronic craniofacial pain.

Recognition and treatment of patients with chronic orofacial pain.

Patients with chronic orofacial pain must be treated with methods different from those used with patients with acute pain. If different methods are not used, the characteristics of chronic pain may become firmly entrenched. Dentists should be aware of the various methods of treatment for this separate pain entity.

Comparison of real and simulated acupuncture and isoproterenol in methacholine-induced asthma.

In a double-blind (patient and evaluator), crossover study effects of real acupuncture, simulated acupuncture, nebulized isoproterenol, nebulized saline and no treatment in reversing methacholine-induced bronchospasm were compared in 12 asthmatics (ages 16 to 64). Saline and simulated acupuncture did not result in any significant improvement in specific airway conductance (SGaw), thoracic gas volume (Vtg) or forced expiratory flow rates compared with no treatment following methacholine-induced bronchospasm. Isoproterenol and real acupuncture were both followed by increases in SGaw and flow rates and decreases in Vtg which were significantly different from the changes observed following no treatment, saline or simulated acupuncture, although isoproterenol produced greater improvement than real acupuncture, although isoproterenol produced greater improvement than real acupuncture. These findings suggest that stimulation of specific acupuncture loci reduces methacholine-induced bronchospasm and hyperinflation to an extent greater than can be attributed to placebo phenomena.

Three essential factors in effective acupunture therapy.

Three essential factors for achieving effective therapeutic results utilizing acupuncture are described: (1) Immune/inflammatory reactions are mobilized when any area of the skin is sufficiently stimulated. (2) Peripheral neural stimulation occurs when specific acupuncture loci are mechanically, electrically, chemically, or thermally activated. Precise stimulation of specific loci (i.e. peripheral neural receptors) may modulate central nervous system regulation of specific physiological functions in the body. (3) Psychological support is well known to be an important factor in all healing experiences, and that includes acupuncture therapy. The authors suggest that the most effective application of acupuncture involves sufficient stimulation of properly selected and precisely localized acupuncture loci combined with a dedicated concern for health that is clearly communicated to patients.