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I.三叉神経痛とは
1.顔面痛の分類
顔面痛を分類すると,
1)原発性三叉神経痛 major(primary)trigeminal neuralgia
2)続発性三叉神経痛 minor(secondary)trigeminal neuralgia
3)顔面神経痛 facial nerve neuralgia
4)非定型顔面痛 atypical neuralgia
5)舌咽神経痛 glossopharyngeal neuralgia
6)迷走神経痛 vagus neuralgia
に分けられる。このうち3)5)6)は稀であり,その診断は神経ブロック法によらねば他の疾患と鑑別が往々にして困難である。
4)の非定型顔面痛というのは,顔面部が非定型的に痛み(神経の走行に沿わず,また痛みの部位がいつも一定していない),全身的なこりや痛みの一環として顔面にも疼痛を感ずるようなもので,しかも流涙,潮紅,浮腫などの自律神経症状などが顔面部にみられることが多く,neurovascular disorderによる痛みと考えられるようなものを指す。若い人で女性などに多い。この治療は,全身的に疲労や緊張などを除くことを目標に,休息とかビタミン剤,トランキライザー,あるいは血管収縮性の鎮痛剤などを与えればよい。
Author states that the facial pain may be categorized in accordance to the source from which the pain may originate:
(1) Major (primary) trigeminal neuralgia, (2) Minor (secondary) trigeminal neuralgia, (3) Facial Nerve neuralgia, (4) Atypical neuralgia, (5) Glossopharyngeal neuralgia, and, (6) Vagus nerve neuralgia.
Major trigeminal neuralgia is recognized by its mode of having a spasmodic attack, pain alog the path of the nerve course, a trigger area, a tendency to occur among persons more advanced in age with prevalence among women more than in men.
Minor trigeminal neuralgia may be characterized by having various causative factors, the pain may be long and drawn out in duration and at times accompanied by disturbances in tactile sense.
For treatment of these cases, the author discusses in detail the method of nerve block by means of employing local anesthesia. An even when alcohol injections may be called for, the author states, that it should be preceded by an anesthetic nerve block.
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