areas of skin located on the lips, nasolabial folds, wings of the nose, eyebrows, a light touch of which causes an attack of pain, and strong pressure eases the developed pain attack in patients with neuralgia trigeminal nerve.

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22.1. TRIGEMINAL NEURALGIA

In the literature, trigeminal neuralgia is divided into two forms: central(damage to Gasserian ganglion) and peripheral(damage to the peripheral branches of the trigeminal nerve). It is impossible to mix trigeminal neuralgia of central and peripheral origin into one disease, because each of these forms has its own clinical course, which requires different methods of treatment.

♦ Trigeminal neuralgia of predominantly central origin

Etiology . Among the most common causes of this neuralgia are the following factors: vascular diseases (hypertension), rheumatism, traumatic brain injury, infectious diseases, lesions of the central nervous system (arachnoiditis, encephalitis), acute cerebrovascular accidents, menopause, chronic bacterial ( sore throats) and viral (flu, ARVI) infections, poisoning with various poisons (lead, copper, arsenic), endogenous intoxications, endocrine diseases, etc. People aged 40-60 years are more likely to get sick.

Clinic . The disease is characterized by the appearance of sharp, cutting, paroxysmal facial pain. Patients compare them to the “passage of electric current.” Painful paroxysms last from several seconds to several minutes. The frequency of attacks varies. Pain can occur spontaneously, but more often appears when the facial muscles move (while talking, eating, washing, shaving, etc.). patients freeze in a certain position, are afraid to move (hold their breath or breathe heavily, squeeze the painful area or rub it with their fingers, some make chewing or smacking movements).

The pain affects a certain area of ​​the face, which is innervated by one or another branch of the trigeminal nerve (usually the II or III branch, less often the I). The pain is accompanied by vegetative manifestations - facial hyperemia, lacrimation, rhinorrhea, hypersalivation (rarely dry mouth). Hyperkinesis of the facial muscles appears - twitching of the muscles of the chin, eyes or other muscles. The attack of pain stops suddenly.

Trigeminal neuralgia of central origin is characterized (occurs in 84% of cases) by the presence hammer (trigger) zones, those. areas of the skin or mucous membrane, irritation of which provokes an attack of pain. The trigger zones on the skin of the face have a nasolable location, because localized in the area of ​​the lips and nose. However, there are trigger zones on the oral mucosa (on the palate, alveolar process of the upper and lower jaws, or in another area). Trigger zones on the mucous membrane are always localized on the side of the lesion of the trigeminal nerve. Balle's painful points- the place where the branches of the trigeminal nerve exit the bony foramen into the soft tissues of the face.

Patients often note that an attack of pain is preceded by vegetative aura - hyperthermia or lacrimation on the affected side. In other patients, the onset of pain is preceded by paresthesia in the form of "pins and needles", itching or tingling.

Kränzl B. (1977) established a relationship between fluctuations in blood pressure and attacks of the disease. The frequency of attacks also increases with increasing air pressure.

Between attacks of pain there is no sensation on the affected side. With a long course of neuralgia, dry skin, loss of eyelashes, seborrheic eczema, hyperpigmentation and even atrophy of the masticatory and sometimes facial muscles appear on the corresponding side. Occasionally, patients note that between attacks acute pain they are left with constant stabbing, pressing, aching pain of a certain degree of severity.

Some patients experience bilateral trigeminal neuralgia of central origin. Clinical symptoms are similar to unilateral neuralgia. Pain may occur first on one side and then on the other, although sometimes it appears on both sides simultaneously.

The second and third branches of the trigeminal nerve are most often affected. The disease lasts from several months to several years (sometimes tens of years).

Treatment trigeminal neuralgia of central origin is carried out by neurologists.

First of all, antiepileptic drugs are prescribed to relieve pain: tegretol (finlepsin), ethosuxemide, morpholep, trimethin, clonazepam and etc.

Tegretol (Carbamazepine, Finlepsin) on the first day, 0.1 (0.2) grams are prescribed 2 times a day. Every day the dose is increased by 0.1 g. Adjusted to a maximum of 0.6-0.8 g per day (in 3-4 doses). The effect occurs 2-3 days from the start of treatment. After the pain disappears, the dose of the drug is reduced daily by 0.1 g and brought to 0.1-0.2 g per day. The course of treatment is 3-4 weeks. Before discharge from the hospital, the dose of the drug is reduced to the minimum dose at which attacks of pain do not appear.

Ethosuximide (Suksilep, Ronton) prescribed at a dose of 0.25 g per day. Gradually increase the dose to 0.5-1.0 g per day (in 3-4 doses), hold the dose for several days and gradually reduce it to 0.25 g per day. Treatment lasts 3-4 weeks.

A course of treatment is being carried out nicotinic acid. It is administered intravenously in the form of a 1% solution, starting with 1 ml ( nicotinic acid dissolved in 10 ml of 40% glucose solution). Every day the dose is increased by 1 ml and brought to 10 ml (on the tenth day of treatment), and then reduced daily by 1 ml and ended with the introduction of 1 ml of the drug. It should be remembered that nicotinic acid should be administered slowly, after meals, in a lying position(because the drug lowers blood pressure).

Conservative treatment includes the prescription of B vitamins, antihistamines, biogenic stimulants (FIBS, aloe, biosed, peloidin, etc.), antihypertensive and antispasmodic drugs.

Physiotherapy is prescribed according to indications (electrophoresis or phonophoresis with analgesics or anesthetics, diadynamic currents, ultraviolet irradiation, UHF, etc.). Surgical treatment of trigeminal neuralgia of central origin by a maxillofacial surgeon does not produce a positive effect.

♦ Trigeminal neuralgia of predominantly peripheral origin

These neuralgia arise as a result of the influence of the pathological process on various parts of the peripheral part of the trigeminal nerve.

TO etiological factors , which can cause trigeminal neuralgia of peripheral origin include the following diseases: pulpitis; periodontitis; chronic periostitis; osteomyelitis; sinusitis; galvanism of the oral cavity; tumors and tumor-like formations of soft tissues and bones of the facial skeleton; dentures that injure the oral mucosa or violate the height of the bite; filling mass, which is removed beyond the apex of the tooth during post-apeal therapy; with ossification of the mandibular canal (the mandibular nerve passes through) or the infraorbital foramen (the infraorbital nerve passes through); simplex or herpes zoster (caused by a neurotropic virus), etc.

It is currently believed that a factor that can support the course of neuralgia is the presence of unresolved foci of chronic infection in the nasal cavity (chronic rhinitis, polyps, etc.), oropharynx (chronic tonsillitis, etc.) and oral cavity (carious teeth, recurrent mucosal diseases membranes or gums, tartar, decayed teeth, etc.).

Clinically the disease is characterized by the presence of paroxysmal pain along the corresponding branches of the trigeminal nerve. Painful paroxysms in trigeminal neuralgia of peripheral and central origin are indistinguishable from each other (see Description of the previously listed symptoms). Pain spreads along the II and III branches of the trigeminal nerve.

Autonomic symptoms (lacrimation, rhinorrhea, hypersalivation, etc.) with peripheral neuralgia are not so clearly expressed. Trigger zones are not so common (in 47% of cases), and Balle's painful points are less common. There is no vegetative aura.

According to A.I. Treshchinsky and A.D. Dinaburg (1983) there is a connection between the zones of pain irradiation and the zone of its origin. If, for example, attacks begin in the area of ​​the alveolar process of the upper jaw (molars and premolars, respectively), then the pain radiates to the area of ​​the tubercle of the upper jaw, etc. at the height of an attack, pain can radiate to the forehead, temple, back of the head, and neck. Conducting topical anesthesia in the area where pain originates can prevent the occurrence of painful paroxysms. By blocking, through local anesthesia (diagnostic blockade), the affected peripheral portion of the trigeminal nerve, pain paroxysms cease for 1-2 hours, less often for more than 3 hours.

Thus, from what was said earlier, it follows that the clinical symptoms of trigeminal neuralgia of central and peripheral origin have a similar course. Diagnosis is being confirmed through a correctly and carefully collected anamnesis, studying the clinical symptoms of neuralgic manifestations and conducting diagnostic blockades with local anesthetics.

♦ Differential diagnosis of trigeminal neuralgia

Ganglionitis of the pterygopalatine ganglion (syndromeSluder) characterized by sharp pain in the periorbital region, in the eyeball, in the root of the nose, upper and lower jaws, and sometimes in the teeth. The pain radiates to the tongue, soft palate, temple, back of the head, ear, neck, shoulder blade, shoulder. The pain lasts from several minutes to several hours. Necessarily pronounced vegetative symptoms - hyperemia and swelling of the skin of half the face, lacrimation, rhinorrhea. There is hyperemia and swelling of the mucous membrane of the posterior nasal cavity. The painful attack stops after application of anesthesia to the posterior nasal cavity, which serves as a differential diagnostic criterion, which indicates the presence of ganglionitis of the pterygopalatine ganglion in the patient. The pain disappears whenpterygopalateanesthesia by palatal route, and if it is impossible to perform this anesthesia, another route of administration of the anesthetic is possible (tuberal, subzygomatic pterygoid, etc.).

Ganglionitis of the semilunar ganglion . The semilunar ganglion is a sensory ganglion of the trigeminal nerve lying in the trigeminal cavity of the dura mater on the anterior surface of the pyramid of the temporal bone. It is provoked by infectious diseases, vascular lesions, intoxication and other factors. There is multifocal pain in the area of ​​innervation of the three branches of the trigeminal nerve with irradiation to half of the head. The pain is random. There are disorders of all types of sensitivity on the corresponding half of the face. Herpetic rashes appear on the skin of the face (usually in the projection of the first branch of the trigeminal nerve). The duration of herpetic rashes is 1-2 weeks.

Ganglionitis of the ciliary ganglion (Oppenheim syndrome). Characterized by attacks of acute pain in the eyeball area. Pain often occurs at night and is accompanied by severe autonomic symptoms (rhinorrhea, lacrimation, photophobia, hyperemia of the conjunctiva of the eye). The attack of pain lasts about half an hour, and sometimes several hours. On palpation there is pain in the eyeball. The appearance of herpetic rashes on the skin of the forehead and nose is typical. Patients may develop conjunctivitis and keratitis.

Neuralgia of the nasociliary nerve (Charlen's syndrome). There are excruciating pains in the area of ​​the eyeball and eyebrows, radiating to the corresponding half of the nose. The pain occurs at night, and vegetative symptoms are pronounced. Pain on palpation of half the nose and the inner corner of the orbit. Herpetic eruptions on the skin of the nose and forehead. Phenomena of keratoconjunctivitis. The pain disappears after application of anesthesia to the anterior nasal cavity, which serves as a diagnostic criterion for neuralgia of the nasociliary nerve.

Ganglionitis of the ear node . There are attacks of burning pain localized anterior to the external auditory canal and in the temporal region. The attacks last from several minutes to an hour. The pain radiates to the lower jaw, teeth and neck. There is a feeling of stuffiness and flapping in the ear. During an attack of pain, hypersalivation is observed on the corresponding side. The pain is provoked by pressing on the area of ​​the external auditory canal (between the external auditory canal and the head of the lower jaw). The pain disappears after intradermal anesthesia in front of the ear tragus, which is a diagnostic criterion for the presence of ganglionitis of the ear node.

Neuralgia of the auriculotemporal nerve (auriculotemporal syndrome, parotid hyperhidrosis, Frey's syndrome). It was first described in 1874 by B.C. Pokrovsky (from the clinic of St. Petersburg Botkin). This information from the domestic doctor went unnoticed. In 1923, Lucie Frey described it under the name "auriculotemporal nerve syndrome." In 1927, Andre Thomas explained the appearance of the syndrome by the ingrowth of part of the regenerating sweat and vasodilator fibers into the salivary fibers. Transection of the auriculotemporal nerve eliminates clinical symptoms.

Occurs after surgical interventions on the parotid gland, trauma to the soft tissues of the parotid region, fractures of the condylar process of the mandible, planar osteotomy of the mandible.

It is characterized by aching or burning pain and the appearance of vegetative-vascular disorders in the parotid-masticatory area (hyperhidrosis, redness, warming, hyperesthesia). It develops most often during eating or at the sight of food (salivation), which causes increased salivation. The syndrome can be caused by smoking, nervous stress, and overheating of the body.

Novocaine blockade of the projection of the auriculotemporal nerve relieves the clinical symptoms of the syndrome(for a description of the blockade, see the section “Treatment of neuralgia”). Equal amounts of anesthetic (Novocaine) and alcohol (80%) are injected into the projection of the nerve for therapeutic purposes. Paraffin therapy and electrophoresis of anesthetics on the parotid area are prescribed. Before meals, it is recommended to take atropine or platyphylline. If conservative therapy is ineffective, surgical intervention (transection of the auriculotemporal and greater auricular nerves) is indicated.

Glossopharyngeal neuralgia face-to-faceabout the nerve . Paroxysmal pain that begins at the root of the tongue or in the tonsil area. They radiate to the palate, pharynx, ear, eye, lower jaw and even neck. Pain occurs when talking, swallowing, eating food (especially very cold or hot). The attacks last 1-3 minutes. The intervals between attacks vary. During an attack, a dry throat appears, and after an attack of pain, increased salivation occurs.

When conducting In the differential diagnosis of this disease, one must remember that pain always begins at the root of the tongue or in the area of ​​the tonsils, and mechanical irritation of these areas always provokes an attack. When the root of the tongue, tonsil and posterior wall of the pharynx are lubricated with an anesthetic (dicaine, pyromecaine), the attacks stop.

Syndrome Eagle . An increase in the size of the styloid process of the temporal bone with characteristic symptomatic manifestations is called syndromeEagle. The normal dimensions of the styloid process range from 25 mm. As it increases, patients note pain when swallowing and moving the tongue, radiating to the ear. There is pain when turning the head, there is a vague headache with nausea, dizziness (this is due to the pressure of the styloid process on the carotid artery, especially when moving the head). Patients complain of dysphagia and otalgia. Palpation of the tonsil fossa on the painful side causes typical pain that the patient constantly experienced. X-ray - elongation of the styloid process (Fig. 21.3.1).

In our clinic, three patients with this diagnosis underwent surgery to shorten the styloid process of the temporal bone (extraoral approach). A lasting positive effect was obtained.

Neuralgia of the tympanic nerve (syndromeReichert). The tympanic nerve is a branch of the glossopharyngeal nerve. It is characterized by attacks of cutting pain in the area of ​​the external auditory canal with irradiation to the face and mastoid area. The pain occurs acutely and subsides gradually. The occurrence of an attack of pain is provoked by palpation of the external auditory canal.

Neuralgia of the superior laryngeal nerve . The clinical picture is largely reminiscent of neuralgia of the glossopharyngeal nerve. The pain that occurs in the larynx is paroxysmal in nature and appears during eating or during swallowing movements. They radiate into the ear. In differential diagnosis, the localization of pain is of primary importance. With neuralgia of the superior laryngeal nerve, pain always begins in the larynx, and on the lateral surface of the neck, slightly above the thyroid cartilage, a painful point can often be found. During an attack of pain, a cough appears.

Neuralgia of the lingual nerve . It is characterized by sharp attacks of pain, which are localized in the area of ​​the anterior two-thirds of the tongue. Pain occurs spontaneously or when eating, as well as when talking. Hyperesthesia of the corresponding half of the tongue often occurs, and often leads to loss of pain and taste sensitivity in this area.

Ganglionitis of the submandibular node . An attack of acute pain in the submandibular region usually occurs 1-2 times a day, lasting from several minutes to an hour. Pain is provoked only by eating spicy or rich food. The pain radiates to the lower jaw and lip, the back of the head, and the neck. Increased salivation may occur. There is no swelling of soft tissues in the submandibular region. Transparent saliva is secreted from the duct of the submandibular gland.

Ganglionitis of the sublingual ganglion . An attack of acute pain in the submandibular region and tongue lasting from several minutes to an hour. Painful paroxysms are infrequent (1-2, less than 3 times a day). The pain radiates to different parts of the lower part of the face and, especially, to the tip of the tongue, as well as the sublingual area. They are provoked by eating spicy and rich food. There is no swelling of the soft tissues of the sublingual area.

Spinal nerve syndrome . It is more often observed with cervical osteochondrosis, ganglionitis of the cervical nodes, intoxication, etc. Symptoms are very variable. An attack of burning, throbbing pain that begins in the spine and spreads to any part of the face and head. Painful attacks last from several minutes to half an hour or more. There is dizziness, nausea, ringing or noise in the ear, and sometimes aphonia and even decreased vision. Patients often have pain points when pressing in the areas of the projection of the upper cervical(at the level of the transverse process of the third cervical vertebra) and cervicothoracic(between the legs of the sternocleidomastoid muscle) nodes, as well as at the point of the spinal nerve(downward from the place where the lesser occipital nerve exits the skin). The most common triggers for pain are hypothermia, overwork, and stress.

♦ Surgery

A.V. Vishnevsky (1934) proved that nerve anesthesia has a certain therapeutic effect on the painful focus due to the removal of painful irritation. Blockades can be used both for diagnostic purposes (it can be established as a result of damage to which anatomical part of the nerve the pain syndrome occurred) and for the treatment of the patient.

The blockade is carried out local anesthetics(novocaine, lidocaine, trimecaine, marcaine, ultracaine, etc.) or mixture of the following composition: polyglucin, (reopolyglucin) 3 ml, 2% lidocaine solution 2 ml, hydrocortisone 1 ml (25 mg). The disappearance of pain after such a blockade, even for half an hour, is an indicator of the correct location of the blockade.

Repeated (up to 15-20 times) use of blockades in some cases may have a positive effect. Location of blockades- these are the places where the peripheral branches of the trigeminal nerve leave the bone (or enter the bone), i.e. places of peripheral and central conduction anesthesia.

Blocking the auriculotemporal nerve is carried out behind the articular head of the lower jaw in a space limited behind by the tragus of the ear, and above by the lower edge of the zygomatic arch. When an anesthetic is injected into a specified location, a branch of the facial nerve is sometimes blocked. To avoid this, the needle should not be inserted to a depth of more than 1 cm, and the amount of anesthetic should not exceed 1 ml. It is advisable to first inject an aqueous solution of a short-acting local anesthetic and leave the needle in place. If the clinical symptoms of damage to the auricular-temporal nerve disappear, and there are no signs of blockade of the facial nerve, then a 1-2% solution of antispasmodic can be administered for therapeutic purposes with the least risk.

At the suggestion of G.I. Semenchenko et al (1979) in patients with trigeminal neuralgia, a 0.25%-0.5%-1%-2% antispasmodic solution can be used for blockade. For peripheral blockades, a 2% antispasmodic solution is used, for central anesthesia (blockades) - a 1% solution, and for blockades of the autonomic ganglia and intradermal infiltration of the trigger zones - 0.25%-0.5% solutions. Blockades are carried out after 3 days, less often - after 2 days. Peripheral blockades alternate with central ones. For blockades, from 0.5 ml to 3.0 ml of a 1-2% antispasmodic solution and 2-5 ml of a 0.25%-0.5% solution are used. After blockade with an antispasmodic solution, dizziness and a decrease in blood pressure are observed. Therefore, after blockade with antispasmodic, it is recommended to observe a doctor for 35-40 minutes. After 2-2.5 hours, soft tissue swelling develops at the site of antispasmodic injection, which goes away on its own after 3 days. To prevent swelling, the use of antihistamines is recommended.

For many years, we have used blockades with antispasmodic solution to treat trigeminal neuralgia of peripheral origin. The course of treatment consisted of 5-7 blockades.

A positive effect was observed in 2/3 of the patients, and 1/3 subsequently used surgical treatment. Relapses of pain appeared in approximately half of the patients after 2-4 years. We did not observe any complications when using antispasmodic.

We have a negative attitude towards alcoholism as a method of treating trigeminal neuralgia, because this procedure gives a temporary effect. After alcoholization, nerve degeneration does not occur, but a painful condition occurs with the addition of neuritis. Often, alcoholization can lead to ganglionitis of a nearby node. Rough scars form at the site of alcohol injection, which further complicate the operation. Alcoholization contributes to the emergence of resistance to anticonvulsants. When alcohol is administered, complications are possible (necrosis of a section of bone or soft tissue, development of an abscess or phlegmon).

In our clinic, it was previously used for the treatment of trigeminal neuralgia. tissue therapy method THEM. Starobinsky and SI. Sheftel (1950) - subcutaneous grafting of skin taken from the patient himself. A positive effect was observed in no more than 30% of operated patients. Relapses appeared after 1-2 years.

Surgical methods of treatment are limited to neurotomy- nerve transplants and neurectomies- excision of a section of a nerve.

NeurotomyIIbranches of the trigeminal nerve using the Roussel method(Russel), which was proposed by the author in 1944. For the treatment of neuralgia of the second branch of the trigeminal nerve, it is rarely used, because the positive effect does not occur for a long time (relapses after 4-5 months) and the operation leaves a cosmetic defect (performed through extraoral access).

To date, many methods are known for neurectomy of the second and third branches of the trigeminal nerve. Methods proposed for the treatment of neuralgia: Tniersch (1883), Römer (1953), Rosenthal (1955), Klampfer (1966) and many others.

The most promising methods for the treatment of peripheral forms of trigeminal neuralgia are decompression operations with the release of the peripheral branches of the nerve from the bone canals.

In our clinic (Kiev Medical Academy of Postgraduate Education), decortication of the infraorbital or mandibular canal with resection of the neurovascular bundle is widely used. A positive effect was observed in almost 90% of patients. There were no complications.

Decortication of the infraorbital canal with resection of the neurovascular bundle . The indications for this surgical intervention are relapses of pain in the area of ​​peripheral innervation of the second branch of the trigeminal nerve after using all the possibilities of conservative treatment and eliminating odontogenic and other pathological processes in the upper jaw, which can cause neuralgic syndromes.

Method of operation. Anesthesia is performed at the round opening through the palatine or subzygomatic pterygoid route (5 ml of a 2% solution of novocaine, trimecaine or lidocaine) and infiltration anesthesia in the area of ​​the vestibule of the mouth against the background of neuroleptanalgesia.

The mucous membrane and periosteum are cut along the transitional fold from the lateral incisor to the second large molar. Soft tissues are separated from the anterior wall of the maxillary sinus, if possible to the lower edge of the orbit. The anterior wall of the maxillary sinus is trepanned to form a through hole about 2.5 - 3 cm in diameter. The bone delimiting the lower two thirds of the infraorbital foramen is removed. As a result, the bone defect takes on a pear-shaped form. A neurovascular bundle is isolated from the soft tissues of the infraorbital region and crossed at the greatest possible distance (usually 2.5 - 3 cm) from the infraorbital foramen. The stump of the neurovascular bundle is captured with a clamp, which subsequently facilitates the operation. The mucous membrane of the maxillary sinus is cut longitudinally and separated in the area of ​​the projection of the infraorbital canal. The depth of the infraorbital canal varies. Sometimes its lower wall is missing in places. In other cases, the canal may be “walled up” in the thickness of the sclerotic bone.

The lower wall of the canal along its entire length and at the same time the adjacent section of the bone of the posterior wall of the maxillary sinus are removed.

The neurovascular bundle is shifted down and cut with a sharp sickle-shaped scalpel as proximally as possible. Bleeding is stopped by electrocoagulation or by applying potassium permanganate crystals to the bleeding stump. Flaps of the mucous membrane of the maxillary sinus are placed in place. The wound in front of the mouth is sutured tightly. If neuralgia is combined with chronic sinusitis, the altered mucous membrane and polyps are scraped out, and an anastomosis is applied to the nasal cavity.

Trigger points are small lumps in muscle tissue. If you press on them, an acute pain syndrome occurs instantly, like a shot, hence the name “trigger” from the English trigger.

Hello! If you are reading this material, then, most likely, you are familiar with trigger points (TP) firsthand and the question: “What is it?” answer - this is when it hurts everywhere. TTs do not pose a threat to health, but significantly worsen the quality of life, causing a lot of trouble. We will now tell you where and why these pockets of pain form, as well as how to treat them.

Trigger points are the body’s response to overexertion, imbalance of muscle loads (improper posture, scoliosis, long-term static postures, sudden movements), injuries or inflammatory processes.

Chronic pain occurs in the muscles and tissue covering (fascia) of the muscles, joints and tendons. This pathology in medicine is called myofascial syndrome (MFS), that is, it occurs in the muscles (myo) and fascia and is manifested by the presence of TT.

Trigger zones are more often formed in static skeletal muscles― in the lumbar region, cervical-brachial, thoracic and spinal regions, in the group of masticatory muscles, triceps muscles of the legs, in principle, they can appear anywhere on the human body.

Classification

Latent TTs are painful only when pressed (palpated). They can make themselves felt by acute attacks even with minor overloads, hypothermia or sprains.

Against the background of frequently recurring attacks, latent formations can turn into active ones. Active TTs are sensitive during movement, in acute cases - even at rest; they respond with sharp pain to slight pressure directly at the site of impact or “shoot” the pain syndrome to other parts of the body.

There are diagrams of the relationship between the location of the TT itself and the associated zones. For example, irritation of the TP in the trapezius muscle radiates to the temple, and the scalene muscles of the neck project pain to the hand, shoulders or shoulder blades.

Diagnostics

The doctor determines the pain point by touch by the characteristic compaction and the presence of a pain reaction when pressing directly under the finger and in the reflection zone. Spinal diseases, internal organs(stomach ulcer, ischemia) can provoke activation of TT, in order to exclude the presence of concomitant pathologies, ultrasound, x-ray, etc. are prescribed.

The diagnosis of “primary MFS” is made by a doctor after complex diagnostics and if one or more additional signs are present:

• point or regional pain,
• limited mobility, lameness,
• thickened zone of hypersensitivity,
• the appearance of a zone of referred pain,
• the possibility of causing pain upon repeated palpation,
• trigger point flinching when pressed,
• emotional stress, internal fear, depression, sleep disturbance.

Treatment

Imagine that you have an insoluble problem, it sits in your head like a nail and does not allow you to relax, but as soon as you find a solution, the nail instantly disappears. The same thing happens with trigger points - they are destroyed when muscle spasm is eliminated, this is the principle of treatment.

How to get rid of muscle tension? -there are several ways:

• long periods of rest,
• warming up (gels, ointments, wraps, compresses),
• gymnastics,
• taking medications, injections.

The doctor decides how to treat. The choice of therapy and its effectiveness depend on the advanced stage of the disease and the severity of symptoms.

Treatment with medications

A method that helps for a long time and immediately is local blockade, when a painkiller (anesthetic) is injected into the TT with a syringe.

In case of acute pain, a temporary relaxing effect is exerted by muscle relaxant drugs, which doctors prescribe in combination with non-steroidal anti-inflammatory drugs (NSAIDs), while other therapy is more successful when taken.

Massage

Smoothing of the TP through massage occurs due to the fact that the blood and metabolic products are first squeezed out from the sore spot, and then, when relaxed, the point is washed with a new portion of “fresh” blood, warmed up and gradually deactivated.

The masseur feels and gradually squeezes the seal. A slight pain appears (in the TT and the irradiation zone), which subsides or disappears completely within 12-15. Then a repeated, stronger compression is made, again held from the moment the discomfort appears until it disappears. After 3-4 such cycles, a warm compress is applied. The procedure ends with massage movements for passive stretching.

As you can see, this massage is complex and requires special skills and a specialist. It is not recommended to do self-massage, firstly, it is impossible to reach many points, even if you manage to do this, you certainly won’t be able to relax, and secondly, there is an inept effect on TT in best case scenario will not bring results.

Gymnastics

You can do special stretching exercises followed by relaxation yourself.

Post-isoteric gymnastics is shown as a means of combating TT. Its principle is muscle relaxation due to tension of antagonist muscles. We remind you that a set of exercises is prescribed by a doctor, and the first lesson is best done under supervision in a physical therapy group.

Conclusion

As you can see, trigger points can be dealt with, the main thing is to follow them after they disappear simple rules security:

• watch your posture,
• avoid incorrect postures,
• exercise,
• do not make sudden movements,
• don't get too cold,
• do not be nervous.

Dear readers! I suggest you look interesting video from Alexandra Bonina about how to get rid of back, joint and muscle pain with trigger point massage.

Take care of yourself. If you found the article interesting and useful, share it with your friends on social media. networks. And if you subscribe to blog updates, then you will be the first to learn many more interesting things about health and healthy way life.
I wish you good luck! Taisiya Filippova was with you.

areas of skin located on the lips, nasolabial folds, wings of the nose, eyebrows, a light touch of which causes an attack of pain, and strong pressure alleviates the developed pain attack in patients with trigeminal neuralgia.

• - see Zakharyin - Geda...

  Medical encyclopedia

• - areas of the facial skin in which pain and temperature sensitivity is impaired according to the segmental type when the middle cerebral tract of the trigeminal nerve or the trigeminal nerve of the same name is damaged...

  Medical encyclopedia

• - painful points on the body, pressure on which can cause a hysterical attack in patients with hysteria...

  Medical encyclopedia

• - areas of bone tissue restructuring that occurs as a result of increased load on normal bone or normal load on bone when it is damaged...

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• - areas of the body that include a set of receptors, the irritation of which causes a certain reflex - see Reflex...

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• - weakly stained secondary chromosomal constrictions according to Feilgen, the same width as the chromosome body; participate in the formation of nucleoli...

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• - see Hysterogenic...

  Medical encyclopedia

"Trigger zones" in books

Grandfather Matvey