***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Pharmacotherapy is the main treatment for management of trigeminal neuralgia . However , many patients become refractory to drugs . OBJECTIVES The present study aim ed to evaluate the effect of adding calcitonin to local anesthetic and methylprednisolone using a modified coronoid approach in management of trigeminal neuralgia pain involving the m and ibular and /or maxillary branches . STUDY DESIGN R and omized double blind clinical trial . SETTING Hospital outpatient setting . METHODS Thirty-three patients received maxillary and m and ibular blocks by a modified coronoid approach .  Patients were allocated into 2 groups . Group 1 received a block with 3 mL of lidocaine 0.5 % plus 40 mg of methylprednisolone and another syringe contained 1 mL of 0.9 % saline . Group 2 received a block with 3 mL of lidocaine 0.5 % plus 40 mg of methylprednisolone and another syringe contained 50 international units of calcitonin .  Pain was evaluated by visual analog scale ( VAS ) before the block ( basal ) , at 2 weeks , one month after the procedure , and monthly for one year . Duration of the effective pain relief of the first block ( VAS = 3 ) was reported . Repeated blockade was allowed for any patient reporting a VAS > 30 mm during one year of follow-up and the number of blocks were reported . Adverse effects were also reported . RESULTS A significantly longer duration of effective pain relief was noticed in group 2 compared with group 1 ( P < 0.0004 ) while the duration of effective pain relief of the second block in group 1 was 28.5 ± 8.9 weeks . Four patients did not need repeated blocks in group 1 versus 15 in group 2 . Six patients received 2 blocks versus 2 patients in each group , respectively . Moreover , 6 patients needed 3 blocks in group1 versus none in group 2 . No serious adverse events were reported during or after the interventional procedure . VAS was comparable in both groups ( P > 0.05 ) . LIMITATIONS Small sample size . CONCLUSION Calcitonin may be a useful additive to local anesthetic and steroid in management of trigeminal neuralgia . Also , a modified coronoid approach for maxillary and m and ibular nerve is simple , free of radiation , safe , and may be an effective percutaneous procedure in trigeminal neuralgia . KEY WORDS Calcitonine , modifed , coronoid approach , trigeminal neuralgia Background In the majority of cases , trigeminal neuralgia ( TN ) is a unilateral condition with ultra-short stabbing pain located along one or more branches of the trigeminal nerve . Although prophylactic pharmacological treatment is first choise , considering of insufficient effect or unacceptable side effects , neurosurgical treatment or lesion treatment should be considered . In addition to all these procedures mentioned above , one approach has been based on local intradermal and /or submucosal injections of Botulinum Toxin Type A ( BTX-A ) . Methods We conducted a r and omized , double-blind , placebo-controlled since November 2012 , and adopted local multi-point injection in 84 cases of classical TN with different doses of BTX-A. Eighty four patients were r and omized into following groups : placebo ( n = 28 ) ; BTX-A 25U  ( n = 27 ) ; BTX-A 75U ( n = 29 ) . Follow-up visits were conducted every week after the injection , and the overall duration of the study for each patient were 8 weeks to observe the pain severity , efficacy and adverse reactions at endpoint . Results The visual analogue scale ( VAS ) scores of 25U and 75U groups reduced significantly compared to placebo as early as week 1 , and sustained until week 8 throughout the study . There was no significant difference in VAS between 25U and 75U groups throughout the study . The response rates of 25U group ( 70.4 % ) and 75U group ( 86.2 % ) were significantly higher than placebo group ( 32.1 % ) at week 8 , and there was no significant difference between 25U and 75U groups . Evaluation of the Patient Global Impression of Change ( PGIC ) demonstrated that 66.7 % ( 25U group ) and 75.9 % ( 75U group ) of the patients reported that their pain symptoms were ‘ much improved ’ or ‘ very much improved ’ versus 32.1 % of the placebo group , and there was also no significant difference between 25U and 75U groups . All adverse reactions were grade d as mild or moderate . Conclusions BTX-A injection in TN is safe and efficient . It is a useful treatment for refractory TN . Lower dose ( 25U ) and high dose ( 75U ) were similar in efficacy in short-term Background Carbamazepine ( CBZ ) formed the gold st and ard drug in trigeminal neuralgia ( TN ) treatment but faces high therapeutic failure . This defined the need to explore a second line of drug therapy . The study aim ed at comparing two alternate drugs i.e. Lamotrigine ( LTG ) and Pregabalin ( PGB ) , in the management of TN refractory to therapeutic doses of CBZ . Methods Twenty-two patients with diagnosis of refractory TN were enrolled and r and omly allotted into 2 groups of 11 each . Each group was subjected to a crossover analysis using LTG and PGB together with CBZ , for a period of 6 weeks . Patients maintained a pain diary , the scores of which , along with global evaluation scores , determined the primary outcome . Reevaluation of symptoms after 6 months was done to assess long term efficacy with study drugs . Results Both LTG and PGB were effective over  CBZ  alone ( p < 0.05 ) ; however , statistically insignificant difference ( p > 0.05 ) was observed between the two groups using Mann – Whitney tests . Unlike LTG , side effects like nausea , insomnia and concentration loss were minimal with PGB thus exhibiting greater patient compliance . Secondary analysis showed complete relief in 4 patients on PGB ( mean dose 240.68 mg/day ) while 6 had partial relief . Three patients on LTG ( mean dose 310.90 mg/day ) reported relapse of acute symptoms and required peripheral alcohol blocks . Conclusion Pregabalin has potential anti-neuralgia properties comparable to LTG . However , the level of patient ’s tolerance seen with PGB exceeds that with LTG . 6 months follow-up records suggest that PGB together with CBZ offers a more reliable pain control than with LTG BACKGROUND Trigeminal nerve block has been widely used for trigeminal neuralgia . This may induce paraesthesia . The second division of the trigeminal nerve passes through the sphenopalatine ganglion , which is located posterior to the middle turbinate and is covered by a mucous membrane . We examined the effectiveness of intranasal lidocaine 8 % spray on paroxysmal pain in second-division trigeminal neuralgia . METHODS Twenty-five patients with second-division trigeminal neuralgia were r and omized to receive two sprays ( 0.2 ml ) of either lidocaine 8 % or saline placebo in the affected nostril using a metered-dose spray . After a 7 day period , patients were crossed over to receive the alternative treatment . The paroxysmal pain triggered by touching or moving face was assessed with a 10 cm visual analogue scale ( VAS ) before and 15 min after treatment . Patients used a descriptive scale to grade pain outcome , and were asked to note whether the pain returned and how long after therapy it recurred . RESULTS Intranasal lidocaine 8 % spray significantly decreased VAS [ baseline : 8.0 ( 2.0 ) cm , 15 min postspray : 1.5 ( 1.9 ) cm , mean ( SD ) ] , whereas the placebo spray did not [ 7.9 ( 2.0 ) cm , 7.6 ( 2.0 ) cm ] . Moreover , pain was described as moderate or better by 23 patients of the lidocaine spray and 1 of the placebo group . The effect of treatment persisted for 4.3 h ( range 0.5 - 24 h ) . CONCLUSIONS Intranasal lidocaine 8 % administered by a metered-dose spray produced prompt but temporary analgesia without serious adverse reactions in patients with second-division trigeminal neuralgia Trigeminal neuralgia is the most common neuralgia . Its therapeutic approach is challenging as the first line treatment often does not help , or even causes intolerable side effects . The aim of our r and omized double blind , placebo controlled , crossover study was to investigate in a prospect i ve way the effect of lidocaine in patients with trigeminal neuralgia . Twenty patients met our inclusion criteria and completed the study . Each patient underwent four weekly sessions , two of which were with lidocaine ( 5 mgs/kg ) and two with placebo infusions administered over 60 minutes . Intravenous lidocaine was superior regarding the reduction of the intensity of pain , the allodynia , and the hyperalgesia compared to placebo . Moreover , contrary to placebo , lidocaine managed to maintain its therapeutic results for the first 24 hours after intravenous infusion . Although , intravenous lidocaine is not a first line treatment , when first line medications fail to help , pain specialists may try it as an add-on treatment . This trial is registered with NCT01955967 We conducted a prospect i ve r and omized controlled study to evaluate whether continuous radiofrequency ( CRF ) combined with pulsed radiofrequency ( PRF ) to the Gasserian ganglion ( GG ) decreases the side effects of CRF while preserving efficacy . Sixty patients diagnosed with classic trigeminal neuralgia ( TN ) were treated with either 75 ° C CRF for 120 s to 180 s ( SCRF group ) , 75 ° C CRF for 240 s to 300 s ( LCRF group ) , or 42 ° C PRF for 10 minutes ( min ) followed by 75 ° C CRF for 120 s to 180 s ( PCRF group ) . Patients were assessed for pain intensity , quality of life ( QOL ) , and intensity of facial dysesthesia before ( baseline ) , and at seven days , three months , six months , and 12 months after the procedure . The efficacy in pain relief was most significant on the seventh day after treatment and there were no significant differences between groups . After 12 months , > 70 % of patients in each group had complete pain relief , and the QOL in all three groups had increased significantly compared to baseline . The intensity of facial dysesthesia was mildest in the SCRF group and most severe in the PCRF group on the seventh day after the procedure , but most persistent in the LCRF group . Patients who receive PRF combined with CRF to the GG can achieve comparable pain relief to those who receive CRF alone , and shorter exposure of CRF could result in less destruction of the target tissue Objective : To estimate the lifetime prevalence of trigeminal neuralgia ( TN ) and  persistent idiopathic facial pain ( PIFP ) in a population -based sample in Germany . Methods : A total of 3336 responders of 6000 contacted inhabitants of the city of Essen in Germany were screened using a self- assessment question naire . 327 individuals , who reported recurrent facial pain and r and omly selected 150 ( 5 % of 3009 ) screening negative subjects , received a phone interview by one of six neurologists and if necessary a face-to-face examination . Those with suspected TN or PIFP following the phone interview underwent neurological examination by two neurologists who were unaware of the presumed diagnosis . A r and om group of 25 ( 10 % of 247 ) phone interview negative subjects was examined face-to-face . All suspected cases of PIFP received otorhinolaryngological examination and diagnostic cranial magnetic resonance imaging ( MRI ) . In TN patients the number of vessel-nerve contacts was determined by thin-slice cranial MRI . Results : Lifetime prevalence of TN was estimated to be 0.3 % [ 10 of 3336 ; 95 % CI 0.1–0.5 % ] , of PIFP 0.03 % [ 1 of 3336 ; 95 % CI < 0.08 % ] . Thin-slice cranial MRI detected five vessel-nerve contacts and no symptomatic lesions in the 10 TN patients . Conclusions : This large population -based study revealed that TN and PIFP are rare facial pain disorders Aim : To investigate the efficacy , safety and tolerability of intradermal and /or submucosal administration of botulinum toxin type A ( BTX-A ) for patients with trigeminal neuralgia ( TN ) . Methods : In this r and omized , double-blind , placebo-controlled study , 42 TN patients were r and omly allocated into two groups , namely , intradermal and /or submucosal injection of BTX-A ( 75 U/1.5 mL ; n = 22 ) or saline ( 1.5 mL ; n = 20 ) in the skin and /or mucosa where pain was experienced . The primary endpoints were pain severity ( assessed by the visual analogue scale ) and pain attack frequency per day . The secondary endpoint was the patient ’s overall response to treatment , assessed using the Patient Global Impression of Change scale . Patients with ≥ 50 % reduction in mean pain score at week 12 were defined as responders . Results : A total of 40 patients completed the study .  BTX-A significantly reduced pain intensity at week 2 and pain attack frequency at week 1 . The efficacy was maintained throughout the 
    Output:
    
Rankogram plots revealed sumatriptan and combined continuous and pulsed radiofrequency thermocoagualtion have the highest probability of being the best treatments in the respective group of interventions .
No inconsistency was observed between direct and indirect comparisons .
Conclusion We found that drug-related interventions that include sumatriptan , intranasal lidocaine , intravenous lidocaine , and botulinum toxin and combined continuous and pulsed radiofrequency thermocoagulation had significant effects in reducing pain in patients with refractory TN .
However , the quality of evidence was grade d as very low for all except botulinum toxin