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Updated: Jun 15, 2026

Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain
Published on: May 10, 2017
Selectively targeting pain in the trigeminal system
Hyun Yeong Kim1, Kihwan Kim, Hai Ying Li
1National Research Laboratory for Pain, Dental Research Institute and Department of Physiology School of Dentistry, Seoul National University, Seoul 110-749, Republic of Korea Department of Physiology School of Medicine, Hanyang University, Seoul 133-791, Republic of Korea Department of Oral Physiology and Neurobiology School of Dentistry, Kyungpook National University, Daegu 700-412, Republic of Korea Department of Anatomy and Cell Biology College of Medicine, Hanyang University, Seoul 133-791, Republic of Korea Department of Neuroscience and Oral Physiology, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan Neural Plasticity Research Group, Massachusetts General Hospital & Harvard Medical School, Charlestown, MA 02129, USA Department of Neurobiology, Harvard Medical School, Boston, MA 02115, USA.
Abstract:
We tested whether it is possible to selectively block pain signals in the orofacial area by delivering the permanently charged lidocaine derivative QX-314 into nociceptors via TPRV1 channels. We examined the effects of co-applied QX-314 and capsaicin on nociceptive, proprioceptive, and motor function in the rat trigeminal system. QX-314 alone failed to block voltage-gated sodium channel currents (I(Na)) and action potentials (APs) in trigeminal ganglion (TG) neurons. However, co-application of QX-314 and capsaicin blocked I(Na) and APs in TRPV1-positive TG and dental nociceptive neurons, but not in TRPV1-negative TG neurons or in small neurons from TRPV1 knock-out mice. Immunohistochemistry revealed that TRPV1 is not expressed by trigeminal motor and trigeminal mesencephalic neurons. Capsaicin had no effect on rat trigeminal motor and proprioceptive mesencephalic neurons and therefore should not allow QX-314 to enter these cells. Co-application of QX-314 and capsaicin inhibited the jaw-opening reflex evoked by noxious electrical stimulation of the tooth pulp when applied to a sensory but not a motor nerve, and produced long-lasting analgesia in the orofacial area. These data show that selective block of pain signals can be achieved by co-application of QX-314 with TRPV1 agonists. This approach has potential utility in the trigeminal system for treating dental and facial pain.
Insights
Researchers found that combining QX-314 with capsaicin selectively blocks pain signals in orofacial nerves. This targeted approach offers potential for treating dental and facial pain by inhibiting pain transmission without affecting motor function.
Area of Science:
- Neuroscience
- Pharmacology
- Pain Research
Background:
- Pain signaling in the orofacial region relies on nociceptors.
- Selective blockade of pain signals without affecting other functions is a therapeutic goal.
Purpose of the Study:
- To investigate the selective blockade of orofacial pain signals using QX-314 delivered via TRPV1 channels.
- To assess the effects of co-applied QX-314 and capsaicin on trigeminal system functions.
Main Methods:
- Utilized rats to examine the effects of QX-314 and capsaicin on trigeminal ganglion neurons.
- Measured voltage-gated sodium channel currents (I(Na)) and action potentials (APs).
- Assessed the jaw-opening reflex and orofacial analgesia.
Main Results:
- Co-application of QX-314 and capsaicin blocked I(Na) and APs in TRPV1-positive neurons but not TRPV1-negative neurons.
- TRPV1 expression was absent in trigeminal motor and mesencephalic neurons.
- The treatment inhibited the jaw-opening reflex and produced long-lasting orofacial analgesia.
Conclusions:
- Selective pain signal blockade in the orofacial area is achievable by co-applying QX-314 with TRPV1 agonists.
- This method demonstrates potential for treating dental and facial pain by targeting specific neuronal pathways.
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