I have emailed in the past with Dr. Vickers about his work on stem cells for patients with chronic, disabling facial pain. He had positive results with injecting stem cells into surrounding ganglia. Recently he has started using Palmitoylethanolamide (PEA) with stem cells.
Here is a good review of how he treats patients with disabling facial neuropathic pain.

https://cardiologytoday.com.au/sites/default/files/cpd/MT2015-09-016-VICKERS_0.pdf

SLC

Anatomy lesson:
https://www.youtube.com/watch?v=v2261IPz3W8

Sphenopalatine Blocks

The sphenopalatine ganglion (SPG) is a collection of nerves (sympathetic, parasympathetic and some sensory). It lies in a bony cavity called the pterygopalatine fossa, which is deep in the midface.

It supplies the lacrimal gland, paranasal sinuses, glands of the mucosa of the nasal cavity and pharynx, the gingiva, and the mucous membrane and glands of the hard palate. It is not involved in feeling or movement.

Sometimes after a nerve is sensitized by trauma, infection or other causes, the sympathetic activity can cause pain. Blocking the sympathetic activity by anesthetizing the SPG may stop the pain.

A sphenopalatine ganglion block is done to:

Diagnose the cause of pain in the face and head
Manage the pain of certain types of chronic headaches
Manage sympathetically maintained facial pain

The Sphenopalatine Ganglion Block Procedure

During a sphenopalatine ganglion block, pain-relieving medicine is injected to the region where the ganglion lies. This may reduce the release of the chemical norepinepherine activating the pain sensitive nerves and reduce the pain.

The patient is usually sedated, and using X-ray (fluoroscopy) guidance, a fine needle is placed near the SPG and anesthetic is injected. The patient will not feel numbness in the face. Pain relief may also not be immediate. A pain diary is used following the procedure to track the response.

Abstract

Objective

To determine if repetitive sphenopalatine ganglion (SPG) blocks with 0.5% bupivacaine delivered through the Tx360® are superior in reducing pain associated with chronic migraine (CM) compared with saline.

Background

The SPG is a small concentrated structure of neuronal tissue that resides within the pterygopalatine fossa (PPF) in close proximity to the sphenopalatine foramen and is innervated by the maxillary division of the trigeminal nerve. From an anatomical and physiological perspective, SPG blockade may be an effective acute and preventative treatment for CM.

Method

This was a double-blind, parallel-arm, placebo-controlled, randomized pilot study using a novel intervention for acute treatment in CM. Up to 41 subjects could be enrolled at 2 headache specialty clinics in the US. Eligible subjects were between 18 and 80 years of age and had a history of CM defined by the second edition of the International Classification of Headache Disorders appendix definition. They were allowed a stable dose of migraine preventive medications that was maintained throughout the study. Following a 28-day baseline period, subjects were randomized by computer-generated lists of 2:1 to receive 0.5% bupivacaine or saline, respectively. The primary end-point was to compare numeric rating scale scores at pretreatment baseline vs 15 minutes, 30 minutes, and 24 hours postprocedure for all 12 treatments.

SPG blockade was accomplished with the Tx360®, which allows a small flexible soft plastic tube that is advanced below the middle turbinate just past the pterygopalatine fossa into the intranasal space. A 0.3 cc of anesthetic or saline was injected into the mucosa covering the SPG. The procedure is performed similarly in each nostril. The active phase of the study consisted of a series of 12 SPG blocks with 0.3 cc of 0.5% bupivacaine or saline provided 2 times per week for 6 weeks. Subjects were re-evaluated at 1 and 6 months postfinal procedure.

Results

The final dataset included 38 subjects, 26 in the bupivacaine group and 12 in the saline group. A repeated measures analysis of variance showed that subjects receiving treatment with bupivacaine experienced a significant reduction in the numeric rating scale scores compared with those receiving saline at baseline (M = 3.78 vs M = 3.18, P = .10), 15 minutes (M = 3.51 vs M = 2.53, P < .001), 30 minutes (M = 3.45 vs M = 2.41, P < .001), and 24 hours after treatment (M = 4.20 vs M = 2.85, P < .001), respectively. Headache Impact Test-6 scores were statistically significantly decreased in subjects receiving treatments with bupivacaine from before treatment to the final treatment (M_diff = −4.52, P = .005), whereas no significant change was seen in the saline group (M_diff = −1.50, P = .13).

Conclusion

. 2015 Jan; 55(1): 101–116.

Published online 2014 Oct 23. doi: 10.1111/head.12458

PMCID: PMC4320756

PMID: 25338927

A Double-Blind, Placebo-Controlled Study of Repetitive Transnasal Sphenopalatine Ganglion Blockade With Tx360® as Acute Treatment for Chronic Migraine

Roger Cady, MD, Joel Saper, MD, Kent Dexter, MD, and Heather R Manley, MS, LPC

Author information Article notes Copyright and License information Disclaimer

This article has been cited by other articles in PMC.

Olympus Stem Cells Using Palmitoylethanolamide (PEA) and Stem Cells for Control of Disabling Facial Neuropathic Pain

April 02, 2018

Medical clinic and research facility Olympus Stem Cells Pty Ltd, based in Sydney Olympic Park, NSW, Australia, are pleased to announce the use of Palmitoylethanolamide (PEA) and stem cells for facial neuropathic pain.

The Director of Olympus Stem Cells, Associate Professor Russell Vickers, is an acknowledged world authority in the use of stem cells to treat neuropathic pain and has written book chapters, presented at international conferences and edited research articles on distressing facial pain.

Multiple aetiologies are known in patients presenting with disabling facial pain and include dysesthesias, trigeminal neuralgia, effects of demyelination as it relates to cranial nerves such as MS, odontalgias, atypical facial pains, osteoarthritic degenerations of the temporomandibular joint and toothache related discomfort. Olympus stem cells acknowledge the contribution of Palmitoylethanolamide (PEA) which is known to:

— Be analgesic

— Be combined with other analgesia

— Be devoid of unwanted side effects

Rather than use narcotic or other analgesics it is known that PEA is a fatty acid amide that binds to a receptor in the cell nucleus and exerts a great variety of biological functions related to chronic pain and inflammation. The main target is thought to be a peroxisome proliferator activated receptor alpha. PEA also has affinity to cannabinoid like coupled receptors but cannot be considered to be a classic endocannabinoid because it lacks affinity for the cannabinoid receptors, CB1 and CB2.

Several research papers have demonstrated an imbalance of the endocannabinoid system and alterations in the level of PEA in acute and chronic inflammation. PEA has been shown to be:

— Anti inflammatory

— Anti nociceptive

— Anti convulsant

PEA is available generally as 300mg, 400mg and 600mg capsules. PEA also is responsible for the decrease in pain sensitivity during and after sport, comparable to the endogenous opiates. Apart from facial pain states PEA may be used in diabetic neuropathic pain, sciatic pain, pelvic pain and entrapment syndromes. To date no drug interactions have been reported in the literature, nor any clinically relevant or dose limiting side effect.

Olympus Stem Cells also treat dry eyes (keratoconjunctivitis sicca), dry mouth (xerostomia) and hair loss (alopecia androgenetica). Professor Vickers is pleased to offer stem cell services including consultations and treatment amongst the 5 medical centres in Sydney Australia. Professor Russell Vickers, has published extensively on the use of stem cells in neuropathic facial pain, stem cell protocols and is a leader in his field. He is conducting clinical treatment of MS patients with the clinical symptoms of facial pain and has expanded this to patients with Empty Nose Syndrome, a complex painful disorder that is especially distressing to patients. Empty Nose Syndrome may follow sinus surgery, septoplasty or other ENT procedures involving the nasal complex.

Associate Professor Vickers sources the abdominal fat for adipose derived stem cells. He processes the fat and obtains stem cell concentrations that are extremely generous in numbers and quality. As a consultant surgeon he then delivers the stem cells to the anatomical area requiring the specific treatment.

Associate Professor Vickers utilises a vast array of medical scientific equipment in his quest to offer the very best of stem cell treatment. For validation he uses the Muse Cell Analyser and achieving 100% of stem cell viability. Additionally Olympus Stem Cells Pty Ltd has the availability of its own Mass Spectrometer and cell counting technology. In many conditions Stem Cell Therapy is a highly effective means of alleviating pain and discomfort for people suffering a variety of conditions ranging from facial pain symptoms of MS to neuropathic facial pain. Associate Professor Vickers has published in peer reviewed journals the efficacy of his treatment. They are proud to be one of Sydney’s best Stem Cell Therapy providers, with a proven track record of providing safe, effective treatment and expert care for their patients. Olympus has a strong focus on research and development and is working hard to constantly further the advancement of stem cell techniques around the world. Our research has been published internationally in peer-reviewed medical and science journals, plus our laboratory boasts some of the best state-of-the-art biotechnology equipment in Australia.

Olympus Stem Cells Pty Ltd is one of the few companies undertaking ground breaking stem cell treatment in Australia and the Asia-Pacific region.

More information on the Olympus clinics and the work that they do can be obtained at http://www.olympushealthgroup.com.au.

Associate Professor Vickers’ recent research publications pertaining to genetics, stem cells and facial pain are extensive. These publications include Human Brain Mapping, the Australian Endodontic Journal, Hair Therapy and Transplantation, The Journal of Neuroscience, Diagnosing Dental and Orofacial Pain, the Journal of the Australian Society of Cosmetic Chemists, Medicine Today (The Journal of the Royal Australian College of General Practitioners), the Open Journal of Dentistry and Oral Medicine, and the Journal of Pain Research. More information on Associate Professor Vickers’ work can be obtained at http://www.clinicalstemcells.com.

Contact Olympus Stem Cells Pty Ltd:

Professor Russell Vickers
+61 4277 11 888
director@clinicalstemcells.com
Olympus Stem Cell Centre, Sydney Olympic Park, 5 Australia Avenue, Sydney Olympic Park, NSW, Australia.