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Tuesday, December 25, 2012

Trigeminal Neuralgia - Medicines & Physiotherapy Management

Trigeminal neuralgia is a neuropathic condition which is characterised by recurrent episodes of pain in face. The pain originates from the 5th cranial nerve called the Trigeminal nerve. It is also known as “Prosopalgia” or “Suicide Disease” or “Fothergill’s Disease”. This condition is considered to be one of the most painful conditions. It may be unilateral or bilateral. Sometimes it is associated with unilateral spasm of facial muscles; such a condition is named as “Tic Douloureux”.

Trigeminal neuralgia is seen in 1 among every 15000-20000 people. It is more common in females than in males. The symptoms are mostly seen in the persons over the age of 50years but it can be seen in children also.

¨        In trigeminal neuralgia repeated attack of intense pain occur in certain areas of face which last upto seconds or few minutes or sometimes few hours. The episodes of pain may occur as frequent as 100s times a day. In some sufferers the pain episode are with intermittent remissions of few months. Some cases show muscle spasm in unilateral facial muscles along with pain.
¨        The trigger point of pain is an hypersensitive area on face which is stimulated by weak factors even slightest touch or air current or some daily activity like talking, shaving, brushing teeth, chewing food or some loud noise.  These factors aggravate the condition.
¨        TN is considered as one of the most painful conditions. Type of pain sensation varies from person to person. The feeling is described as “Electric Shock”, burning, stabbing, pressing, crushing or exploding etc.
¨        In about 10-12% cases problem is bilateral. But pain is not felt on both side of face at the same time. Because both the right & left trigeminal nerves are separate so, one nerve don’t affect the contralateral facial areas. Bilateral involvement indicates that both the nerves are affected.
¨        With progression the frequency and severity of pain episodes worsen. Pain spreads through branches of nerve. Some people also felt the pain in Index finger.

Several studies and research work has been done to find out the cause of trigeminal neuralgia and there are many theories regarding the cause behind this pain syndrome. Previous research workers thought that this pain is caused due to the compression of trigeminal nerve at the site of opening where it emerges from skull. Compression is due to several causes such as a tumour, aracnoid cyst, any venous loop or aneurysm, and sometimes it may be a plaque of Multiple Sclerosis.

Some newer studies reveal that any enlarged blood vessel of brain probably the superior cerebellar artery compresses the trigeminal nerve near its connection with pons. This persistent compression damages the myelin sheath of nerve making it hyper sensitive. Thus severe pain attacks occur in trigeminal Never distribution areas due to any weak stimulus. Also the ability of nerve to shut off the pain sensation is diminished & pain is felt even after the stimulus is removed.

Some other causes of trigeminal neuralgia are Trauma to the nerve due to any accident or Chronic entrapment in peripheral NS, some other conditions like MS, any expanding neural lesion or Some Brain stem disease. Each of these condition lead to demyelination of trigeminal nerve which alters the nerve function making it hyper sensitive.
In some cases TM is of idiopathic origin.

Diagnosis of Trigeminal Neuralgia [TN]
TN worsens with time and in old cases recovery is very difficult to get. So it should be diagnosed as early as possible. Like many other diseases there are no methods like physical tests or laboratory methods for accurate diagnosis of TN. Therefore it is frequently misdiagnosed.

Sometimes dentists misdiagnose TN as Temporomandibular disorder or Masticatory pain, which are of somatic origin rather than neural origin. Therefore other similar conditions should be ruled out by proper diagnosis before starting the treatment

Medical Management
Modern medicine helps to manage the pain temporarily

Surgical Management
The outcome of surgery is generally not good in TN. therefore it is not recommended often. But when medicines are not effective, surgery is done.

Physiotherapy Management
Physiotherapy is mainly concerned for pain management in TN. It uses a specialized technique called as “Pain Shield” which can replace the medicines and surgical treatment. It uses Therapeutic Ultrasound with a unique frequency & intensity that allows prolong treatment sessions about 6hours daily. The Treatment can be done during overnight sleep. It is very effective in pain management and helps in nerve recovery. It slowly reduces the drug doses & finally the adverse effect of drugs is eliminated.

The Pain Shield patch is applied on a bony surface in the face which allows the ultrasound waves to travel across the entire skull and reach the root of the trigeminal nerve to promote healing of nerve origin. Patients must be undergo this procedure with helps of expert Physiotherapist

Dr.Bandana Bose. MPT
Senior Physiotherapist
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Disclaimer: These articles is for information only and should not be used for the diagnosis or treatment of medical conditions. we used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.