Trigeminal Neuralgia Physical Therapy Treatment Approach
Fothergill’s Disease (FD) also known as Trigeminal Neuralgia is characterized by paroxysmal attacks of severe, sharp, stabbing, electric shock-like pain affecting one side of face mainly second and third divisions of it. It can be triggered by chewing, speaking, and cold winds. Most of the time patients with FD or TN showed partially or refractory responsiveness to drug therapy or surgery for relief of pain. Hardly any studies have reported the role of physical therapy in Fothergill’s Disease or Trigeminal Neuralgia.
The present study was conducted on 5 (M:F=1:4) patients of FD/TN with age being above 40 years. They were referred to the Neuro-Physiotherapy Department from the Department of ENT and Dental over a period of one year in India.
The result of this study showed a significant decrease in pain with the VAS score or visual analog scale. The significant decrease in the BIP- Facial Scale indicates that there was an improvement in their functional activities, in quality of life, physical and emotional functions.
Obvious limitations of this study included the research design itself in the form of pilot study that limits generalization of the concepts to other individuals with similar problems and short-term follow up of only four weeks and only 5 subjects were used. It is recommended to perform similar studies with a larger sample with long-term follow up.
Here was the proposed treatment to help relieve the severity of symptoms with trigeminal neuralgia.
- Patients were treated with continuous Transcutaneous Electrical Nerve Stimulation (TENS) 250 Hz with a pulse of 120 u, for 20 minutes over the path of affected nerve for 5 days a week for 4 weeks. One electrode was placed just before the ear, the other one at the end of the respective nerve. However, placement was adapted to pain referral and to effectiveness whenever necessary.
- To reduce muscle spasm, a hot moist pack was applied on neck and trapezius muscle for 10 minutes, Isometric neck exercises for each side and pain-free neck range of motion exercises (neck flexion, extension, and side-flexion) for five repetitions were given.
- Relaxation techniques, which included deep breathing exercise were performed for 10 minutes. Distraction techniques are also incorporated. Patients were asked to be involved in those activities in which they like to perform instead of sitting and thinking of their pain situations. These activities were asked to be repeated in their home.
- To reduce the hypersensitivity, patients were asked to cover the affected side of their face with a soft cloth or with a cotton pad for 15 minutes per day, which may help in promoting a reduction of the nervous system to the constant afferent input.
- Finally, patients were asked to avoid the use of cold water for drinking and washing their face, use of a scarf to avoid exposure of the face to the cold environment and to avoid eating hard foods and chewing food on the non-affected side.
For those suffering from trigeminal neuralgia, please let us know if this approach provides any relief.
Is there Any Role of Physiotherapy in Fothergill’s Disease?
Dildip Khanal, Subhash M Khatri and Deepak Anap. J Yoga Phys Ther 2014.
A Survey To Observe The Commonly Used Treatment Protocol For Trigeminal Neuralgia By Physiotherapist Int J Physiother. Vol 3(5), 643-646, October (2016)