What happens when surgery fails to solve the problem it was prescribed for? For many people, the answers to this question aren’t encouraging. But for a 65-year old female (and the topic of a recent case report), a failed surgical intervention was thankfully not the last resort in her quest for answers when it came to trigeminal neuralgia.
Trigeminal neuralgia isn’t a common ailment, affecting only “4-5 people per 100,000 people in the general adult population, with the incidence rising to 20 per 100,000 after the age of 60 . It is a “severe, recurrent stabbing pain that primarily affects the distribution of 1 or more of the 3 branches in the trigeminal nerve .” Thus, the sudden acute pain is limited to the face and potentially triggered by even light stimulation of facial muscles (think talking, eating or in severe cases, movements of air).
In terms of treatment, medications like anticonvulsants, antispasmodic agents or Botox are commonly deployed to ease sufferers pain . Surgery is usually only recommended in cases when medications or injections have either failed to solve the problem or have grown less effective over time.
Understandably, the effects this disorder can have on a person’s quality of life are significant.
So far, there has not been extensive literature on chiropractic care and trigeminal neuralgia, and the literature that does exist has been described as “lower level clinical evidence.” Hence, the latest case report is one worth noting, especially given it is one of only 12 case reports in common circulation on the topic, and 1 of only 2 that “demonstrate a reduction in direct indicators of vertebral subluxation following a course of chiropractic care .”
The patient in question had been suffering medically diagnosed trigeminal neuralgia for 6 years and had been managing her symptoms via anticonvulsant medication. One year post-diagnosis, she underwent surgery to treat the symptoms but the surgery failed. The case report notes that:
“Due to failed response to surgery she sought chiropractic care to help alleviate her symptoms. She reported that while she received chiropractic care, she experienced remission of symptoms and decreased Tegretol [anticonvulsant medication] use, which had reduced from 4.5 tablets per day to 0-1 a day, after an approximately 9-month period.”
What happened next? She remained under care until her chiropractor moved away. Upon cessation of care, symptoms returned and her dosage of medication was increased to its previous level. Her pain was described as “widespread sharp, intermittent left scalp and facial pain that she rated 8-9 out of 10 on a visual analog scale .” She also reported “excessive fatigue, changes in her mental health (including anxiety, poor concentration, and memory loss), and constipation .”
The chiropractor that took over her case observed that her symptoms (sharp, intermittent left-sided pain) had previously responded well to Activator Methods Chiropractic Technique and resumed care using that modality.
The extensive examination that took place is noted in the full case report (published in the open-access Journal of Contemporary Chiropractic and referenced below . It includes details of the cranial nerve tests, postural examinations, and vertebral subluxation listings, and is certainly worth a full read.
It should be noted that the chiropractic used a battery of tests commonly utilized to identify vertebral subluxations and the patient was managed accordingly. The authors detailed her progress (alongside extensive detail on activator methods chiropractic technique, subluxation listings, and thermography scan details). Among the outcomes were the following:
“A progress examination was performed on the 12th visit which included patient self-reported physical and mental health, and HWQL assessment, and Cranial Nerve VII, posture, cervical spine ROM, vertebral subluxation, sEMG and thermography examinations. Her perceived physical health rating improved from 5 to 6 out of 10, mental health from 6 to 7 out of 10. Improvements were recorded in both the physical health and mental/ emotional wellbeing domains of the self-reported HWQL assessment.”
By the 16thand 18thvisits (beyond the original care plan) she noted further improvements including, ”a sustained reduction in facial pain, and a further 200mg self-reduction of Tegretol, reducing 100mg on the 15th and 20th visits. Her Tegretol intake now reduced to 500mg from 900mg daily. The patient reported feeling more energy and not needing an afternoon sleep at the 16th visit, and feeling so much more alert on the 18th visit.”
While it may have been a discouraging finding that when the patient ceased care in the first instance, her symptoms returned, it is perhaps unsurprising given the length of time she may have been experiencing these symptoms and subluxation patterns. While the case report carries the usual limitations – that chiropractic is not a treatment and we can’t generalize based on this case report alone – it is interesting that the symptoms tend to return when chiropractic care is out of the picture.
Could it be that, for this woman at least, vertebral subluxation patterns are linked quite directly with her experience of trigeminal neuralgia? Or is it that cranial nerve work executed by a chiropractor is as effective (or more effective) than drugs or surgery in this instance? It seems the answer is a firm yes. Until higher-level research is undertaken, it is only evidence like this that we have to go on. In this case, and in eleven others cited in the case report, all signs point to the positive.
2.Trigeminal Neuralgia, Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/diagnosis-treatment/drc-20353347