Issue link: https://www.massageandbodyworkdigital.com/i/1208028
40 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 2 0 Clearly more is going on than meets the eye. It is possible that trigeminal nerve compression happens at more than one location, so correcting it in one spot doesn't solve the problem. It may be that changes in cerebral perfusion—the amount of blood flow through local cerebral arteries—influences pain signals. We know that injured nerves in the peripheral nervous system can become inflamed and compressed at multiple locations—this is sometimes called multiple crush syndrome. It seems reasonable that the trigeminal nerve might also be vulnerable to this phenomenon. And living with the threat of unpredictable bouts of breathtaking pain inevitably has an effect on mood states, which can exacerbate pain awareness. TN may also cause structural changes in the central nervous system that lead to increased numbers of pain- related receptors and higher levels of pain-related neurotransmitters; this is central sensitization. This sequence doesn't happen to everyone, but it can be a factor in chronic pain syndromes for patients who have TN and many other conditions. "I have a list of coping skills. When things feel overwhelming, I take a walk. I write a letter. I call a friend or family member. I do five minutes of yoga. I get up and move, listen to music, or play the guitar. Mainly, I give my mind something to do." —SF TREATMENT OPTIONS Conventional treatment options for TN typically begin with medication, then may progress to interventions that destroy part of the trigeminal nerve, or microvascular surgery. The first-line medications used to treat TN are sodium channel blockers. These interfere with nerve cell excitability. They can dull the pain of TN for some patients, but the side effects can be severe, and many people find they cannot tolerate the drugs. "At its peak, I was having up to 40 attacks per day. Tegretol helped, but it made me feel like the stupidest person in the world, and tired, and hungry all the time—I didn't like the effect at all. But it made the flashes less intense. I stayed on it until my surgery." —SF A rhizotomy is a procedure designed to damage segments of the trigeminal nerve. This can happen in a number of ways, including balloon compression, glycerol injection, radio frequency thermal lesioning, or stereotactic radiosurgery ("gamma knife" surgery). These interventions are done under anesthesia with low risk of complications. They lead to long- lasting numbness or paresthesia, and they typically yield good results for one or two years, and then TN symptoms return. Microvascular decompression is the most invasive treatment option, with the highest risk of complications, but it also has the longest effect. About 70 percent of people with TN symptoms and neurovascular conflict (as confirmed by MRI imaging) have pain relief for five years or more following microvascular surgery. In this procedure, the surgeon cuts a hole in the temporal bone behind the ear. Then, the surgeon moves the artery and places a Teflon cushion to protect the trigeminal nerve. "After my surgery, I had two horrible days, and then wonderful relief. That was five years ago. Now the tingling is getting worse, like a thousand tiny needles in my face, and I'm having twinges once a week or so. I know I might have to go back to see what to do next." —SF Other options for TN treatment include acupuncture, biofeedback, mirror therapy, and stress-management techniques. None of these have a strong evidence base, but they are helpful for some people. Neck and shoulder massage may help with some of the common stress patterns seen in people with TN. Image courtesy of Massage Business Blueprint. Some people with TN won't let you touch their face; others will love it. Be guided by their feedback. Image courtesy of Massage Business Blueprint. 2 3