Massage Therapy and Trigeminal Neuralgia
May 2, 2016
Massage Therapy and Trigeminal Neuralgia
May 2, 2016
Trigeminal Neuralgia (TN) usually occurs when the myelin sheath of the trigeminal nerve has been worn away, sometimes due to a blood vessel causing compression to the nerve, or if the patient has multiple sclerosis (MS), a disease which attacks the myelin sheath. Sometimes TN can be brought on by an arteriovenous malformation or a tumor. Trauma, dental work, and strokes affecting the nerve can also trigger TN. The trigeminal nerve consists of three branches, which service the face and up into the scalp. Any branch, and more than one, can be affected. Occasionally, it can occur bilaterally.
When diagnosed, TN is classified as one of two types, which The National Institute of Neurological Disorders and Stroke describes as follows: The typical or "classic" form of the disorder (called "Type 1" or TN1) causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode. These attacks can occur in quick succession, in volleys lasting as long as two hours. The "atypical" form of the disorder (called "Type 2" or TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than Type 1. Both forms of pain may occur in the same person, sometimes at the same time. The intensity of pain can be physically and mentally incapacitating.
I have seen a handful of patients over the years with TN. The first one came into an emergency room where I was doing my clinical rotation. I will never forget what she cried, "Please, knock me out, or kill me, but I can't bear this pain!" She was medicated and sent home. I've often wondered about her. The ER doctor called her a "Frequent Flyer," but once he left the room, the nurse on duty reminded me that the patient's pain is whatever they say it is. I refused to work on the first client who asked if I could help TN, referring her to a neurologist. Several years ago a long-time client with MS told me her TN, which had been in remission for a long time was back, and she wanted me to work. I told her she needed to see a neurologist, to which she replied, "My neurologist is the one who sent me to see you, so don't be a chicken!" I used a very cautious approach, fearing that massage would trigger an attack. Her jaws were almost rigid bilaterally, so I focused on relaxing and softening the tissues using gentle massage and heated eye pillows over the face. It was entirely successful. In the following years that I worked on her, she had no more complaints of TN.
It is one thing to read and learn about a condition and quite another to experience it firsthand. I had begun to experience some very short but severe episodes of pain in my upper jaw. It felt as if I were being struck with an electrical shock that would paralyze me with pain for just a second, and then be gone. I decided to have some dental work done, thinking that whatever was hurting would get cleared up at the same time. The attacks of pain became more frequent, lasting up to twenty mind-bending minutes, and the area involved expanded from my temporomandibular joint (TMJ) up into my eye and the side of my head. While in the dentist chair one day, I was struck with an episode. I told my dentist I would rather die than feel this pain again, which brought to mind the patient in the ER all those years ago. Before he even began explaining it to me, I realized that I was experiencing TN. I chose to treat it the same way I do headaches, heat and massage until all of the painful, tight and hardened tissues are soft and malleable. For myself, it worked completely. I haven't had an attack in about two years.
Since this experience, I have sought clients with TN, offering treatment in exchange for allowing me to experience working on them. The results I've had are excellent, with complete pain relief for three clients. However, because they either did not have an actual diagnosis of TN, there were other conditions going on, as well as other treatments being used, a reliable case study could not be produced. I live and work in a small town, but hopefully, the right client with the right diagnosis will become available to study in the near future.
TN is serious in that the pain is debilitating. According to the NIH, the incidence of new cases is about 12 per 100,000 people a year, and is more frequently found in women. Current treatment for TN begins with anticonvulsant medications, and tricyclic antidepressants are prescribed for pain relief. TN is not believed to be related to depression or psychological factors, but analgesics are generally ineffective.
TN is a progressive condition, and if medications lose their effect over time, there are more invasive treatments available for pain relief. These include injections and several different types of surgery, all which involve the risk of unpleasant side effects. The NIH handout for TN states, "Some individuals manage trigeminal neuralgia using complementary techniques, usually in combination with drug treatment." Although they list low-impact exercise, yoga, and visualization among other approaches, there is no mention massage therapy. In my limited experience, massage therapy for TN has relieved everyone who has attempted it. From what I understand of this condition, it progresses over time. As the tissues become more compressed, the pain becomes more intense. If heat and massage can soften, mobilize, and relieve pain elsewhere in the body as it does, it can certainly relieve at least some of those cases of TN. It only makes sense to try therapeutic massage before administering drugs or performing surgeries.
- NIH Trigeminal Neuralgia Fact Sheet http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm
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