★ Massage for PTS Trigeminal Neuralgia (TN)

What is trigeminal neuralgia?

The trigeminal nerve (the fifth cranial nerve, or simply CN V) is a nerve responsible for sensation in the face and motor functions such as biting and chewing; it is the most complex of the cranial nerves. Trigeminal neuralgia (TN) is a unilateral painful disorder that is characterized by brief, electric-shock-like pains, is abrupt in onset and termination, and is limited to the distribution of one or more divisions of the trigeminal nerve.

Classification. Under the general heading of neuralgia are trigeminal neuralgia (TN), atypical trigeminal neuralgia (ATN), occipital neuralgia, glossopharyngeal neuralgia, and postherpetic neuralgia (caused by shingles or herpes).

Is trigeminal neuralgia serious?
Trigeminal neuralgia is the most common cause of facial pain and is diagnosed in approximately 15,000 people per year in the United States. Trigeminal neuralgia pain is exceptionally severe. Although the condition is not life-threatening, the intensity of the pain can be debilitating.
Are there different types of trigeminal neuralgia?
There are two types of trigeminal neuralgia that one can experience: type 1 and type 2. Type 1 trigeminal neuralgia (TN1) is characterized by sharp (also referred to as lancinating) pain, which comes in sudden bursts. Type 2 trigeminal neuralgia (TN2) is characterized by constant pain.
What triggers neuralgia?
Neuralgia is a stabbing, burning, and often severe pain due to an irritated or damaged nerve. The nerve may be anywhere in the body, and the damage may be caused by several things, including aging. diseases such as diabetes or multiple sclerosis.
What is the difference between neuropathy and neuralgia?
Neuropathy is a nerve condition that often can result in feeling pain, numbness, tingling, swelling, or muscle weakness in different parts of the body. It usually begins in the hands or feet and gets worse over time. Neuralgia refers to pain along the nerve pathway as a result of damage or irritation to that nerve.
How do I calm my trigeminal nerve?
Many people find relief from trigeminal neuralgia pain by applying heat to the affected area. You can do this locally by pressing a hot water bottle or another hot compress to the painful spot. Heat a beanbag or warm a wet washcloth in the microwave for this purpose. You can also try taking a hot shower or bath.
Can trigeminal nerve repair itself?
The good news is that the vast majority of these peripheral trigeminal nerve injuries undergo spontaneous regeneration. However, some injuries may be permanent with varying degrees of sensory impairment ranging from mild numbness (hypoesthesia) to complete anesthesia.
Will neuralgia go away by itself?
In most people, trigeminal neuralgia improves with treatment or goes into remission on its own. However, recurrences do occur, often after a long pain-free period. Also, as with any ongoing painful condition, depression may occur, but there are treatments for depression that can help.
How long can neuralgia last?
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.
Is neuralgia caused by stress?
While trigeminal neuralgia itself isn’t caused by stress alone, stress can aggravate the condition. There isn’t a lot of understanding about how or why, but one possibility is the relationship between stress and pain. Studies have shown that chronic pain can lead to stress-induced heightened pain sensitivity.
Does an MRI scan show nerve damage?
MRI is sensitive to changes in cartilage and bone structure resulting from injury, disease, or aging. It can detect herniated discs, pinched nerves, spinal tumors, spinal cord compression, and fractures. Brain magnetic resonance imaging (MRI) with and without contrast helps to distinguish secondary causes of trigeminal neuralgia (TN) from the idiopathic form. This study is an imaging modality of choice and indicated in patients presenting with trigeminal neuralgia when younger than 60 years, principally to exclude tumor.
What is the most common cause of trigeminal neuralgia?
The main cause of trigeminal neuralgia is blood vessels pressing on the root of the trigeminal nerve. This makes the nerve transmit pain signals that are experienced as stabbing pains. Pressure on this nerve may also be caused by a tumor or multiple sclerosis (MS).
Can a dentist damage the trigeminal nerve?
Damage to branches of the trigeminal nerve following maxillofacial surgery and dental treatment is unfortunately common, in most cases the symptoms are transient and patients fully recover sensation over time. Persistent nerve damage results in severe complications such as neuropathic pain and trigeminal neuralgias.
What happens if the trigeminal nerve is damaged?
Trigeminal nerve injuries not only cause significant neurosensory deficits and facial pain but can cause significant comorbidities due to changes in eating habits from muscular denervation of masticatory muscles or altered sensation of the oral mucosa.
How do you sleep with neuralgia?
The best way to sleep with occipital neuralgia is in a position that does not place more pressure on the nerves. Following are some guidelines: Sleep on your back. Use a pillow that supports the neck and keeps the head aligned with the body (neutral position).
Does ibuprofen help neuralgia?
Over-the-counter drugs such as aspirin and ibuprofen are not effective against trigeminal neuralgia. Anticonvulsants and muscle relaxants are prescribed to block the pain signals from the nerve.
Can a virus cause trigeminal neuralgia?
Varicella-zoster virus can infect the trigeminal ganglion, but viral infection is not frequently considered as a cause of trigeminal neuralgia.
How do I brush my teeth with trigeminal neuralgia?
Avoid tartar-control toothpaste, which can irritate the gums. Dr. Gremillion also recommended using super soft toothbrushes. Some members have also found using a toothpaste designed for sensitive teeth has enabled them to brush their teeth without their TN flaring up.
What causes inflammation of the trigeminal nerve?
There are inflammatory causes of trigeminal neuralgia because of systemic diseases including multiple sclerosis, sarcoidosis, and Lyme disease. There also is an association with collagen vascular diseases including scleroderma and systemic lupus erythematosus.
What foods are good for trigeminal neuralgia?
  • brown rice.
  • cooked or dried fruits such as cherries, cranberries, pears, prunes.
  • vegetables such as artichokes, asparagus, broccoli, chard, collards, lettuce, spinach, beans, squash, and sweet potatoes.
Is exercise good for trigeminal neuralgia?
DR. JONATHAN H. SMITH RESPONDS: Moderate exercise may improve pain symptoms in trigeminal neuralgia (TN), a neurologic condition that causes chronic facial pain.
What vitamins are good for trigeminal neuralgia?
Vitamins such as vitamin D and B12 are often advised as “good” for trigeminal neuralgia.
Is trigeminal neuralgia permanent?
Attacks may begin mild and short, but if left untreated, trigeminal neuralgia can progressively worsen. Although trigeminal neuralgia cannot always be cured, there are treatments available to alleviate the debilitating pain. Normally, anticonvulsive medications are the first treatment choice.
Is coffee bad for trigeminal neuralgia?
In the investigated setting, caffeine consumption does not significantly alter trigeminal pain processing. This observation might help in the further understanding of the pathophysiology of pain disorders that are associated with excessive smoking habits such as cluster headache.

Trigeminal neuralgia is a kind of nerve pain that can give stabbing or burning sensations down the side of the face, usually on one side only. The pain may only last a few seconds or minutes but may repeat many times during an attack. For some people, face pain is present all the time. Trigeminal neuralgia can be excruciatingly painful.

Trigeminal neuralgia is more common in multiple sclerosis than in the general population and can be confused with dental pain. If you are experiencing these symptoms, you should be assessed to see if it is a symptom of your MS especially before you consider any major dental work.

The pain can be triggered by everyday activities such as eating, shaving, talking, or being out in even a light breeze. Noticing any triggers can help you manage the pain by avoiding them where possible. Treatment is usually with a drug called carbamazepine, to begin with. If drug treatments are not working, surgery may be an option. Carbamazepine is used to prevent and control seizures. This medication is known as an anticonvulsant or antiepileptic drug. It is also used to relieve certain types of nerve pain (such as trigeminal neuralgia). This medication works by reducing the spread of seizure activity in the brain and restoring the normal balance of nerve activity.

Trigeminal neuralgia, sometimes called tic douloureux, is a type of nerve (neuropathic) pain in the side of the face and can be a symptom of multiple sclerosis. Different people experience trigeminal neuralgia in different ways. It is most commonly felt in the cheek or in the upper or lower jaw but some people experience pain up towards the eye, ear and forehead or inside the mouth. It can feel like it is coming from one or more teeth so many people visit their dentist to begin with. It is usually on one side of the face only (unilateral) although in rare cases it occurs on both sides of the face (bilateral) although not at the same time.

For some people, it is a sudden severe sharp pain like an electric shock but for others, it may be a more long-lasting aching or burning sensation. It typically occurs as sudden short attacks lasting from a few seconds to a couple of minutes. For some people, these attacks occur many times a day; this is an example of paroxysmal symptoms. Some people are aware that an attack is coming but, for most people, it arrives without warning.

Attacks may continue for days or months but there can also be pain-free times, known as periods of remission, which last for months or even years. For some people, the pain becomes continuous.

Causes

This symptom is called trigeminal neuralgia because it is the trigeminal nerve that is affected. Neuralgia means pain that follows the path of a nerve. The trigeminal nerve controls the muscles needed for chewing and is responsible for the feelings of touch and pain in the face. There are two trigeminal nerves, one on each side of the face, and each nerve has three main branches so giving the name trigeminal (with “tri” meaning three). Trigeminal neuralgia can affect one or more of these branches and the location of your pain depends on which one(s) are affected.

In MS, trigeminal neuralgia is most often caused by damage to the myelin sheath around the trigeminal nerve. In people who do not have MS, it is most often caused by a blood vessel pressing on the nerve inside the skull which is known as compression. This can occasionally happen in people with MS so it can be important to determine which is the cause of your pain before considering treatment options, especially surgery.

Triggers

The bouts of pain felt in trigeminal neuralgia are often triggered by daily activities, some of them very brief or seemingly trivial. These can include:

  • Washing
  • Talking
  • Loud sound
  • Chewing
  • Shaving
  • Putting on makeup
  • Swallowing
  • Kissing
  • Head movements
  • Drinking
  • Smiling
  • Brushing your teeth
  • A breeze or air conditioning
  • Hot, cold, or spicy food
  • Vibration from walking
  • Vibration on a car journey

However, the pain may occur spontaneously with no obvious trigger.

Recent research suggests that between four and six in every 100 people with MS experience trigeminal neuralgia which is about 400 times more often than the general population. Trigeminal neuralgia is sometimes an early symptom in MS, but it also becomes more likely the longer you have had MS.

It is rare for people under 40 who do not have MS to experience trigeminal neuralgia so, for those in this age range, it is particularly important to consider if the symptom is part of their MS.

If your pain feels like it might be associated with one or more of your teeth, then it is worth visiting the dentist first. It would be worth mentioning that you have MS and that trigeminal neuralgia may be a possibility. If the dentist can find nothing wrong with your teeth or suggests major dental work, such as an extraction or root canal, it may be worth exploring the possibility of trigeminal neuralgia before proceeding further.

Sometimes trigeminal neuralgia can give pain around the ear which feels similar to an ear infection. Your GP or practice nurse should be able to check this for you.

If you are concerned about your pain, contact your MS nurse or neurologist directly or ask your GP to refer you for assessment. It will be important to describe your pain as clearly as possible and to say if it is excruciating so that you are referred as soon as possible.

There is no specific test for trigeminal neuralgia so diagnosis and treatment depend on your description of your pain. You may have an MRI scan to rule out other conditions or to see if your MS is more active at the moment. An MRI scan can sometimes show if trigeminal neuralgia is due to a blood vessel pressing on the nerve inside the skull. This is known as compression and is the main cause of trigeminal neuralgia in the general population although not in people with MS.

Trigeminal neuralgia is a long-term condition. Although there is no cure, it can usually be managed to some degree with treatment.

 

Massage for Trigeminal Neuralgia

How do you test for trigeminal neuralgia?
Trigeminal motor function is tested by palpating the masseter muscles while the patient clenches the teeth and by asking the patient to open the mouth against resistance. If a pterygoid muscle is weak, the jaw deviates to that side when the mouth is opened.

The treatment procedure I use to treat TN is very simple. It involves stretching the three branches of the trigeminal nerve on the patients’ face. This may have a positive effect by reducing the swelling caused by a build-up of edema in the nerve.

Stretching nerves – whether it is the trigeminal nerve or the greater or lesser occipital nerve – cause a reflex effect allowing edema to exit the problematic nerve. This reduction of edema decreases the swelling of the nerve and improves its blood flow – resulting in improved function and reduced nerve pain. Improving blood flow is the key to allowing the nerve to start to heal and normalize.

In short, stretching procedures can and may result in less pain and/or a resolution of the dysfunction of the TN or any nerve that has a build-up of edema due to stress – whether mechanical, chemical, or otherwise. This is the theory upon which I based the treatment procedure for patients with TN.

So, the question is: why do nerves swell with edema, become dysfunctional, and often generate nerve pain?

The answer is stress to the nerve. When a nerve is stressed, it produces macromolecules known as proteoglycans. These long-chain proteins can absorb up to 50 times the weight of water molecules thus causing a physical swelling of the nerve. The proteoglycans are like tiny sponges inside the nerve.

Why do the nerves produce proteoglycans?

This is better answered by a physiologist; however, it is my understanding that there is an ancient gene that we all have in us.

The physiological response to a nerve being injured or stressed is to swell with these water molecules that attach themselves to the proteoglycans. By stretching the affected nerve, we can reduce the swelling by allowing some of the water molecules to exit through the elastic properties of the nerves.

Why do the nerves produce proteoglycans?

This is better answered by a physiologist; however, it is my understanding that there is an ancient gene that we all have in us.

The physiological response to a nerve being injured or stressed is to swell with these water molecules that attach themselves to the proteoglycans. By stretching the affected nerve, we can reduce the swelling by allowing some of the water molecules to exit through the elastic properties of the nerves.

Can neck problems cause trigeminal neuralgia?
Therefore, concussive trauma to the head and neck or upper back causes injury to nerve pathways in the spinal cord and brain stem and it can because of trigeminal neuralgia. After cervical trauma, facial pain can be triggered immediately or can occur months or years later.
How do you relax the trigeminal nerve?
Many people find relief from trigeminal neuralgia pain by applying heat to the affected area. You can do this locally by pressing a hot water bottle or another hot compress to the painful spot. Heat a beanbag or warm a wet washcloth in the microwave for this purpose. You can also try taking a hot shower or bath.
Is massage therapy good for nerve damage?
Massage therapy may be beneficial for patients with nerve damage or tingling and burning sensations in the skin, hands, and feet. Caregivers may administer massage therapy, but a trained therapist can be more effective in pinpointing the proper areas and using the right amounts of pressure.
Can you rub out a pinched nerve?

Massage or physical therapy

Applying gentle pressure around the affected area may help relieve tension, and a full body massage can help the muscles relax. Deep tissue massages may not be a good idea because the extra pressure may make the symptoms worse, it depends on each individual but massage therapy can be also be an effective treatment as well. Massage works to ease the pressure that is felt on a pinched nerve. This works for nerves that are pinched from muscular tissue.

What is the fastest way to heal a pinched nerve?
  1. Adjust your posture. You may need to change how you’re sitting or standing to relieve pain from a pinched nerve. …
  2. Use a standing workstation. Standing workstations are gaining popularity and for good reason. …
  3. Rest. …
  4. Splint. …
  5. Stretch. …
  6. Apply heat. …
  7. Use ice. …
  8. Elevate your legs.
more info at: 

https://www.massagetoday.com/articles/15193/Massage-Therapy-and-Trigeminal-Neuralgia

https://mstrust.org.uk/a-z/trigeminal-neuralgia

https://mstrust.org.uk/news/views-and-comments/trigeminal-neuralgia

https://www.daniellopezdo.com/palpate-release-mandibular-branch-trigeminal-nerve/

https://www.curablehealth.com/blog/recovery-story-niki?gclid=EAIaIQobChMIgJnvuOPJ7wIVmTytBh1aWg8tEAAYAiAAEgKc__D_BwE







https://www.massagetherapycanada.com/pain-management-lets-face-it-3896/


https://www.scienceofmassage.com/2019/03/case-of-the-month-issue-1-2019/

https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/trigeminal-neuralgia-fact-sheet

https://en.wikipedia.org/wiki/Trigeminal_neuralgia


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