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. 2010 Sep;54(3):177-86.

Trigeminal neuralgia and chiropractic care: a case report

Robert J Rodine  1 , Peter Aker
Affiliations

Trigeminal neuralgia and chiropractic care: a case report

Robert J Rodine et al. J Can Chiropr Assoc. 2010 Sep.

Abstract
in English, French

The following case describes a 68 year-old woman with a 7(1/2) year history of worsening head and neck pain diagnosed as trigeminal neuralgia following surgical resection of a brain tumor. After years of unsuccessful management with medication and physical therapies, a therapeutic trial of chiropractic was carried out. Chiropractic care included ultrasound, manual therapies (manipulation and mobilization), soft tissue therapies, and home stretching exercises. After an initial treatment period followed by 18 months of supportive care the patient reported satisfactory improvement. It became evident that there were at least three sources of her symptoms: mechanical and/or degenerative neck pain, temporomandibular joint syndrome, and trigeminal neuralgia. While never completely pain-free, the patient continued to report that her pains reduced to minimal at times. At the most recent follow-up, the pain had not returned to pre-treatment intractable levels. This case study demonstrates the importance of diagnosing and treating multiple sources of pain and the positive role chiropractic care can have in the management of patients with these clinical conditions. The potential for convergence of sensory input from the upper three cervical segments and the trigeminal nerve via the trigeminocervical nucleus is discussed.

Le cas suivant décrit une femme de 68 ans qui présente un historique de 7,5 ans de douleurs qui s’aggravent au niveau de la tête et du cou.Le diagnostic : névralgie essentielle du trijumeau à la suite d’une résection chirurgicale d’une tumeur cérébrale. Après des années de tentatives de gestion infructueuses au moyen de médicaments et de physiothérapie, elle a suivi un essai de traitements thérapeutiques chiropratique. Les soins chiropratiques reçus incluent des ultrasons, de la thérapie manuelle (manipulation et mobilisation), des thérapies de tissus mous et des exercices d’étirement à domicile. Après une période initiale de traitement suivie de soins de soutien pendant 18 mois, la patiente a rapporté une amélioration satisfaisante. Il est devenu évident que ses symptômes découlaient de trois sources : douleurs mécaniques ou dégénératives au cou, syndrome de l’articulation temporomandibulaire, et névralgie essentielle du trijumeau. Bien qu’elle ne soit toujours pas entièrement libre de douleur, la patiente continue à rapporter que ses douleurs sont minimales à certains moments. Lors du suivi le plus récent, la douleur n’était pas revenue aux niveaux réfractaires prétraitement. Cette étude de cas démontre l’importance du diagnostic et du traitement des sources multiples de douleur, ainsi que le rôle positif que joue les soins chiropratiques dans la gestion des patients qui présentent ces troubles cliniques. Le potentiel pour la convergence de l’apport sensoriel provenant des trois nerfs rachidiens cervicaux supérieurs et du nerf trijumeau par le biais du noyau trigéminocervical fait l’objet d’une discussion.

Keywords: chiropractic; facial pain; head pain; neck pain; spinal nucleus; trigeminal neuralgia.

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Figures

Figure 1
Figure 1
Contrast enhanced computed tomography taken of patient in March, 2000 showing surgical site. Resection of a portion of the left cranium and underlying grey matter is observed
Figure 2
Figure 2
Five view cervical spine radiographic series taken approximately 18 months prior to initial chiropractic visit showing degenerative changes at C5, C6 and C7.
Figure 2
Figure 2
Five view cervical spine radiographic series taken approximately 18 months prior to initial chiropractic visit showing degenerative changes at C5, C6 and C7.
Figure 3
Figure 3
A sketch of the brainstem demonstrating convergence of the upper cervical segments with trigeminocervical nucleus. Reprinted with permission from Elesevier.
See this image and copyright information in PMC

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