Trophic Electrical Stimulation for Trigeminal Neuralgia: Frequently asked questions

Background

Patients presenting with a diagnosis of Trigeminal neuralgia also usually have a long history of pain and related problems like headaches, dental pain and earache type symptoms. It is also common for one side of the face to be ‘the bad side’ in that the symptoms are far stronger on this side. Over the years you will have altered the way you use your face. This altered usage for example talking or eating over to the good side will have begun as a way of avoiding triggering the pain. Any movement that triggers sharp prolonged pain is to be avoided. However, over time this will lead to muscle imbalance which will cause many problems of its own including exacerbating the pain. This cycle of pain becomes worse over the months as the system gets more out of balance.

Why do I need emg testing?

The electromyographic testing provides a pain free way of in effect listening to what the nerve is saying. This will allow the physiotherapists to determine the type of muscle imbalance problem you have and they can then tailor the treatment accordingly. Repeated testing at reviews will show on paper improvements which are objective and often welcomed where most measures of outcome in pain treatment are subjective.

It is generally agreed that in trigeminal neuralgia the nerve is over excitable and this causes much of the pain. An emg test focusing on the temporalis muscle ( to your temple area) and the Masseter (the muscle involved when your jaw works, just in front of the ear over the joint) frequently exhibit this over activity which gets worse on even 5 repetitions of a movement. Imagine that then compounded across a day of movement and you can see why the pain is so bad and why it is commonly worse as the day progresses.

An effect called ‘stair casing baseline’ is also often seen. Basically this means that after each movement the muscle does not rest off properly and rests at a slightly higher level. Each new movement raises this level fractionally. By the end of the day, or even a conversation, the levels can be upto 10 times as high at rest as on the ‘good’ side. In essence this means that the muscle is working all the time to do nothing and not surprisingly therefore gets tired, sore and hard to move. Try holding your arm out at shoulder height and see how long it takes for the muscles to get tired and then achy, that’s a bit like how your Masseter feels working all the time with no rest periods.

What would stimulation do for me?

Trophic Electrical Stimulation plays signals to the muscle that the nerve would do in its healthy state. These signals can be used to increase blood supply to the area and build up the red muscle helping to combat muscle imbalance and fatigue problems i.e. those that get worse as the day progresses. The correct pattern of signals can also teach the system to shut off and thereby reduce gross over activity patterns this helps to combat the increasing rest levels through the day and thus reduce the tension type pain from continuous nerve activity.

Patients are required to treat themselves daily at home and so a large degree of commitment is needed. Whilst you may feel better after even the first treatment, it will take several weeks for sustained improvements to begin to occur. However, with all pain conditions the first thing is to be able to alter the level of pain and in some instances a slight increase in pain is felt for the first few days.

Patients report being able to decrease their daily intake of painkillers, less disturbed sleep, better mouth opening and less spasm type pain. The treatment does take time but the improvements are cumulative. It is not always a smooth road to less pain, much like when you change your painkillers you have to find just the right amount. However, there are no side effects with TES and treatment can be resumed if you have future bad periods, for example, at times of stress like bereavement.

I have already used a TENS unit. Why is this different?

TENS is a type of stimulation that is used to stop the nerve transmitting pain signals to the brain. It is often used in patients with chronic pain problems for pain relief purposes. It acts as a nerve blocker and its effects cease when the unit is turned off.

TES (Trophic electrical stimulation) sends signals down the nerve and facilitates the pathway. It is therapeutic which means that physiological changes are made to alter the system to a more healthy state and changes remain once the unit is switched off. It decreases pain by helping restore muscle balance and correct movement patterns, as well as teaching the nerve how to turn off in the rest phase.

Have you treated other patients with similar problems?

Yes. The Lindens Clinic is a specialist centre for the treatment of facial paralysis and pain; as such we have treated a wide spectrum of disorders with a variety of onsets.

How do I make an appointment?

Ring the Lindens clinic (0161 718 8620) and ask for an appointment. Because we are a private clinic we can accept self referrals and do not need a GP referral letter, although these are always useful if they can be provided.