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Title: Management Of Trigeminal Neuralgia(TGN) Pain With Neural Interventions (Low Dose Neuromodulators, Nerve Block) Along With Muscular Interventional Approach Of Addressing Myofascial Pain Component, Ultrasonography Guided Dry Needling(USGDN)
e-poster Number: INSIM86
Category: Pain
Author Name: Dr Ganesh Wadje
Institute: TNMC and BYL Nair charitable Hospital
Co-Author Name: Dr Varsha Suryavanshi, Dr Ujjwalraj Dudhedia, Dr Anand Nirgude, Dr Ashish Mali
Abstract :
Aims: To present novel perspective of myofascial pathology as a cause of pain in trigeminal neuralgia.
To describe a newer muscular interventional approach USGDN with neural interventions.
Introduction: TGN is a chronic pain condition affecting trigeminal nerves managed routinely with anticonvulsants, surgery, radiofrequency ablation (RF)
Methods: 45 years patient with TGN. Post tooth extraction pain VRS 8/10 over left face radiating to pre and post aural, temporal region, shocking, burning, aching, continuous, exacerbations with exposure to air, unable to brush teeth since 6 months .
Started oral Pregabalin 75mg od, Ultracet bd, Myospaz bd
Results: pain reduced to VRS 6/10, Given mandibular nerve block with good pain relief for 7 days, later on pain recurred VRS 5/10 continuous with less intensity.
Started USGDN facial, neck, scalp muscles with 32G solid needles found tight masseter, lateral pterygoid, temporalis.
After 2 sessions VRS 2/10, current like pain frequency reduced from continuous to 7-8 times/day
Pt had 80% relief from all symptoms with 4 sessions, frequency reduced to 1-2/day with less intensity.
Total 6 sessions done. Medications tapered and stopped. No complains after 3 months.
Discussion: The uniform lasting pain relief achieved by USGDN suggests that Insertion of needle in myofascial trigger points ( MTrPs), produces local twitch reflex (LTR) in muscles with corresponding relaxation. The intense muscle spasm probably led to the generation of MTrPs in face, neck, masticatory muscles causing pain.
Conclusion: considering neuromyopathy as cause of pain, USGDN with Neural interventions has been proved to be effective in TGN.
