Trigeminal Neuralgia, "the suicide disease" Helped by Upper Cervical Care

The Journal of Upper Cervical Chiropractic Research published a study on June 23, 2014 that documented the case of a woman suffering from trigeminal neuralgia (TN) who was helped by chiropractic care. The American Association of Neurological Surgeons describes TN as "Trigeminal neuralgia, also known as tic douloureux, sometimes is described as the most excruciating pain known to humanity. The pain typically involves the lower face and jaw, although sometimes it affects the area around the nose and above the eye. This intense, stabbing, electric shock-like pain is caused by irritation of the trigeminal nerve, which sends branches to the forehead, cheek and lower jaw. It usually is limited to one side of the face."

The study authors note that medical management of TN usually involves medications possibly followed by surgery. They also report that approximately 50 percent of TN cases managed medically will ultimately have surgery for their condition. The authors point out that the medications commonly used to treat TN have a long and serious list of side effects including double vision, involuntary eye movement, dizziness, extreme fatigue or drowsiness, headaches, involuntary muscle movement, nausea, vomiting, jaundice, skin rashes, and hypertension.

In this case, a 30-year-old woman went to the chiropractor with a chief complaint of left-sided facial pain. She had previously received a diagnosis of TN. She described her condition as the worst pain she had ever experienced, listing it as a 10 out of 10 in severity. She described her pain as dull, aching, and burning down the left side of her jaw and cheek. Additionally, the woman reported that she was also suffering from left-sided neck pain, bilateral shoulder pain, TMJ pain, mid-back pain, and right-sided low back pain.

In her history, the woman reported that her TN started about eight months ago which seemed to be immediately after a visit to the dentist. She had also had a car accident several months prior to the onset of her TN. Some of her medical doctors even suggested that her problem arose from "mental stress onto her from her young son." This suggestion infuriated the woman.

A chiropractic examination was performed on the woman that included palpation, leg length analysis, and specific spinal x-rays of the upper neck. From these, it was determined that vertebral subluxation was present in the upper neck. The authors explain subluxation and the chiropractic approach by saying, "Chiropractic has one goal: to reduce or eliminate the vertebral subluxation. The vertebral subluxation has been described as follows: Loss of juxtaposition of a vertebra with the one above, the one below, or both. It must consist of occlusion of an opening. Nerve impingement. Interference with the transmission of mental impulses."

The results of the care reported that the woman experienced less pain from the onset of care. She did experience a flare-up of her TN around her 5th chiropractic visit. However, by her 10th visit the woman reported that she was no longer having any pain.

(Editor's note: Remember the objective of upper cervical care is to correct head neck misalignment that is interfering with proper brain to body communication. When this is corrected the body functions at a higher level and can often correct other problems more efficiently on its own. Please do not confuse upper cervical care as a treatment for any condition, disease or symptom.)

Resolution of Trigeminal Neuralgia Following Upper Cervical Chiropractic Care

A case study published in the scientific periodical, the Annals of Vertebral Subluxation Research, documented the resolution of Trigeminal Neuralgia in a patient following chiropractic care. Trigeminal Neuralgia (TN) is  a nerve disorder characterized by episodes of intense pain in the face.  The study published on August 12, 2013, was titled, "Resolution of Trigeminal Neuralgia Following Subluxation Based Chiropractic Care: A Case Study & Review of Literature."

The authors begin by noting, "Since the first century A.D., trigeminal neuralgia (TN) has been regarded as one of the most painful and enigmatic diseases known to man. It has been generally accepted that patients will never be completely free from the condition regardless of the therapy." The authors set out to show that based upon case study and literature review, chiropractic offers a more permanent solution. Other names for this disorder have included "tic douloureux" and the "suicide disease", due to the severe nature of the pain it causes.

In this case, a 40-year-old woman came to the chiropractor with a diagnosis of TN that she had been suffering from for six months. The history notes that by the time the patient had gone to the chiropractor, she had already been to the emergency room twice, had seen five different specialists (EENT, neurologist, and neurosurgeons), as well as three dental specialists. When describing her pain on a scale of one to ten, with ten being the worst, the pain was described as a ten double plus.

In a failed attempt to help this problem, the woman had one tooth extracted, and she was prescribed a total of 15 different medications including morphine, oxycontin, and percocet. The case history also noted that due to the severity of the pain every aspect of this woman's life was affected; including work, sleep, recreation, and daily routines.  Because of this condition and the mounting financial burden from doctor and prescription costs, the woman was also severely depressed.

A chiropractic examination and x-rays revealed the presence of subluxations at the first and second cervical vertebrae located inthe upper neck. Specific adjustments were given to address the subluxations. Adjustment frequency was initially three visits per week for the first month, and then slowly the frequency of visits was reduced. 

The study notes that immediately after starting chiropractic care, the woman had complete resolution of all symptoms including spasm, pain, and swelling. Her range of motion had returned to normal and all spinal tenderness was gone.  She was able to return to her normal activities and remains free of her problems. The authors wrote in their conclusion, "It has been over 8 years since the patient in this case study first received chiropractic treatment. In addition to her receiving 100% resolution after one adjustment, it has been remarkable to observe that no attacks have occurred since then."

 

(Editor's note: Remember the objective of upper cervical care is to correct head neck misalignment that is interfering with proper brain to body communication. When this is corrected the body functions at a higher level and can often correct other problems more efficiently on its own. Please do not confuse upper cervical care as a treatment for any condition, disease or symptom.)

Trigeminal Neuralgia, The Patient and Upper Cervical Care

Trigeminal Neuralgia Relief found in Upper Cervical Care

by Dr. Geoffrey Besso

Trigeminal Neuralgia is a very painful condition, often called the “suicide disease”. This chronic condition affects the fifth cranial (trigeminal) nerve, causing sharp, painful, and shooting pain in the face. We have had great success helping patients find relief from this condition in the past, and last fall Thomas T. entered our office in great pain. This is his story.

    "I was diagnosed with having Trigeminal Neuralgia, which is painful condition that causes a false signal to the right side of my face. The smallest things, such as washing my face, brushing my teeth, eating, talking and even walking, would cause a “taser-like” shock to happen. A neurologist prescribed anti-seizure medicine and I was told to do a follow-up appointment in 6 months. I began doing a lot of research, and after awhile I read that Upper Cervical care could help alleviate my terrible pain.

    Although I am still taking the anti-seizure medicine, I haven’t had one Trigeminal Neuralgia attack since I’ve been seeing Dr. Besso. I’m sure all that pressure and misalignment was causing the frightening and awful scary facial pain.

    As a side note, I’ve had bad back, neck, and joint aches for the last 20 years. After my first NUCCA adjustment at the Besso Clinic, my back pain was greatly reduced. It didn’t happen overnight but after a few months of treatment my neck, back, and joints hardly ever ache. I just thought all these pains were part of aging, I had no idea I could feel this good again.

    My hopes are that I can discontinue using that medicine, and plan on writing a follow up when that happens, so this is to be continued….."

-T.T. Cleveland, Ohio

(Editor's note: Remember the objective of upper cervical care is to correct head neck misalignment that is interfering with proper brain to body communication. When this is corrected the body functions at a higher level and can often correct other problems more efficiently on its own. Please do not confuse upper cervical care as a treatment for any condition, disease or symptom.)

Upper Cervical Care and The Suicide Disease

The Problem of Trigeminal Neuralgia and Other Chronic Pains


by Dr. Ward

Popular web resources on the facial pain Trigeminal Neuralgia (TN) only have drugs, injections, and surgeries as possible treatments. But they’re missing a potential important ingredient to resolving TN symptoms: upper cervical chiropractic care.

Trigeminal Neuralgia is the #1 cause of facial pain, with 4 to 5 persons per 100,000 having the disease. Some authorities say that more might be suffering, but aren’t counted because of misdiagnosis.


According to the National Pain Foundation, 1.7 millions have been diagnosed with Trigeminal Neuralgia. TN’s reputation as one of the most severe body pains makes that 1.7 million too many. In many cases TN grows to be a debilitating and chronic pain that threatens the livelihood of the one who suffers with it.

In the past TN has been called Tic douloureux, and also the suicide disease, because the suffering it causes some patients drove them to take their life. Modern medicine has improved pain management through drugs and surgical procedures, and takes credit for reducing TN’s deadly reputation.

Yet, medicines don’t always work, and the idea of a cranial surgery can be too expensive, or downright scary for many. Some choose to seek help from alternative treatments. Indeed, popular web sources like Mayo.com list some of those therapies, like acupuncture, biofeedback, and vitamin therapy.

Still, there is one glaring omission of what might help TN. Upper cervical care.

There are several theories on what causes, or possibly exacerbates the symptoms of facial nerve pain. The most popular is a mechanical explanation: there is pressure on the facial nerve, inside the skull, most likely cause by a blood vessel. Pain then occurs with little or no warning, often just with moving the head, eating, or touching the face.

It’s thought that the pressure actually occurs at the base of the brain stem, where the roots of the facial nerve are.

What’s interesting about the facial nerve is that it’s not just found at the brain stem. There are actually cell extensions of the facial nerve which descend down into the spinal cord to the level of our second cervical vertebra. So, reach back to just about the back of your hair line, at the back of your neck. You have cells hooked up to the trigeminal nerve which are nestled less than a few inches away from your finger.

If there was a doctor who could do a surgery and take away small amounts of pressure at the top of the spinal cord, in between the second vertebra and the bottom of the head, do you think it might relieve the pressure on the facial nerve?

Now what if that doctor wasn’t doing surgery, but was gently improving the balance between the head and neck? Balance that affects nerve pressure and blood flow into the brain stem. Would you think that might relieve pressure on the facial nerve?

And what if I told you that non-surgical doctor was a chiropractor, practicing upper cervical chiropractic?

Upper cervical chiropractic worked for one TN patient of an upper cervical doctor in St. Louis. And it did for James Tomasi, who you can read about here, or listen to his story in the recording above. I have personally  seen improvement in facial pain in 3 different patients in the last 45 days.

So, why haven’t you heard about this before? Good question. Here’s one answer: when you search the current National Institute of Heath’s clinical trials, there are only 3 TN studies. And not one of them is examining Trigeminal Neuralgia and upper cervical care. There is very little funding for upper cervical research period, let alone research into a non-back-pain related condition.

Here’s a second answer:  Mayo and other authorities are  comfortable reporting on the potential of acupuncture, vitamins, and biofeedback, because it’s not upper cervical care. You simply haven’t heard about Trigeminal Neuralgia and upper cervical care because of bias.

And it’s not just limited to facial pain, but other chronic pains as well. Thankfully patient advocacy groups like the Facial Pain Association are willing to tell others about facial pain and upper cervical chiropractic.

(Editor's note: Remember the objective of upper cervical care is to correct head neck misalignment that is interfering with proper brain to body communication. When this is corrected the body functions at a higher level and can often correct other problems more efficiently on its own. Please do not confuse upper cervical care as a treatment for tinnitus or any other condition, disease or symptom.)

Have You Heard Of Upper Cervical Care?

by Mindy Drake D.C.

If not, you’re not alone. Most people haven’t, and the funny name kind of makes you wonder what type of care this is? When we speak about ‘upper cervical care‘, we’re actually referring to the area of the upper spine that connects your head to your neck. There are 24 vertebrae in your spine- they’re like little square donuts stacked on top of each other, forming a tunnel for your spinal cord, and the spaces between them are like exit windows for all of your nerves. Your spine is really just a very ‘drafty’ house for your nervous system!

The top seven vertebrae are called your ‘cervical spine’, basically meaning the ‘bridge’ between your head and your body. The very top two vertebra, right up near your head, are the ‘upper cervical’ spine, and they have the very important job of holding up your head, allowing it to move in all directions, and they also surround and protect your brain stem. The design of this area makes it the weak spot in your body, and it’s very vulnerable to injury. Now, your brain stem is the most important part of your body- it’s kind of like your battery, and all of the nerves in your whole body eventually travel into the brain stem, either from the spinal cord below, or from the brain above. If those two very special vertebrae at the top of the neck, called the Atlas (C1) and the Axis (C2) are not in perfect alignment due to trauma or an accident, often the nerves that come out of that area can be irritated, and can cause pain and dysfunction. Usually the pain will start slowly, and get worse as the bones are misaligned for a longer period of time.

C1 and C2: Atlas and Axis

Upper cervical doctors require additional training to learn how to adjust the top of the neck precisely and gently; there are a few different techniques for this very precise work (N.U.C.C.A, Knee Chest, Toggle Recoil, Grostic/Orthospinology, Atlas Orthogonal and Blair). It’s very similar to all of the others, but involves a little different analysis of the spine, and some additional muscle testing.

The most important word to describe what we do as upper cervical doctors is ‘specific', and we take extra time to carefully analyze, and then very gently adjust the top of the neck. We also do extra testing to make sure we only adjust when absolutely necessary. This procedure gently and effectively ‘put’s your head on straight’ (all of our mothers and teachers love to hear this!), but crucially, it also takes pressure and irritation off of the nerves of the upper cervical spine, which are frequently implicated in migraine headaches, occipital neuralgia, and trigeminal neuralgia, and this also removes irritation from the brain stem area. This is a very good thing, and frequently can lead to a decrease in pain, sometimes almost immediately.

Another benefit of specific upper cervical care is that if we can gently and effectively correct the position of the top two vertebra, it takes far fewer adjustments to help the adjustments stay in place, and quite often the lower areas of your spine will align all by themselves with very little help from us. Your body can heal itself; sometimes it just needs a little boost in the right direction.

The Upper Cervical Story of Louella Harris

Louella's Story is amazing and the non-profit organization she started is equally so. The National Awareness Campaign for Upper Cervical Care (NACUCC). The next few posts will be from information put out by NACUCC. Enjoy!


"So Much Pain. So Unnecessary!"

Louella Harris contracted polio in 1958, in Kenya, East Africa she was 3 years old. Thirty-four years later, after appearing on television and radio for affirmative action in her state, obtaining a Master's degree and getting married, pain began creeping up Louella's arms and neck and burned into her chest. Her medical doctors called it a combination of Post Polio Syndrome, and a condition called Fibromyalgia. Their only recommendations were painkillers and exercise. The pain grew so intense that Louella became confined to bed for months. Any sort of movement at all was agony. Her husband, Richard, became her personal attendant, He dressed and fed her and helped with all her personal needs on a daily basis. Louella couldn't even sit up to watch television or hold a book.

In desperation, the Harrises tried everything, including chiropractic. The problem was that the chiropractic procedure she experienced, while it had helped others, didn’t seem to help her. To make matters worse her medical doctors only offered drugs and exercise. Nutrition wasn't even affecting the pain. At that point, there honestly didn’t seem to be any answers anywhere.

Then, one day, while she lay in bed fighting the pain and watching the clock to see when she could take her next pain pill, Louella had an uncanny feeling come over her. The inexplicable feeling carried a message. The message was that indeed there was an answer for her. And when she found it, it was going to be much bigger than just for her.

A few weeks later, a friend called and told her about a little known procedure practiced by less than 2000 chiropractors worldwide. Louella located one of the Upper Cervical chiropractors in her state. He turned out to be a highly skilled, big-hearted doctor who took the time to call her back and answer as many questions as possible without actually examining her. He gave Louella no guarantees, but the information he shared with her was different than anything she had ever heard of before. That in itself gave her hope.

Four months after Louella first experienced precision Upper Cervical chiropractic she was out of bed, back to work, and pregnant! Nine months later she gave birth to a baby girl at age 39, naturally. That was just the beginning.

After her dramatic recovery, Richard and Louella met people who had struggled with all kinds of conditions. These were people who had been told by their medical doctors there was nothing that could be done for them. Yet their conditions were either being eased or eliminated all together by having their bodies balanced and proper communication between the body and the brain stem restored. These were people who had suffered from fibromyalgia, migraines, epilepsy, ADD, hypertension, trigeminal neuralgia, TMJ, some forms of arthritis and carpal tunnel, immune system disorders, herniated disks, numbness and tingling in the limbs, allergies and asthma, neck, back, arm and feet pain, sciatica and more, all of which were improving to some degree or another. Victims of accidents were being helped at a fraction of the time and expense as those undergoing traditional forms of rehabilitation. The procedure was not a cure-all by any means. However, it was surprising how much improvement was experienced by so many people with a variety of conditions that did not seem to have any apparent commonality.

Richard and Louella soon realized that if healthy children and adults would get under this care, countless problems could be avoided before they ever start. But people just didn’t know to do that. The Harrises didn't. In fact, when it finally dawned on the Harrises how fundamental this procedure was to overall health, they were appalled at their own ignorance and the ignorance of the general public. They had lived almost 40 years with absolutely no information about this at all.

It was obvious that at the age of 3 when Louella’s health problems first started, if someone had told Louella’s parents about this procedure, her whole life might have been different. When the Harrises grasped the fact that all that suffering might have been avoided, not just in her life, but in the lives of millions of others, they felt impelled to take a leap of faith, drop both their careers, and found the National Awareness Campaign for Upper Cervical Care. The N.A.C.U.C.C. is a non-profit consumer awareness organization dedicated to educating the public worldwide about this care.

During one of her interviews on CBS, Louella said, “This type of health care was available all the time I suffered. We just didn't know about it. It's one thing to hurt because nothing can be done. It's entirely another to suffer because of ignorance. That's tragic. There are millions of adults in pain right now because they've never heard of this. There are millions of children facing a lifetime of problems because their parents are unaware of the critical role the care of the brain stem area, plays in the future health of their child. There’s so much pain and it’s so unnecessary. It has to stop. The NACUCC is committed to reaching every man, woman and child with this information. When the public at large finally grasps how fundamental Upper Cervical health care is to the health of the entire body, it will change how we take care of ourselves and how we take care of our children.”
BRAIN MESSAGES DIRECT ALL BODY FUNCTIONS!

Research is showing that body imbalance and brain-to-body disruption of communication can cause or complicate all kinds of conditions. The previously mentioned conditions are listed not because this procedure cures any of them, but because it demonstrates that the body can heal itself in many different ways if it is given what it needs to heal. The conditions listed have been known to improve or be eliminated when different individuals have had their atlas and/or axis, (C1 and C2) corrected. This does not mean that these conditions will be eliminated in every person who has their Upper Cervical spine realigned. It does mean that if the condition is being caused or complicated by an atlas/axis being out of position, the condition is likely to improve or be eliminated once the bones are repositioned.

Please note that 2 people can be diagnosed with the same condition and after their atlas is corrected, the condition in one may be completely eliminated, while the same condition in the other person may improve only a little. Carpal tunnel is a good example of this. If the problem is actually in the wrist, then correcting the atlas may help the condition only minimally. If, on the other hand, the atlas is causing irritation in the nerves flowing down into the arm and into the wrist, the carpal tunnel is likely to improve remarkably. Note, however, that 99% of the people we have tested in our seminars around the country, have all been imbalanced with one short leg. Even the person who has carpal tunnel in the wrist from repeated use of the wrist and hands such as a typist or a factory worker, most likely has a misaligned atlas as well. Correcting the atlas and restoring brain-to-body communication and body balance will, at the very least, help them cope with their condition better.

When an Upper Cervical Spinal Correction is made, Body Balance is restored. Stress, tension and pressure from the area below the Brain Stem are removed. This reactivates the flow of healing messages from the brain to the affected part of the body and immediately, the self-healing process begins. It is imperative that you have your atlas examined. It’s role in overall health is so crucial, you need to at least rule out the possibility that a misaligned atlas is involved in your condition(s).

When I Cancelled Plans To Commit Suicide…

...I had no idea we would eventually help thousands of people, with all sorts of health problems, around the world get their normal lives back. After 12-years dealing with the agony of Trigeminal Neuralgia, the unbearable pain robbed me of hope and all desire to live.

The disease, TN, better known as the ‘Suicide Disease’, is an incurable nerve condition of the face. TN is the most painful condition experienced by man, with suicide being the only documented means of lasting relief. Years of medical treatments that included powerful epileptic drugs left me doped like a zombie.

Rhonda, my wife, researched several major surgeries that could sever the nerve leaving me with facial paralysis, or cover the nerve, which might cause blindness, but they cost in excess of $40,000, while offering a limited chance of success. I was running out of time, trying to escape this pain that had taken over my life.

The ‘traditional’ medicine as well as natural treatments, like dental work, acupuncture, chiropractic and herbal (natural) healing offered only temporary reductions or provided no relief. No remedy or drug lessened the horrible pain inflicted by the excruciating spasms I called ‘the beast’. After 12 years of suffering, the only option that made sense to me was to end my life.

One night my wife Rhonda heard a radio broadcast by a motivated woman who shared her remarkable, emotion-packed story of a relatively unknown scientific procedure which reduced her crippling misery with Fibromyalgia, eventually restoring her to a pre-agony state of being.

This turned out to be the very procedure that ultimately ended my pain and eventually brought back my life. My wife scheduled a meeting with an upper cervical doctor close to our home. Within three days of the first realignment of my head the pain was greatly reduced, by the third treatment (9 days later), I was pain free! The cost of finding relief equaled the cost for two months of the three drugs I had taken for over 10 years.

I completed full treatment, and now see my doctor for check-ups only. The only recurrences have been after trauma to my head. The spasms left as soon as I was re-x-rayed and the upper cervical area (C1C2) was corrected again.

-James Tomasi, pastor, author, and Upper Cervical Care advocate.

This head/neck misalignment can cause or contribute to a whole host of health problems because it interferes with body balance and the proper function of the nerve system. This one tiny problem affects your posture and balance (aching joints/pain) and how your nerves work (factor in many diseases). You owe it to yourself to see if this can help you. Find hope at www.thepowerofuppercervical.com and visit www.upcspine.com to find out more and to find a doctor near you.

One TN Patient's Experience

Perhaps their experience will guide you to the light at the end of your dark tunnel.

My story began 10 years ago with a fast onset of terrible pain. I went to the G.P., general dentist, oral surgeon, ENT, chiropractor, neurologist, neurosurgeon. It was the ENT professional who first diagnosed this after I had had the "usual" treatment of root canal and my dental fillings all changed to composites. After the diagnosis I was sent to the neurologist and on to the neurosurgeon who seemed gleeful to see me. When I balked at the first consultation, he assured me I "would be back." I have wandered through the usual maze of drug therapy, staggering, falling, and feeling in a daze. I have listened to others who swore by acupuncture (it did nothing for me); crystal therapy (yes, I tried that too!); chiropractic maneuvers (made it worse), and even having the offending nerve cut by an oral surgeon (permanent numbness but pain returned, of course). I have been depressed, given antidepressants, been more depressed, considered ending it all. But through it all I have worked! Have to. How? It has been an absolute heroic event. Finally, this past fall someone tried to convince me to try a "specialized chiropractic treatment" upper cervical. Sure, I thought. Another voo doo thing. I was sent a tape to listen to. The tape sat on my desk for months. One day I thought I would listen to it before I threw it out. Listened to it and thought, this is absurd. I listened to it several times and then thought, well, I'll try one more shot at voo doo. Finding one of these specialized people was hard. I did careful research, finally calling the national organization and spending a long time on the phone with the person in charge. I came away with two names of certified practitioners. I made an appointment and cancelled. Waited another few months. The pain was bad. Made another appointment and kept it. The specialist told me about the atlas bone in my spine. I was unconvinced, but now what did I have to lose? It was one more try with witchcraft or on to surgery. So, I gave it a try. I got better. I was skeptical. I am a tough patient. Since I started, I have had very good success with this procedure. I am now down way down on my meds. I can now function and eat and talk. I am still unwilling to say unequivocally that what I am doing will work for anyone else, but so far it has given me relief. At least the pain is gone...for now.

Trigeminal Neuralgia and Upper Cervical

Yet another example of Upper Cervical Care and the results possible.

Chiropractic management of trigeminal neuralgia: A preliminary study

Roger Hinson, DC and Susan Brown, PhD, DC.

Trigeminal Neuralgia (TN), the most common pain disorder of the face and one of the most painful afflictions known,1 affects one or more branches of the fifth cranial nerve and has a reported annual incidence of 4.3 per 100,000.2 Once known as the suicide disease, TN effects women more often than men and the annual incidence rate increases significantly with age. The pain, abrupt in onset and typically lasting no more than a few seconds, can be triggered by both mechanical and thermal stimuli from inside or outside the area of pain. TN may undergo spontaneous remissions and recurrences, but the frequency of pain commonly increases with chronicity. 3

Medical management starts with a course of anticonvulsants (carbamazepine, gabapentin, phenytoin) gradually increasing in dosage as symptoms warrant. Surgery is performed if symptoms are initially, or become, refractory to medication. Percutaneous ablation of the Gasserian ganglion is the most commonly practiced approach but carries a relatively high risk of numbness and dysesthesia. Microvascular decompression (MVD) of the trigeminal root, involving open surgery through the posterior fossa, has the best results with long term pain relief and the lowest chance of numbness and dysesthesia but greater incidence of serious complications. All currently practiced neurosurgical procedures are associated with significant morbidity and recurrence rates.

There is no reference in the indexed literature to the efficacy of chiropractic procedures for TN. We report outcomes of an 8 week trial of chiropractic care on 8 subjects suffering from TN.

Patient Background

Eight subjects were recruited for this study through a support organization for facial pain sufferers. All reported with a previous diagnosis made by a neurologist of trigeminal neuralgia. Seven subjects met diagnostic criteria for trigeminal neuralgia set forth by the International Headache Society (IHS), while one subject (5) described pain more characteristic of atypical trigeminal neuralgia (ATN) as there were no pain free periods and Aslow@ pain, i.e. aching, burning sensations, was more bothersome than brief, lancinating pain. One subject (7) suffered from trigeminal neuralgia and contralateral anesthesia dolorosa (AD), an iatrogenic disorder caused by surgical deafferentation and characterized by a constant sensation of numbness and burning pain. She had suffered from bilateral TN prior to unilateral radio frequency ablation two years previous.

All subjects were under medical therapy at the time of enrollment and five had undergone unsuccessful surgical treatment, four subjects had undergone two procedures and one had undergone a single procedure. All were female and the ages ranged from 47 to 79 (mean, 62; SD 11.6) years. Chronicity of TN symptoms ranged from 1 15 (mean, 7.4; SD 5.3) years.

Methods

Informed consent was obtained from all subjects prior to enrollment. (Upper Cervical)Chiropractic management was per Grostic technique protocol, which utilizes three mutually orthogonal x ray views for measuring upper cervical displacement from a theoretical norm. Adjustments were administered by one clinician as indicated by supine leg length estimation and dual probe thermocouple analysis. The adjustments consisted of a low force, precisely vectored impulse delivered to the transverse process of C1 with an instrument. Patients were seen three times per week for the first 2 weeks of care, then twice a week for weeks 3 and 4. Visits were scheduled for weeks 5 through 8 as needed, typically once a week.

Pain was assessed via short form McGill Pain Questionnaire (SF MPQ), VAS and pain drawing. Depression was evaluated with the Modified Zung Depression Index. The Rand SF 36 was used to evaluate quality of life. Questionnaires were administered at two weeks prior to (Upper Cervical) chiropractic care, on the first day of care, and after 4 and 8 weeks of care. Subjects maintained a diary in which number, intensity and duration of paroxysms and analgesic usage were recorded.

Results

Reduction in pain was reported by all subjects during the experimental phase. Mean values after eight weeks of intervention were reduced by 69% for MPQ and 78% for VAS. Depression as measured by Zung was reduced by 43%. Pain drawings demonstrated reductions in distribution of pain for all patients. Antiseizure medication usage was discontinued by two, decreased by 33% by one and by 66% by one, and unchanged by four subjects during the eight week period of intervention. Two subjects reported complete absence of paroxysmal pain within four days of first adjustment and no return of paroxysms during eight weeks of intervention. One subject suffering from otalgia had no recurrence of such pain subsequent to first adjustment.

Discussion

The spinal tract and nucleus of the trigeminus descend from the caudal brainstem down to the level of the second cervical vertebra. That area of the nucleus located in the cervical spine, the subnucleus caudalis (Vc), contains second order neurons receiving pain and temperature stimuli not only of trigeminal origin, but also from the facial (n intermedius), glossopharyngeal and vagus nerves, and converges with neurons in the upper cervical dorsal horn which convey equivalent stimuli from upper cervical dorsal rami.

Trigeminal, geniculate, glossopharyngeal, vagal and occipital neuralgias have been described as hyperactive dysfunction syndromes. The efficacy of antiseizure compounds in the treatment of these primary neuralgias results from the depression of exitatory mechanisms of Vc neurons.4 The venules which drain the lateral columns proximal to the dorsal horn where Vc is located operate at low pressure and have little redundancy 5. If adverse mechanical tension were transmitted to the cord via upper cervical dentate ligaments, this area would be among those earliest effected. Such tension could lead to direct mechanical compression of the descending tract of the trigeminus, which lies on the periphery of the cord adjacent to the dorsal spinocerebellar tract, or of Vc. Compression might also lead to venous stasis with resulting hypoxia and hyperexcitability of Vc. We speculate that such tension may result from displacement of the atlanto occipital and atlanto axial joints, and that correction of such displacements may result in attenuation of Vc hyperactivity.

Conclusions

Results from this study suggest that upper cervical chiropractic procedures may be of benefit to TN sufferers. Further study is needed to better qualify the efficacy of chiropractic procedures for TN and other primary neuralgias. A controlled trial is planed to improve the evidence base on which clinicians and patients can make decisions.

References

1. Goodman J. chap 14. In: Biller J, Ed. Practical Neurology. Lippencott Raven, 1997: 142 3

2. Katusic S, Williams DB, Beard CM, Bergstralh EJ, Kurland LT. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945 1984. Neuroepidemiology 1991;10(5 6):276 81

3. Adams R, Victor M, Ropper A. Principles of Neurology, Sixth Ed. McGraw Hill 1997

4. Kondo T, Fromm GH, Sxhmidt B. Comparison of gabapentin with other antiepileptic and GABAergic drugs. Epilepsy Res 1991 Apr;8(3):226 31

5.Gillilan LA. Veins of the spinal cord. Anatomic details; suggested clinical applications. Neurology 1970 Sep;20(9):860 8

Parkinson's Disease, Meniere's Syndrome, Trigeminal Neuralgia and Bell's Palsy

by Michael T. Burcon, DC
Abstract

I currently have 16 Meniere's syndrome, two Parkinson's disease, two Trigeminal neuralgia and two Bell's palsy patients under my care. They all have one thing in common: The atlas vertebra is subluxated posteriorly, which has caused the head to project forward, taking away the healthy curve of the neck.

In each patient, the pelvis has twisted to take pressure off the important nerves in the upper neck and brainstem, causing one leg to appear shorter than the other; normal lumbar curvature is compromised; and finally, if not specifically adjusted, the patient compensates by developing an exaggerated curve in the thoracic spine.

I hypothesize that in each patient, kink(s) in the neck inhibited the normal flow of cerebrospinal fluid out of the skull and down the spine; this created excess pressure in the fourth ventricle, causing abnormal function of some of the structures in the midbrain. It also inhibited the flow of blood into the occipital area of the brain by kinking one of the vertebral arteries. Additionally, I suggest that the posterior atlas irritated the anterolateral aspect of the brainstem, irritating any combination of the bottom seven cranial nerves.

All 22 patients improved dramatically after one or two adjustments under cervical-specific chiropractic care. When the atlas returns to juxtaposition, the spinal cord relaxes and actually positions itself lower within the spinal column.