Evidence in Action My Patient Has Facial Pain — What Can I Do to Help ?

The Patient Your patient, a 42-year-old woman, presents to your office complaining of intermittent but severe unilateral facial pain. She describes her pain as " lightning flashes " that follow a path from her right ear to the chin. She first noticed the pain one week prior while brushing her teeth. The painful episodes are becoming more frequent and severe, particularly when chewing, talking, yawning, or brushing her teeth. Her current health history includes infertility treatment and is otherwise unremarkable. Sixteen years ago, your patient was treated for trigeminal neuralgia (TN). At that time, she sought care from a neurologist who prescribed Tegretol (carbamazepine) and her symptoms fully resolved. Until now, she has not experienced a recurrence. Prior to seeking your advice, she consulted with her infertility specialist who advised against taking Tegretol while pursuing an active infertility program. Your patient informs you that she does not want to stop the infertility treatment and asks if chiropractic care can help reduce her pain. The Examination Vital signs are within normal limits. Ears, nose, sinus, mouth, and temporomandibular joint (TMJ) evaluation fails to reveal any significant abnormalities or tenderness. Upper-and lower-extremity sensory, motor, and reflex evaluation is unremarkable. Light palpation along the angle of the right mandible triggers a brief " shooting pain " to the chin and there is significant hypertonicity of the suboccipital and upper-cervical paraspinal musculature, particularly on the right side. Decreased segmental motion in the occiput and upper-cervical region is noted. The Condition Potential sources of facial pain are many and appropriate management depends on identification of the cause of the complaint. Facial pain may have a neurologic origin, such as trigeminal or glossopharyngeal neuralgia, multiple sclerosis, or shingles. It may also be associated with various disorders of the teeth, TMJ, sinus, or musculoskeletal structures. 1 Based on your evaluation, you suspect this patient is experiencing a recurrence of trigeminal neuralgia. Because of the musculoskeletal findings (joint restriction, paraspinal hypertonicity), should you assume that chiropractic care has the potential to help this patient? You may wonder if this is wishful thinking or if there is evidence to support this thought. Where do you go to find evidence? PubMed is an excellent online resource for health care providers and a great place to search for articles evaluating chiropractic care of trigeminal neuralgia. Searching with the key words, trigeminal neuralgia AND chiropractic, or with trigeminal neuralgia AND manual therapy, …