Upper
Cervical Chiropractic Management Of Trigeminal Neuralgia:
A Series Of Case Reports.
Joseph
J Ierano B.Sc., D.C.
Proc.
WFC Congress, Sydney, Australia 2005. p291.
Click here to view PDF poster of this
study
Abstract
Introduction:
Trigeminal Neuralgia (TN) is a debilitating facial pain
condition with an uncertain aetiology, though it has
established criteria for diagnosis. Upper cervical spinal
kinematic dysfunction has been implicated; in particular,
the chiropractic neuro-musculo-skeletal (NMS) based
subluxation hypothesis. Clinical observation supports this,
particularly chiropractors claiming to normalise functional
capacity of the upper cervical joint complex. However, no
extensive scientific data on these observations exists,
excepting specific case reports, and the fact that close
anatomical relationship exists between Trigeminal nerves
and the cervical spine.
Subjects within this group demonstrated various levels of
prior intervention - pharmacological, surgical,
complementary - including other forms of chiropractic
technique. Goals of this study were to assess change in
pain perception with diagnosed chronic TN over the course
of 16 chiropractic visits, and any change in medication
dependency or functional capacity.
Methods:
Three patients were sourced from the Sydney Support Group
of the Trigeminal Neuralgia Association of Australia, two
others were referrals to this authors' office. They were
placed on a program of chiropractic care if they met
established criteria of TN diagnosis, and protocols
pertaining to Atlas Orthogonal Chiropractic (AOC) spinal
adjustment procedures. That is, the patient had to exhibit
concurrent upper cervical spinal kinematic dysfunction to
be included.
Outcome measures included pre and post adjustment
radiographs and McGill and Visual Pain scales. Correction
of upper cervical mal-alignment used vectors calculated via
sagittal, frontal and horizontal plane radiographic views.
Vectors were then applied to the side-lying patient at the
level designated to be in line with the atlas transverse
process on the superior side of atlas tilt, using a
low-force and amplitude percussion atlas adjusting
instrument.
Adjustments were performed until rectification of atlas
mal-alignment was corrected according to AOC subluxation
diagnostic protocols, being:
• static sub-occipital palpatory pain improvement of
neuromuscular structures and digitally palpable tissue
compliance changes
• visual evidence of improvement of postural supine leg
length inequality
• structural/postural realignment toward orthogonal of the
cranio-cervical junction, measured on radiographs
• analysis of symptomatic changes reported via the
patient
A maximum of 16 visits were conducted, depending on need
for adjustment. Case 2 discontinued at visit nine and case
5 has only needed 11 visits in one year.
Results:
All but one patient reported decreased pain values.
However, they did report other functional improvements such
as neck pain reduction. The majority of subjects displayed
no complete cessation of perceived TN pain, but decreased
medication dosages were recorded. Subjective reports and
objective findings of NMS related improvements are also
discussed (See "outcomes" shown here) indicate that in all
cases the cranio-cervical relationship resembled a more
orthogonal (right angled) relationship. The theory that a
subluxation being reduced to affect pain, posture and
function is therefore explored.
Conclusions:
Four of five subjects in this study demonstrated decreased
perception of pain, which was often directly related to
decreased medication intake. Two experienced complete pain
cessation for the first time in years. The results suggest
a correlation between applied, specific, mechanical vectors
to the upper cervical spine and TN pain. The mechanisms of
action, though widely
hypothesised, are largely unknown. Credible support for a
NMS connection with TN could only be forthcoming with
larger, longer-term studies. Questions on sustained pain
relief and other benefits are also raised.
References:
Sweat RW. Atlas Orthogonal Chiropractic
Program. Seminar Workbook, 2nd Edition. RW
Sweat Foundation, Atlanta GA, USA.
Pederick FO. Cranial and Other Chiropractic Adjustments in
the Conservative Treatment of
Trigeminal Neuralgia: A Case Report. Chiropr J Aust 2005;
35: 9-15.
Hinson R. Chiropractic Management of Trigeminal Neuralgia.
Proc 6th Biennial WFC Con-
gress, May 2001: 295-6
Wood I (Ed). Newsletters of The Trigeminal Neuralgia
Association Ltd. Castle Hill NSW,
Australia.
