Fothergill’s Disease (FD) also known as Trigeminal Neuralgia is characterized by paroxysmal attacks of severe, sharp, stabbing, electric shock-like pain affecting one side of face mainly second and third divisions of it. It can be triggered by chewing, speaking, and cold winds. Most of the time patients with FD or TN showed partially or refractory responsiveness to drug therapy or surgery for relief of pain. Hardly any studies have reported the role of physical therapy in Fothergill’s Disease or Trigeminal Neuralgia.
The present study was conducted on 5 (M:F=1:4) patients of FD/TN with age being above 40 years. They were referred to the Neuro-Physiotherapy Department from the Department of ENT and Dental over a period of one year in India.
The result of this study showed a significant decrease in pain with the VAS score or visual analog scale. The significant decrease in the BIP- Facial Scale indicates that there was an improvement in their functional activities, in quality of life, physical and emotional functions.
Obvious limitations of this study included the research design itself in the form of pilot study that limits generalization of the concepts to other individuals with similar problems and short-term follow up of only four weeks and only 5 subjects were used. It is recommended to perform similar studies with a larger sample with long-term follow up.
Here was the proposed treatment to help relieve the severity of symptoms with trigeminal neuralgia.
- Patients were treated with continuous Transcutaneous Electrical Nerve Stimulation (TENS) 250 Hz with a pulse of 120 u, for 20 minutes over the path of affected nerve for 5 days a week for 4 weeks. One electrode was placed just before the ear, the other one at the end of the respective nerve. However, placement was adapted to pain referral and to effectiveness whenever necessary.
- To reduce muscle spasm, a hot moist pack was applied on neck and trapezius muscle for 10 minutes, Isometric neck exercises for each side and pain-free neck range of motion exercises (neck flexion, extension, and side-flexion) for five repetitions were given.
- Relaxation techniques, which included deep breathing exercise were performed for 10 minutes. Distraction techniques are also incorporated. Patients were asked to be involved in those activities in which they like to perform instead of sitting and thinking of their pain situations. These activities were asked to be repeated in their home.
- To reduce the hypersensitivity, patients were asked to cover the affected side of their face with a soft cloth or with a cotton pad for 15 minutes per day, which may help in promoting a reduction of the nervous system to the constant afferent input.
- Finally, patients were asked to avoid the use of cold water for drinking and washing their face, use of a scarf to avoid exposure of the face to the cold environment and to avoid eating hard foods and chewing food on the non-affected side.
For those suffering from trigeminal neuralgia, please let us know if this approach provides any relief.
Sincerely,
Mike
References
Is there Any Role of Physiotherapy in Fothergill’s Disease?
Dildip Khanal, Subhash M Khatri and Deepak Anap. J Yoga Phys Ther 2014.
A Survey To Observe The Commonly Used Treatment Protocol For Trigeminal Neuralgia By Physiotherapist Int J Physiother. Vol 3(5), 643-646, October (2016)
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I am a young man and I am 27 years old .. I suffered from triangular nerve pain three years ago and I have used a lot of medications but I have not improved and I would like to try a physical therapy..
what are you recommend me?
I have not found any of that to directly improve the pain of my TN. Similar does help some of my other pain though – neck And back.
Hi, could you please advise me what all the individual settings might be for an empire 300pv would be. My wife’s TGN has come back with a vengeance after laying dormant for almost two years. Thank you Jack
Hi Jack, I am sorry to hear about your wife’s situation. I am not familiar with the Empire 300pv if it is similar to a tens unit based on the study I mentioned in my blog, here are the settings they utilized:
Patients were treated with continuous Transcutaneous Electrical Nerve Stimulation (TENS) 250 Hz with a pulse of 120 u, for 20 minutes over the path of the affected nerve for 5 days a week for 4 weeks. One electrode was placed just before the ear, the other one at the end of the respective nerve. However, placement was adapted to pain referral and to effectiveness whenever necessary.
I hope your wife is able to find some relief. Sincerely, Mike
Hi, I am 23 year old female.. started having pain over my left lower part of face four years back.. a year later I started having flickering sensation below the angle of my mouth which now progressed to twitches.. I have seen many doctors and was treated for TMD.. But wit no relief..
Using hot water and avoiding cold surroundings has decreased the frequency of pain even though mild pain is always present.. but the twitching hasn’t.. it’s there almost everyday..
Could it be trigeminal neuralgia?
I have read that it’s rare below 40 years.. ?
Yes i could be because It has happened to me also n i m just 32 so it can happen any age i guess
Hi Karen
You are wonderful to share this information.
Can you tell me the dosage and brand you use?
Thanks so much
When you write “avoid eating hard foods and chewing on the non- affected side” technically that means avoid eating and chewing, in other words, avoid chewing on the non-affected side. I am assuming you mean, “avoid eating hard food and avoid chewing on the affected side”? Is that correct?
From the article:
Advice
Patients were asked to avoid the use of cold water for drinking and washing their face, use of scarf to avoid exposure of the face to cold environment, avoid eating hard foods, chewing food from non-affected side.
I have shooting pain in tight side of ear and also back side of throat.
This pain is continuous for two years.and I have also tenderness in my tongue far last one year.
Pain of tongue,inside ear and throat in very severe what should I do. becoz I m only 24 years old.plzzz help mee
I have had TN for over 10 years. It comes and goes and has lasted several days at a time.
I was at my wits end when one day a woman at the health food store directed me to Alpha Lipoic Acid.
This has been a God send. When I feel it coming on by a twinge in either ear area I begin taking my ALA and it subsides quickly.
You can take this consistently or just when you begin to feel it coming on.
Obviously I am NOT a Dr. or in the medical field but a long time sufferer of this horrific pain.
Talk to your Dr. and do your research this has given me relief and hope.
Thank you for this information on physical therapy approach and individuals should know that stem cell therapies are also very effective on this.
Where are you located
We have four locations in the Greater Milwaukee area in Wisconsin. Here is a link if needed.
Hello
My father is suffering from trigeminal neuralgia, and the pain triggers regularly in a month or so.
He’s been suffering with this since 2 years.
Please suggest any excercise or anything that can relieve the pain.
Requesting additional clarity, please. If the pain is on the right side, is it recommended to chew on the right or left? Thank you!
I have Trigeminal neuropathy, does Tense work for this as well using the same spots as in the picture?
Thanks a lot!!
thank you for giving me great information