Thursday Thoughts: Neuroscience Nugget - Sticks and Stones

I am currently treating a very sweet older lady who was "diagnosed" with Trigeminal Neuralgia.

To make a long story short, her daughter found me on the internet and they made an appointment to see if I could help relieve her pain and improve her function. Upon evaluation she was found to have

• right temporal pain, facial pain
• mandible deviation to the right
• click in the right TMJ
• increase in tone and mild tenderness in the right mandible elevators
• typical forward head posture
• intermittent pain

The first thing I did was tell her what good news intermittent pain is, then I proceeded to explain that her signs and symptoms are consistent more with TMD, which is easily helped with education, avoiding certain activities/positions, and the right movements.

After some light IASTM and joint mobilizations to the TMJ, she felt and moved much better. She was instructed on some mandible protrusion (directional preference for forward head), chewing on both sides as tolerated and some head nods as she was a bit too kyphotic for cervical retractions.

She followed up the next week with 50% decrease in frequency and intensity for several days, then the two days immediately before the follow up she was 100% pain free. One of her first questions was, "What about the Trigeminal Neuralgia?" I told her every time she follows up with her specialist, who insists on medication X, and this diagnosis, to treat it like "Sticks and Stones." I did make sure to tell her that the specialist meant well, but just did not know about these conservative treatments and pain science education. The patient admitted feeling worse about her condition after every follow up, but thinking of the diagnosis label as Sticks and Stones may break may bones, but names will never harm me, meant a lot to her, and she was able to successfully follow up, get a decrease in dosage for doing so well, and not feel worse about the Thought Viruses thrown at her.

Keeping it Eclectic...