Quick Case: Laser Therapy for Trigeminal Neuralgia

By: Dr. J. Gnanaraj, H.Charles Richard M.P.T. and Dr. Sunitha Gadudasu

Trigeminal Neuralgia is a condition that can cause excruciating pain and could be very debilitating because of the chronic nature [1]. The pressure on the nerve is considered the cause of the pain and conventional medicines try to offer pain relief, ablation or decompression. We describe the use of successful laser therapy.

CASE REPORT

Mrs. J is a 42-year-old housewife who was diagnosed to have Trigeminal Neuralgia a few months after she developed severe pain on the right side of the face. The progressive pain interfered with her daily activities like brushing, washing the face, etc. She was referred to NIMHANS in Bangalore where she was diagnosed as having Trigeminal Neuralgia. This was in 2014 and she was on regular medication since then without significant relief. She was advised surgical treatment and hence she presented to our center. By the time, she presented, she was on the maximum dose of the medicines and the side effects.

At presentation, her VAS [Visual Analogue Scale] pain score was 8 [2]. She received treatment with laser at 4 Joules per cm square for 5 minutes a day and received only T. Carbamazepine at the reduced dose of 200 mg three times a day. She started improving after two days of treatment and after a week was painless and said that she could bathe first time after 2 years. Her VAS score has almost come down to 0.

DISCUSSION

The damage to the protective coating of the nerves exposes the nerves and causes pain with the trigger. It is usually a sharp, strong, shooting type of short lived pain set off by the trigger. The anticonvulsants work by decreasing the nerve stimulus while painkillers can decrease the pain. The decompressive surgical procedures aim to decrease the swelling around the nerve.

The laser treatment works by decreasing the edema and may be the neural output from the nerve. The short-term effect is a dramatic improvement. The long-term results are awaited.

Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.

H.Charles Richard M.P.T. (ORTHO), M.I.A.P Physiotherapist at the SEESHA Karunya rural community hospital in the Karunya University campus, Coimbatore: The department specializes in treating a variety of sports injuries and has weight reduction programs.

Dr. Sunitha Gadudasu is currently working as a Dental Surgeon at Seesha Karunya community Hospital, Coimbatore, Tamil Nadu. She graduated from TN MGR University, Chennai ‐Tamilnadu. She is also certified in rotary endodontics from International Academy of Rotary Endodontics, USA. She also completed her M.B.A. (Hospital Administration).