Facial Pain and Trigeminal Neuralgia: Pain Management Options

October 21, 2013June 24, 2014 / Thomas Cohn, MD

Trigeminal neuralgia is a condition that causes facial pain. The trigeminal nerves or nucleus (their origin) send signals of severe pain to the brain. The symptoms are often severe stabbing pain or electrical shocks. Pain is on the side of the face, usually always one side, and comes in episodes. The frequency and length of attacks is variable. It can occur at any age, but is more common in those older than 50, and has multiple causes and treatments.

Causes of Trigeminal Neuralgia

Causes of trigeminal neuralgia are numerous. It can be related to a variety of neuropathies, including multiple sclerosis and diabetes. Vascular changes can cause pressure on the trigeminal nucleus and pain, and tumors can also affect the nerves. In most cases, the cause is often not found, and may be a spontaneous problem, possibly due to a previous infection.

The main characteristic of trigeminal neuralgia is facial pain. If a cause can be found, such as vascular compression or tumor, neurosurgical correction sometimes can lead to a cure. However, in many cases, nothing can be found on diagnostic tests. Treatment then is focused on management of pain symptoms and diminishing activities that irritate the region.

Facial Pain Management

Medication management is often the first line of treatment of trigeminal neuralgia. Neuropathic medications are very effective for this condition. The most common of these medications are drugs used for seizures. It is often a trial and error method used to find the right medication and limit side affects. Neurologists are often the first physicians managing the problems since they are experts in the diagnosis of nerve issues, and have extensive experience with prescribing these medications.

If the pain is not readily controlled with medications, a segment of those with trigeminal neuralgia are referred to a pain specialist. The trigeminal nerve can be blocked and settled down with local anesthetic and steroid injections in some patients. When injections work, relief can be almost instantaneous and put a patient in remission for months at a time. If the relief is not prolonged but good, then ablation/destruction of the trigeminal nerve may also be effective. The nerve can be abated several ways, including by a radiofrequency needle technique, special radiation, or surgery.

Good sources of additional reliable information on trigeminal neuralgia can be found through Mayo Clinic and the National Institutes of Health.

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Yoga and Pain Relief

September 25, 2013June 24, 2014 / Thomas Cohn, MD

Note: this is a guest post by yoga instructor, Lynn Shuck.

As a yoga instructor, I’m expected to say that yoga can relieve pain. And I truly believe it can. But I do urge caution when approaching yoga for pain relief because, in fact, a class that moves too fast, or an instructor who pushes you beyond your limits can actually cause pain rather than relieve it. With good instruction and personal attention, yoga can most decidedly help with pain relief by bringing the muscles and skeleton into their natural balance.

It’s All About Skeletal Alignment

When the skeleton is aligned, the muscles work in tandem the way they are intended. If some muscles get overworked through habitual movement patterns, other muscles will stop doing their jobs and weaken. Those tight muscles can bring the skeleton out of alignment (picture the person who sits at a computer all day and becomes hunched over, chin thrust forward). If those patterns are repeated on the yoga mat, tight muscles will just continue to overwork and the skeleton will not be supported any differently than it already is.

Imbalance can also occur starting with the skeleton. Shin bones that bow back affect everything above the legs, tipping the thighs and pelvis out of alignment, which then impacts the spine. A broken bone that doesn’t heal correctly or an accident that impacts any part of the skeleton will invariably affect the way the muscles work as well. If the skeleton isn’t upright, muscles will do their best to hold up the body any way they can.

Fixing Imbalances

As an Eischens Yoga instructor and yoga therapist, I look for imbalances such as:

Tight, overly developed muscles
Bones that don’t stack properly
Collapsed or locked joints
Constriction in the breath

When a student wants to use yoga for pain relief, my intention is to keep the body from going further out of balance. Often, using simple, easily accessible asanas, we can bring the body back to better alignment – thus reducing pain and tension.

Uttanasana

As an example, Uttanasana is a simple forward fold commonly taught in most classes. Sometimes, hip and low back pain can be addressed using this pose. If I observe thighbones that sit too far away from the mid-line of the body, I might have the client roll up a towel to about 2 or 3” wide. They would place the roll between the legs at the top of the thighs near the groin. Pressing firmly into the towel at the top of the thighs without rolling onto the inside edges of the feet, I will then have the client perform Uttanasana, moving down and up in a limited range of motion several times, continually pressing into the towel. When finished, the legs will usually come into better positioning in the hip sockets reducing hip and back pain momentarily. The more regularly these muscles are used to re-align the thighbones, the longer the body will maintain this new positioning. I refer to this as using effort in the pose to create effortlessness after the pose.

Utilizing yoga for pain relief requires understanding the physical imbalances, and then using asana to bring the body back into balance. Practicing yoga without awareness may well be counter-productive, so find a teacher who specializes in pain relief and then trust your own experience. Yoga shouldn’t hurt; it should make you feel better.

Author Bio:

Lynn Shuck is a certified Eischens Yoga Instructor. She has been practicing yoga for nearly 25 years, and has been teaching yoga since 1996. Her training with Roger Eischens led her to work specifically with alignment as well as injury recovery/prevention. From 1998 to 2011, she led workshops and classes throughout the Detroit metro-area. Lynn is known for her keen eye for individual movement patterns, as well as her ability to bring yoga to all kinds of people: experienced and beginning yogis, athletes, weekend warriors, and those who think they are too stiff for yoga. Lynn relocated to Minnesota in 2011.

Phantom Limb Pain: Causes & Pain Management

September 18, 2013September 27, 2016 / Thomas Cohn, MD

Phantom limb pain is pain that is thought to be coming from a body part that no longer exists, such as an amputated foot. People often report phantom limb in amputated legs or arms, but it can also come from breasts, eyes, or other body parts that no longer exist.

These phantom pains come on shortly after the body part has been removed, usually within days. The sensations are very unpleasant and can include feelings of:

Stabbing
Burning
Throbbing

What Causes Phantom Limb Pain?

The cause of phantom limb pain is unclear. The distal pain receptors that were located in the absent body part are gone. The nerves that carry the signals to the brain however, are usually still present and so are all the connections in the brain. The wiring in the spinal cord and the brain are extremely important, since normally there are many signals impacting these nerves that allow the body to properly interpret the meaning of the signals.

When a limb is amputated, only a small portion of the wiring is destroyed. The last part of the connections to the limb and the rest of the wiring remain intact. The brain is still able to receive signals. As a result, the sensory receptive circuits send short-circuited messages of incorrect data. A sensory signal somewhere in the body starts activating the wires that once lead from the amputated body part. Once they reach the spinal cord, the sensory nerves have many interconnections. These interconnections are intact despite the amputation and can continue to transmit signals. The brain can now receive these interconnection type signals, and the brain may perceive these signals incorrectly as “phantom” pain.

Phantom pain does not occur with every amputation. There are several factors that can increase the risk of phantom limb pain:

Severe pain in the region prior to the amputation.
Pain in the stump following the amputation.
A poor fitting artificial limb

Treatment of Phantom Pain

Treatment of phantom limb pain is complex, involving a combination of any of the following:

Modalities
Physical therapy to decrease the sensitivity of the residual limb and to train a person to use remaining skills to overcome the impairment.
Prosthesis
Medications, especially neuropathic drugs and analgesics. Neuropathic medications are drugs that decrease the firing rate of neurons and thus the pain.
Injections can also be used to block nerves remaining in the residual limb.

Limb management after amputation is often coordinated by a Physical Medicine and Rehabilitation specialist. These physicians are musculoskeletal experts with extensive training in management of amputations, from medication management to coordinating the team of providers involved in the complex care of these patients. If phantom pain is a problem after an amputation, an experienced Physical Medicine pain physician may be the expert needed to help coordinate the pain management.

Have you experienced phantom limb pain? We’d love to hear your story in the comments section.

Do Women Feel More Pain than Men?

September 11, 2013September 27, 2016 / Thomas Cohn, MD

Over the past few years, some studies have contended that women report more pain intensity than men. But there is no definitive answer to the question of whether or not women feel more pain than men.

Women may report more pain than men, but women are also generally more likely to go to the doctor for medical problems. For many men there is a stigma attached to seeing a doctor for pain – many would prefer to “tough it out.” One of the most common reasons people go to the doctor is pain. Since women tend to report their problems more than men, it’s easy to assert that women feel more pain than men.

Everyone Feels Pain Differently

However, this connection may be correlation, not causation. In practice, pain is very subjective, and every person describes his or her pain differently. By definition, pain is an unpleasant sensory or emotional experience associated with actual or potential tissue damage. The regions of the brain responsible for perception of pain are right next to critical emotional areas of the brain. For any painful condition, every person will report a different experience. As a result, it is impossible to compare men to women in their perception of pain.

To make sense of this oft-debated topic, we can make a few general statements about men, women, and how they feel pain:

Women go to the doctor more often than men,
Women tend to report their emotions more readily than men.

Since pain is subjective, each situation is unique and different and cannot be compared. Some people tend to hide their pain and emotions, while others want everyone to know their problems.

Do Men Feel More Pain than Women?

While some believe women feel more pain than men, others assert that women are much tougher than men, since no man has ever given birth. Again, the truth is that some people are tough and just grin and bear it while others scream every time they stub a toe. Men may be slightly more stoic at times, but once they have pain, they are usually no different than women.

4 Types of Pain after a Car Accident (and Treatment Options)

September 3, 2013June 24, 2014 / Thomas Cohn, MD

Car accidents nearly always result in injury. These injuries can be mild to severe, but most often cause some form of pain. Here are some of the most common forms of pain that occur after a car accident and pain management options for each:

Neck pain from whiplash. Whiplash is perhaps the most common injuries sustained as a result of a car accident. It can result from the most catastrophic wreck, or the smallest parking lot fender bender. It occurs during accidents when the vehicle impact jerks the head around so much so that the neck over or hyper extends. Whiplash can cause neck pain, stiffness, and headaches. Often, people with whiplash do not feel symptoms until well after the accident.
Back pain from a herniated or bulging disc. Similar to neck injuries and whiplash, the spinal cord can sustain injury due to the violent jerking motions associated with many car collisions. The bones in your spine are cushioned by discs. During a car crash, these discs can slip out of place and cause pain. Read more about herniated discs.
Head pain due to Concussion. It is common for people in car accidents to hit their head on the steering wheel, headrest, or vehicle interior. If the head is hit hard enough it can become concussed – resulting in headaches, confusion, and loss of consciousness.
Leg, ankle, foot pain. In more severe car collisions, when there is substantial structural damage to the vehicle, injuries to the lower extremities can occur. These can range from slight sprains, to broken bones. Pain from these injuries also ranges greatly depending on the extend of the damage.

Pain Management Options

Whiplash. Treatment options can include a judicial use of NSAIDs, physical therapy, and use of a neck brace.
Spine injuries. Back pain from spinal injuries can be managed with medications, physical therapy, and injections.
Concussion. If you think you may have a concussion it is important to seek medical help immediately. Concussion severity can range greatly. Slighter concussions should be treated with simple rest. More severe concussions can have a negative impact on your memory and reflexes. In the most extreme cases hospitalization may be required.
Leg pain. Again, treatment options largely depend on the injury sustained, but generally the RICE method is the first option for treatment. Physical therapy or surgery may be required with more severe injuries.

Car accidents are common occurrences that can result in a number of painful injuries. If you are still dealing with pain from a previous car accident, talk to your physician about a pain management plan that can help you back to a pain free life.