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Title: Using Pulsed Radiofrequency (PRF) Of Mandibular And Maxillary Nerve Followed By Ultrasound Guided Dry Needling (USGDN) Of Masticatory Muscles With The Premise That Trigeminal Neuralgia (TGN) Is Actually A Neuro-Myalgia.
e-poster Number: INSIM107
Category: Pain
Author Name: Dr. Jhanvi Vora-Hemani
Institute: Ashirvad Institute for Pain Management and Research
Co-Author Name: Dr. Lakshmi Vas, Dr. Ankush Dipak Wasnik, Dr. Khyati Ramesh Patel
Abstract :
Introduction: The pain in Trigeminal Neuralgia (TGN) is unilateral, severe, lancinating and limited to the area of distribution of the trigeminal nerve. Medications form the first line of TGN therapy. Interventional options including percutaneous radiofrequency (RF) ablation, rhizotomy, and microvascular decompression are considered second line. This case series of 25 patients shows that there is a major myofascial contribution to TGN pain from the masticatory muscles.
Aims & Objectives: To prove that pain experienced in TGN arises not only due to abnormal neural activity of the nerve but also due to the resultant electrochemical abnormality at the end plate which eventually leads to the generation of myofascial trigger points (MTrPs) in the masticatory muscles supplied by the nerve.
Treatment was initiated with PRF of the terminal branches of trigeminal nerve followed by USGDN of muscles 15 days after PRF to achieve complete remission and withdrawal from medications.
Material & Methods: Pain scores, frequency of shocks, pain in between attacks and SF-36 was noted before treatment, immediately after Pulsed radiofrequency, 15 days post PRF and then after 10 sessions of USGDN of muscles of mastication.
Results: Reduction in all the parameters of pain before and after USGDN was statistically significant.
Conclusion: Trigeminal neuralgia is neuro-myalgia where complete relief can be achieved only after addressing the muscle as well as the nerve with a less invasive and safer intervention like PRF+USGDN rather than the Thermal RF ablation which is presently practiced. It proved to be a conservative yet highly effective treatment.
