Case Study of Trigeminal Neuralgia Using Neurofeedback and Peripheral Biofeedback

Abstract

Introduction. Trigeminal neuralgia is characterized by brief episodes of extremely intense facial pain often radiating down the jaw. These episodes can occur spontaneously or be triggered by light touch, chewing or changes in temperature. The pain can be so intense as to be completely disabling. This case study concerns a 46-year-old nurse with a 15-month history of trigeminal neuralgia. She had been maintained poorly on propoxyphene napsylate/apap100/650 mg (Darvocet-N100) over the previous year. Her neurologist’s next planned intervention was to sever the trigeminal nerve. Method. Over a period of nine months, this client had 10 peripheral biofeedback training sessions (including dynamic EMG biofeedback)and diaphragmatic breathing in conjunction with a program of stress management and counseling. She also received 29 sessions of neurofeedback (including T4, C3, C4, C3-C4 and T3-T4). C3 seemed to be the most effective placement for sleep maintenance issues, and T3-T4 seemed to be the most effective placement for pain issues. Results. The client experienced a substantial reduction in pain and bruxism as well as improvement in sleep quality. Symptom reduction fluctuated with life stress issues and with adjustment in both peripheral and neurofeedback protocols. The success of this treatment allowed the client to avoid radical surgery (severing of the trigeminal nerve) and to discontinue use of propoxyphene napsylate/apap 100/650 mg. In a 13-month follow-up, the client reports having an active lifestyle and  managing her pain quite well on 20 mg of tramadol (Ultram) every 12 hours as long as she uses her self-regulation techniques. Conclusion. This case study suggests that a multi-modal approach of neurofeedback, peripheral biofeedback, stress management, and counseling was clinically efficacious in treating the symptoms of this difficult and painful condition.