Background & Aims

Diagnosing and treating facial pain, esp. Trigeminal Neuralgia and Trigeminopathies, are real challenges to pain therapists. Established techniques from Acupuncture and from Naturopathic Medicine can become valuable tools in caring for those patients in a University Hospital outpatient clinic.

Methods

The well established “Very Point Technique“ (VPT), developed by Gleditsch¹ for localizing acupuncture points in ear acupuncture, investigates skin areas by applying quick and gentle uniform strikes , perpendicularly to structures of interest, using an acupuncture needle (for small areas) or cotton swabs (larger sites); changing sensation (by the patient) , and/or triggering a blink reflex ²·³ (a component of the startle reflex ), and/or hooking needle movement, to find an active acu-point.
Application of Capsaicin has been a longstanding method of Counter-Irritation in Naturopathic Medicine, now being explained by acting on the capsaicin receptor (vanilloid subfamily member TRPV1), by selectively stimulating and in high doses defunctionalizing C-fibre mediated chemonociceptors. ?

Results

Case: A 53yr old female patient with ‘trigeminal neuralgia‘TN (co-morbidity MS =Multiple Sclerosis) was referred the Outpatient Pain Clinic to get “bridging treatment“ before operation (Janetta-OP). VPT-investigation revealed a patchy area of allodynia with irregular border, only partially corresponding with the typical trigeminal nerve area (2nd branch). Having thus shown more centrally mediated trigeminopathy, a local counter-irritating procedure on the facial area of interest (application of capsaicin-8%-medicated-patch-treatment), together with optimizing jaw alignment (dentistry) , resulted in first time sensitivity to (low dose) anticonvulsants; without pain, only minor dysaesthesias remained. (A relapse by dental procedure was controlled by adding dronabinol.) The corresponding “MS-typical“ sign (infratentorial lesion at the exit point oft the trigeminal nerve) presented on the cMRI not before 2 months later, and progress of MS was controlled by anti-MS specific therapy.

Conclusions

The VPT (“Very Point Technique“), derived from ear acupuncture, is a established, simple, inexpensive, and easy to learn and to apply neurophsiological test for everyday pain clinic practise when caring for patients with neuropathic facial pain.
Locally applying high-dose capsaicin to the region of interest can be a valuable Counterirritation-Method derived from Naturopathic Medicine, resulting in Peripheral Desensitization ; this might be decisive for conventional medical treatment to become effective .

References

1 – Gleditsch J, The “very point“ Technique: a needle based point detection method;
Acupuncture in Medicine (aim.bmj) May 1995, 13(1) 20-21
2 – Pearce JM, Observations on the Blink Reflex, EurNeurol 2008;59(3-4):221-3
3 – Brooks JM, Jardim MR, There is still a role fort he Blink Reflex in the Diagnosis and Follow-up of Multple Sclerosis ; Clin Neurophysiol. 2015 Apr; 126(4): 126(4): 743-7
4 – Abdel-Salam OME, Capsaicin, The Vanilloid Receptor TRPV1 Agonist in Neuroprotection: Mechanisms Involved and Significance
Review, Neurochem Res. 2023 Nov;48(11):3296-3315
doi: 10.1007/s11064-023-03983-z. Epub 2023 Jul 26.

Presenting Author

Ute Kock

Poster Authors

Ute Kock

Dr. med.

Medical University of Vienna

Lead Author

E-mail

Topics

  • Treatment/Management: Complementary and Alternative therapies