Homoeopathy Shoots the Shooting Pain

[A Case of Trigeminal Neuralgia treated at Ber sarai Dispensary]Dr Pawan Goel, Chief Medical Officer(H), Ber Sarai Dispensarydrpawangoel@yahoo.co.inABSTRACTTrigeminal neuralgia is rare but one of the most annoying medical condition affecting mostly people of 50 years of age and above presenting with severe facial pain ,needs medical and surgical intervention depending upon the case.A diagnosed case of TN treated at Ber Sarai Dispensary with Homoeopathic remedy Natrum Mur in span of approx one year the frequency and intensity of the neuralgic pains reduces drastically ,with overall improvement in general condition of patient.KEY WORDSTrigeminal neuralgia,natrum mur ,homoeopathy,syphilitic miasm,

INTRODUCTION

Trigeminal neuralgiaaneuropathicdisorder illustrated by episodes(periodic or non periodic) of intensepainin the face. The clinical association between TN andhemifacial spasmis the so-calledtic douloureux. The pain generally felt in the ear, eye, lips, nose, scalp, forehead, cheeks, teeth, or jaw and side of the face. DEMOGRAPHY

TN is a rare disease.TN occurs most often in people over age 50, and the average for women is slightly higher than for men.TRIGEMINAL NERVE AND ITS TRIBUTARIES CLINICAL CORRELATION

The pain of TN is from thetrigeminal nerve. The trigeminal nerve is a pairedcranial nervethat has three major branches:

theophthalmic nerve(V1),

themaxillary nerve(V2),

themandibular nerve(V3)

. One, two, or all three branches of the nerve may be affected. 1012% of cases occur on both sides of the face. Trigeminal neuralgia most commonly involves the middle branch (themaxillary nerveor V2) and lower branch (mandibular nerveor V3) of the trigeminal nerve.

ETIOLOGY 1. Pressure exerted by the underlying blood vessel on the trigeminal nerve and the tributaries2. Mechanical damage to the nerve by dental procedure,infections3. Over time, changes in the blood vessels of the brain can result in blood vessels rubbing against the Trigeminal Nerve Root.4. Aging leading to the demyelination of the nerve ,multiple sclerosis.5. Rarely present with the tumour of the nerve GRADATION OF PRESENTATION

S NOTN1TN2

1typical or classic formatypical form

2extreme, sporadic, sudden burning or shock-like facial pain in the areas of the face where the branches of the nerve are distributed lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw.aching, burning, stabbing pain

3Higher intensityLower intensity

4These attacks can occur in quick succession, in volleys lasting as long as two hours

Lesser duration

Both forms of pain may occur in the same person, sometimes at the same time.

CLINICAL PICTURE

Trigeminal neuralgia symptoms may include one or more of these patterns:1. Episodes of severe, shooting facial pain that may feel like an electric shock2. continuous attacks of facial pain or attacks triggered by things such as touching the face, chewing, speaking and brushing teeth3.episodes of facial pain lasting from a few seconds to several seconds4. Episodes of several attacks lasting days, weeks, months or longer some people have periods when they experience no pain5. Pain in areas supplied by the trigeminal nerve (nerve branches), including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead6. Pain affecting only one side of face.7. Pain focused in one spot or spread in a wider pattern 8. Attacks becoming more frequent and intense over timeTRIGGERSOF TRIGEMINAL NEURALGIAA variety of triggers may set off the pain of trigeminal neuralgia, including:-- Shaving---Touching face--- Having food --- Drinking--- Brushing your teeth

---. Talking--- Putting on makeup--- Facing breeze directly on face----SmilingDIAGNOSIS

TN diagnosis is based primarily on the persons history and pattern of symptoms description of pain, including the:1. Type. Pain related to trigeminal neuralgia is sudden, shock-like and brief.2. Location. The parts of face that are affected will tell the doctor if the trigeminal nerve is involved., along with results from physical and neurological examinations.

Tests used to confirm the diagnosis 1. A neurological examination. Touching and examining parts of face can help the doctor determine exactly where the pain is occurring and if appear to have trigeminal neuralgia which branches of the trigeminal nerve may be affected.2. Magnetic resonance imaging (MRI). An MRI scan of your head can show if multiple sclerosis is causing trigeminal neuralgia.

TRIGEMINAL NEURALGIA TREATMENTtrigeminal neuralgia treatment generally starts with suitable medications and general managements includes the maximum possible avoidance of triggering factors

Interventions are required at:Status quo with medication, Side effects of medications ,Finding of life threatening underlying pathology like tumors

Case at Ber Sarai Homoeopathic Dispensary I present a case of trigeminal neuralgia that defines the need of rational integration of ayush (homoeopathy in this case) with modern system of medicines so that patient is ultimately benefitted of her sufferings .

Mrs usha age 65yrs resident of saket visited ber sarai homoeopathic dispensary in middle of september 2014 for her sufferings of trigeminal neuralgia after getting treatment from AIIMS in medicine as well as in the dept of neurosurgery.The presenting complaints were severe shooting pain radiates from lower end of left ear to the jaw and settle in the teeth,along the left side of face much tingling and burning with excessive lacrimation ,Facial pain worse by touch with intolerance of heat and chewing .Headache in the morn that persists whole day with slight relief in even after sleep .

Observation: woman of medium build with earthy complexion, waxy anxious face

Past history and family history NSTreatment history Oxydol 300 mg tds from AIIMS med opd with no relief ,Gamma knife at vimhans, Surgery at AIIMS :decompression of trigeminal loop (L) done .

Generals

Appetite: increased ravenous ,relish food sometime without appetite

Thirst: increased for large quantities of water Desire foods having large quantities of saltAversion bread fatty foodSleep sleepy in noon with relief of headache after short bouts of sleepSweat on slight exertion with occasional yellow staining Thermal reaction cannot tolerate heat feels better walking in fresh air.Mind and thinking patient was very much anxious of her health and she was doubtful of her recovery,excessive thinking of her disease made her worse ,consolation aggravates her in general

Analysis:Case on the basis of symptomatology suggested anti syphilitic remedy for the treatment .Rubrics taken for reference purpose from synthesis repertory like

Hypochondrisis ( so marked in patient that sometime she used to said pl doc give her something for sos and her friend is taking bell and cimicifuga so I have to write for her satisfaction and eventually gave saclac )consolation agg

face pain stitching left side

shooting left side

from perspiration :weakness Prescription and Follow UpS NODATESYMTOMATOLOGY/

BASIS OF PRESCRIPTIONFOLLOW UP

I-INTENSITYOF PAIN

F-FREQUENCY OF PAIN

A-ALLOPATHIC DOSAGE RX

119/9/2014Left Sided Trigeminal Neuralgia WithShooting PainLacrimation

Aggravation TouchChewing

Heat Intolerance Headache Agg Morn Relieved By SleepEarthy Complexion Oily As IfGreased

Nat Mur 30 Td S For 4 Days Sl 30 For 2 Wks

223/9/2014I -SAME

F -REDUCED BY 30-40%

A OXYTOL 300 ADV TO REDUCED FROM TDS TO OD

AMLONG 25OD TO CONTINUE

SL 30 TDS FOR 1 MONTH

325/10/2015Headache BetterLacrimation Stopped

I- SAME

F-REDUCED BY 70 % APPROX

A-SAME AS ABOVESL 30 TDS FOR 6 WKS

431/1/2015Headache ReappearNeuralgic Pain Same As In Beginning Detailed Case With Mentals And Physical Gen Prescribed On The Totality Of Symptoms

Nat mur 200

3 doses empty stomach

Adv To Stop Allopathic Med And Suggested For Follow Up In Case Of Severe Complications

528/2/2015I REDUCED

F REDUCED BY 80%

A- STOPPED

67/4/2015GC BETTER I- REDUCED BY 80%

F- REDUCED BY MORE THAN 80%

A-STOPPED SL 30 BD FOR 1 MONTH

76/6/2015Symptoms Subsides Completely INTENSITY AND FREQUENCY OF PAIN REDUCED DRASTICALLY SL 30 OD FOR 6 WKS

Result and conclusion: Patient was suffering from trigeminal neuralgia on account of loop formation along the course of trigeminal nerve. Surgery was done for decompression and allopathic medicines were prescribed to patient . Symptoms in response to triggering factors were persistent even after surgery and with modern medicine .Homoeopathic medicine was prescribed on the basis of totality of the case considering the character of the pain and general features .There is much reduction in the intensity and frequency of the episodes of neuralgic pain and reduction in the dosage of allopathic drugs thus reducing the drug dependency defining the need of rational integration of modern medicine and procedure with the AYUSH (homoeopathic in this case) for the service of mankind as in this case obstacle to recovery was removed by surgery ,acute phase was covered by allopathic medicines and with aid of homoeopathic medicines allopathic medicines were tapered off.References: http://www.livewellpainclinic.com/trigeminal_neuralgia.aspxhttps://en.wikipedia.org/wiki/Trigeminal_neuralgiahttp://fpa-support.org/trigeminal-neuralgiaWilliam boericke ,pocket manual of homoeopathic material medica &repertory,B Jain publisher(p) LTD ,9 th edition

Dr Frederik Schroyens ,Synthesis repertory ,homoeopathic publishers London ,edition 7.1Annexure: