Question: x I have been practicing facial acupuncture for five years, and love treating my patients for their beauty and health conditions. I have a patient presenting with nerve-related face pain and numbness, and am having difficulty getting significant results. Can you give me advice as to what to do?
Recently I was able to help a patient recover from trigeminal neuropathy utilizing acupuncture, instrument-assisted acupressure, and several ancillary modalities. Perhaps sharing her case study will provide the insight you are seeking.
Patient Information / Presenting Concerns
My patient was a 48-year-old, Caucasian female. Her chief complaint was trigeminal nerve pain on the left side of her face. Her pain began three years ago with periodic episodes of pain on the left side of her face, along the trajectory of the left trigeminal nerve. Two months before seeking acupuncture treatment, her pain became chronic with no intermittent relief. She also developed facial numbness and swelling across the entire left side of her face.
Prior to acupuncture therapy, my patient consulted a dentist, an ENT specialist, a neurologist and a neurosurgeon. After a CAT scan and MRI, her neurologist and neurosurgeon concluded she was suffering from trigeminal neuralgia. The treatment recommendation was microvascular decompression (MVD).
One week prior to surgery, the neurologist and neurosurgeon amended their diagnosis from trigeminal neuralgia to trigeminal neuropathy. As MVD is indicated for trigeminal neuralgia, but not trigeminal neuropathy, the surgery was cancelled. Having been successfully treated with acupuncture for a previous unrelated situation, she contacted me regarding her current medical condition.
Upon her initial visit, her Visual Analogue Scale (VAS) (0 = no pain, 10 = extreme pain) was 10. Her Measure Yourself Medical Outcome Profile (MYMOP) for facial pain (0= no pain, 6 = extreme pain) was so severe she recorded her pain level as 8. She also complained of lack of energy / fatigue. Her MYMOP rating (0 = no loss of energy/fatigue, 6 = extreme loss of energy / fatigue) was 5.
She stated her trigeminal pain interfered in all aspects of her life (ability to work, care for her family, exercise, and social life). MYMOP report (0 = no impairment, 6 = maximum impairment) for these activities was 6.
She reported being an active person prior to her condition. She worked 40-50 hours/week, exercised regularly, and enjoyed time with her husband, children and friends. Since the onset of her illness, her exercise regime and other activities had significantly decreased. Her pain interfered with her ability to perform her work, enjoy her family, and social life. Although she did not like the idea of relying on medication for her pain relief, she took gabapentin, dosed as needed.
My patient reported being in good health except for allergies to dust and pollen. She had no history of diabetes, high blood pressure, head injuries, infections, stroke, or brain tumors. She also admitted that although her diet was healthy, she enjoyed a cup of coffee in the morning, a cup of black tea in the afternoon, and 1-2 glasses of wine with dinner.
Her bowels were normal. Her sleep was interrupted due to her facial pain. In spite of her condition, she had a healthy attitude about life and believed she would recover from her illness.
Upon palpation, the left side of her face felt extremely tight, swollen and inflamed. During palpation, she reported superficial numbness of the forehead, cheek and jaw area. Upon visual inspection, her left eye was red and irritated. She also had facial asymmetry with left-side facial contortion. Her tongue was dark and quivering, with a pointed, red tip. Her pulse was overall thin and wiry, and deep in the kidney yin / yang positions.
Diagnostic Assessment and Therapeutic Intervention
Upon completion of intake, I concluded her pattern of disharmony was related to internal wind with qi and blood deficiency and stagnation. Treatment strategy was designed to resolve internal wind, and build and move qi and blood. Treatment protocol included facial cupping, acupuncture, instrument-assisted acupressure, microcurrent (sub-sensory mild e-stimulation), and LED (low-level light therapy).
My patient received two treatments within 48 hours. Both treatments began with light face cupping to improve tissue circulation and lymphatic drainage, followed by sub-sensory microcurrent (400 microamps) to improve motor coordination.
Body acupuncture was then applied to resolve the TCM root cause, followed by local points to harmonize the trigeminal nerve and face pain. LED light therapy was applied over the acupuncture needles on the face to reduce pain, decrease inflammation, promote tissue healing, and enhance the effectiveness of the acupuncture treatment.
Although the specific acupuncture point prescription varied with each treatment, a combination of the following points was used:
- Distal points: Taixi (K 3), Xingjian (LV 2), Taichong (LV 3), Qiuxu (GB 40), Neiting (ST 44), Xuehai (SP 10), Sanjian (LI 3), Hegu (LI 4), Shousanli (LI 10), and Quchi (LI 11) to disperse internal wind, and build and move qi and blood.
- Local points: Fengfu (GV 16), Fengchi (GB 20), 1 cun posterior to Yifeng (TH 17), and Xiaguan (ST 7) to dispel wind, subdue nerve pain, and improve motor activity. Yangbai (GB 14), EX .Yuyao, Tongziliao (GB 1), Sizhucong (TH 23), and EX Xinming to address the opthalmic branch of the trigeminal nerve. Sibai (ST 2), Juliao (ST 3), Dicang (ST 4), and Quanliao (SI 18) to address the maxillary branch of the trigeminal nerve. And Jiache (ST 6), Chengjiang (CV 24), and EX Jiachengjiang to address the mandibular branch of the trigeminal nerve.
Body points were inserted at medium depth to obtain mild de qi sensation. Most face points were inserted superficially. Xiaguan (ST 7) and 1 cun posterior to Yifeng (TH 17), the respective trigeminal sensory and facial motor nerve access areas, were needled at medium depth to facilitate nerve repair.
Acupuncture needles were retained for 30 minutes. The total treatment time per visit was approximately 60 minutes.
I was unable to see my patient for the next three weeks. In lieu of acupuncture, she was prescribed an instrument-assisted (see link in bio) daily self-acupressure protocol tailored for her condition. The patient then returned for two more treatments similar to the above, spaced over an interval of 72 hours. At the end of the four weeks, my patient reported significant improvements as reflected in all VAS and MYMOP indicators.
Follow-up and Outcomes
This patient was compliant with both in-office acupuncture and at-home instrument-assisted acupressure treatments. Although she did not keep a daily record of pain scale changes, at the end of four weeks, she reported significant improvements in all VAS and MYMOP indicators. After four weeks of treatment, her VAS score decreased from 10 to 2. Her MYMOP follow-up for facial pain decreased from 8 to 0, her energy level score changed from 5 to 2, and activity score shifted from 4 to 2. The patient also reported she is no longer reliant on gabapentin for her pain.
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References
- Kim JI, Kim HJ, et al. Acupuncture for the treatment of trigeminal neuralgia: a protocol for the systematic review of randomized controlled trials. Medicine, 2018 Mar;97(11):e0108.
- Huseyin S, Burhanettin U, et al. Successful treatment of a resistance trigeminal neuralgia patient by acupuncture. Clinics, 2009 Dec;64(12):1225-1226.
- Nayak R, Banik RK. Current innovations in peripheral nerve stimulation. Pain Res Treat, 2018 Sep 13;2018:9091216.
- Lee M, Lee DH, et al. Cupping for treating pain: a systematic review. Evidence-Based Compl and Alt Med, 2011:467014.
- Falaki F, Nejat AH, Dalirsani Z. The effect of low-level laser therapy on trigeminal neuralgia: a review of literature. J Dent Res Dent Clin Dent Prospects, 2014 Winter;8(1):1-5.
- Ibrahim M, Patwardhan A, et al. Long-lasting antinociceptive effects of green light in acute and chronic pain in rats. Pain, 2017 Feb;158(2):347-360.
- Tan JY, Suen L, et al. Sham acupressure controls used in randomized controlled trials: a systematic review and critique. PLoS One, 2015;10(7):e0132989.
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