CRANIAL NERVE 5, TRIGEMINAL PAIN

CRANIAL NERVE 5, TRIGEMINAL PAIN

Facial pain can be really frustrating detective work to figure out for both patients and doctors alike. I was reminded of that recently with a patient that had been doctoring in multiple places for 18 months, with some unexplained tooth pain, to no avail. In this blog I would like to explore one source of facial pain that is often overlooked and that is trigeminal referred nerve pain from the cervical spine.

I still recall during human dissection in my first year of chiropractic school discovering that unlike most nerves, which were pretty small and elusive, the trigeminal nerve and its node were surprisingly large and easy to find. The trigeminal nerve is part of the 12 cranial nerves which exits through various openings in the skull, unlike the spinal nerves that exit at the level of the vertebral column below. It's a very large nerve with many sensory and motor functions. It affects a huge area over the lateral part of the face from the ear forward. In particular, the trigeminal nerve provides sensation to the upper and lower jaw and the base of the teeth.

What makes the trigeminal nerve unique from a chiropractic perspective is the following anatomical fact: the nerve cell that sends out its long nerve endings to the side of the face starts in the brainstem and dips all the way down in the spinal cord of the upper cervical spine, all the way down to the level of the second cervical vertebrae. As a result, any irritation to the upper cervical spinal cord has the potential to refer sensation to the side of the face. And very often this will localize over the jaw, and the lower teeth.

I'm certainly not suggesting that your first call when experiencing tooth pain should be to the chiropractor, but after a dental checkup, if you still have unexplained pain in the lower teeth especially, diffusely in the corner of the jaw or ear, it's certainly worth having a chiropractic evaluation. Not all upper cervical benign misalignments are likely to cause that, but functional lesions associated with enough torsion and extension can create some irritation of the upper cervical spinal cord and get the trigeminal nerve cells to misfire. This would result in vague unexplained pain in the above areas.

CHIROPRACTIC CARE AFTER SPINE SURGERY ?

That was a question posed to me earlier this week. I was going to refer the patient to some material that I had written about it, but to my great surprise and chagrin, I had done no such thing yet, and it was time to fill the gap.

The answer :

• Depending upon WHICH surgery you had, chiropractic care can resume close to normal after a waiting period of 8-12 weeks. Those surgeries include laminectomies, foratotomies, facet joint partial resection. You can adjust at that segment, obviously with some modification of depth and rotation. For DISC REPLACEMENTS, you need to stay away from the segment replaced but otherwise can adjust adjacent segments pretty normally (I tend to limit rotation and lower the depth threshhold as well).

• For SPINAL FUSION, using graft bone or metal hardware, no manual adjustment within 2 segments is the rule, and you have to wait a full 12 weeks and get confirmation from the treating surgeon that all hardware is secure before proceeding. There is still a lot you can do at other segments, as the fused segment is often a compensatory area in the first place.

• Soft tissue care is still readily available after any type of surgery, so long as the doc or the massage therapy can modify therapy technique to prevent compression of soft tissues onto the underlying bone. Not only is soft tissue care available I frankly think anyone with a prior spine surgery should be evaluated for the necessity of soft tissue care. Scar tissue and adhesions can be a major source of continued pain after surgery when all of the orthopedic imaging shows good results. I especially find cupping useful since it distracts and separates tethered myofascial layers , rather than compress.

• Acupuncture therapy can go on unrestricted, so long as the patient can be positioned comfortably for the duration of the treatment.

SITTING FOR DUMMIES

https://studio.youtube.com/video/4elMaXDAJcE/edit

The human body was not engineered for prolonged sitting as we are currently doing, but learning a few basic tricks can help you survive that necessity of modern life a whole lot better.

Why Does Everything Hurt on One Side of my Body ?

https://www.sciencedirect.com/topics/medicine-and-dentistry/periaqueductal-gray

It's a question that periodically gets brought up. Some patients have a striking tendency to develop recurrent injuries, pain patterns consistently or exclusively on one side of their body. They wonder if this is a coincidence, or if there may be a master mechanism driving that.

Short of being broadsided by a truck on one side of your body, you do need to look for reasons why patients continuously develop problems unilaterally. Here are some of the two most common mechanisms I have seen:

– from a mechanical standpoint, a chronic mechanical disruption or instability of the lower extremity can create stress on one side of the body. This is the case with undiagnosed or uncorrected short legs, which I have seen in a surprising number of adult patients who are told of it for the first time. The other mechanical issue that can affect one side of the body is significant upper cervical subluxation patterns, which affect utilization movement and coordination on one side of the body and leads to inefficiency injuries.

– Probably more commonly there is a neurological "glitch" in the central nervous system which affects sensory perception, motor response and coordination to one side of the body and leads to chronic recurrent pain and injuries unilaterally. A lot of people have the residuals of a very old mild traumatic brain injury causing these types of issues, although they are usually adamant they've never had such a thing. We can usually uncover that by doing a few subtle neurological testing for balance, vestibular function, and muscle tone symmetry between the right and the left side. There are several known neurological pathways descending from the brain that affect pain perception and modulation unilaterally in particular.

As always treatment depends upon correctly assessing what may be driving the issue, and trying to incorporate the right measures to correct it

Healthy All in one Fish Cakes

I am a bit proud of this recipe because of the unusual level of perseverance it took to get it right - 9 tries to be exact - all of which I ate in spite of the fact they were pretty nasty, because we do not waste food at our house. This version is a powerhouse of nutrition and still has some of the comfort food feeling you would expect from a good fish cake.

https://www.youtube.com/watch?v=TnRS5OAdNvU&t=6s

WHAT IS A FACET JOINT ?

Spinal discs are getting the lion’s share of the attention when it comes to painful structures of the spine. I often see the proverbial “deer in the headlight” look on patient’s faces when we discuss their imaging and what we think is causing their problem

Each spinal segment, except for the very first one in the upper cervical spine, is composed of a disc and two facet joints, one on the right and one on the left. The discs and facets are vastly different in their anatomy and their function. The discs are meant to be the primary weight bearing structures while the facet joints are meant to guide fine movement in rotation and lateral bending, This often in distorted in pathological states , when the facets start bearing extra weight that the discs should be shouldering - often the case with states of “swayback” or hyperlordosis.

Facet joints can be the source of a lot of pain, In a way that is very different from a spinal disc. The pain tends to be more local . Facet joints are less likely to cause pain into the arm or leg unless they have significant osteoarthritis and cause spurring into the spinal nerve opening from the posterior aspect.

https://www.youtube.com/watch?v=CZ86VzZOrGw

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The Dark Side of Marijuana use for Chronic Pain and Psychiatric Management

https://www.ctvnews.ca/health/cannabis-use-impacts-cognitive-ability-beyond-intoxication-study-1.5747545#:~:text=The%20systematic%20review%20of%2010,making%2C%20suppressing%20inappropriate%20responses%2C%20and

This blog entry is only going to scratch the surface on what is ultimately a very complicated topic. But I felt compelled to put a few words out since I see a dangerous trend in this article gave legitimacy on a broader scale to my concerns.

The research on the medical use of whole plant marijuana including both CBD and THC is pretty robust, but with many caveats that are overlooked. It is pretty specific for certain conditions, and needs to be incredibly finely dosed. In the same way any other pharmaceutical would be used. It has indications, benefits, and side effects. And not everyone responds to it.

The research on the appropriate use of properly dosed medical cannabis has been hijacked by a whole subculture that has broadly applied the potential benefits to inappropriate uses. I see an alarming trend of many patients self directing the use of recreational grade cannabis for medical purposes. Because it's "natural" doesn't mean it's good or safe in all circumstances. Arsenic and poisonous mushrooms are very much naturally occurring substances as well. In the instances where I see self-directed cannabis use, there is no consistency of that dosage, no clear indication of what the purpose is, and no monitoring. And the side effects are overt and overlooked.

One of the most concerning side effects is the long-term cognitive impairment associated with daily cannabis use. This is a known fact even in medical prescriptions of whole plant marijuana, but in those circumstances the severity of the condition being treated warrants the potential side effect. The term "pothead" did not come out of a vacuum. It's a real documented phenomenon that appears to be irreversible in the long run.

I'm not trying to discount the very legitimate uses of medical cannabis that some of my patients are resorting to. It often is a better and safer alternative than some of the high grade pharmaceutical approaches they have tried as well. But it needs to be done with the same caution as one would use for any other pharmaceutical substances.

Cardio Workout from Home with a Twist (or two)

https://www.youtube.com/watch?v=fYQq4iyUYAM

I am continuously adding to the resource file of home workout videos that may be appropriate for our patients needs. While we have a robust selection in the area of no equipment weight training, strength, flexibility, yoga, and Pilates, I have had comparatively fewer offerings in the area of new equipment cardiovascular workouts.

This gap became more relevant to me a few weeks ago after our household added a wonderful 12 week old puppy, and I am in charge of the morning shift, which is historically when I get my exercise in. I have since then learn to do yoga with a tongue in my ear and a paw on my belly, but I have not been able to escape to my spin bike in the loft without enduring howls of desperate longing from the puppy a floor below.

Until she becomes old enough to do vigorous outdoor walking as an alternative, I've been looking for home cardiovascular videos I can do in the smaller space of my living room. And while I appreciate the walking videos from Leslie Sansone, about which I blogged a little while ago, I was looking for something a little more entertaining. I have always been curious about doing Zumba class but have felt many of the videos to be a little bit too complicated unless you have a good repertoire of their dance moves. I came across this particular channel that has several really good beginner Zumba videos. They range in length from 20 to 30 minutes which is ideal for a morning workout or after work workout. These may be a great alternative for people who are dog walkers on rainy days as well.

You have to remember that dancing has a lot of well documented scientific benefits beyond just cardiovascular endurance, including agility, long-term cognitive decline prevention, and general creativity.

And while my puppy has been wholly unimpressed by my dance moves, she has been agreeable to chase around the living room without howling while I attempt to mimic Zumba Zulu.