Photobiomodulation as an adjuvant in the pharmacological treatment of trigeminal neuralgia. Case report

Abstract

BACKGROUND AND OBJECTIVES:Trigeminal Neuralgia causes intense suffering and impaired quality of life. The diagnosis is clinical. Thermography has been proven to be a useful tool, both for confirming and monitoring this neuralgia. Photobiomodulation is being increasingly well documented, specially when associated with the first-choice therapy, which is pharmacotherapy. In this case report, the objective was to investigate the performance of the laser, associated with anticonvulsants, in a patient with trigeminal neuralgia, considering its results from a clinical and thermographic point of view. CASE REPORT: Male patient, 62 years old, presenting idiopathic trigeminal neuralgia, diagnosed 4 years before, being controlled with oxcarbazepine (600mg), divided in 2 daily doses, being the dose doubled in the last year. In the last 4 months, the symptoms worsened with the increase in the drug dosage, generating side effects not supported by the patient. Photobiomodulation was proposed as a complementary treatment, with infrared thermography being performed before and after treatment. After the low-intensity laser therapy protocol, there was a significant improvement, demonstrated both by the patients report and the thermography, maintaining this result in the 6-month control. The dosage was reduced to 300 mg/day, restoring quality of life. CONCLUSION: Low-intensity infrared laser photobiomodulation can be extremely useful when associated with an appropriate drug in the control of idiopathic trigeminal neuralgia, both in the immediate and medium-term outcome.

Diagnosis and Treatment of Patients with Trigeminal Neuralgia: A Review

“…The diagnosis may also be complemented by infrared thermography. 5 The classic diagnosis is based on a history of pain such as an "electrical shock" felt in one of the branches of the trigeminal nerve that lasts for a variable period of time (normally short). There is often a stimulus, but not necessarily only one.…”

“…TN manifests as attacks of "electrical shock", "burning" or tingling at undefined intervals, generally triggered by non-nociceptive stimuli, such as chewing, combing the hair, brushing the teeth, shaving or even gentle touches in the involved region, which is a phenomenon known as allodynia. 4,5 Most cases of TN are caused by neurovascular compression, but a significant quantity is secondary to inflammation, tumor or trauma. 3 TN is often misdiagnosed or under-diagnosed 6 and can be confounded with pain of an odontogenic origin.…”

Application of low-level laser therapy in trigeminal neuralgia: a clinical case

“…The patient usually goes through several health professionals until reaching the correct diagnosis. The dental surgeon is often one of the first professionals to be sought and has an important role in the differential diagnosis regarding odontogenic and orofacial pain 3 .…”

Terapias farmacológicas para a neuralgia do trigêmeo: revisão de literatura

“…É uma dor muito repentina e inesperada 3,5,9 , pode ocorrer de maneira espontânea ou então ser desencadeada por estímulos simples, não nocivos, como a fala, a mastigação ou até mesmo uma brisa leve 7,10,11 .…”