Physical therapy treatment for facial and jaw pain associated with trigeminal neuralgia using Systemic Manual Therapy (SMT)

This study aimed to evaluate the effectiveness of Systemic Manual Therapy using a HOAC-APD model to treat trigeminal neuralgia-associated facial pain (TN). Cohort retrospective multivariate analysis using a modified adaptive platform design. Overall progress across episode of care and average rate of improvement in TN symptoms and overall complaints was measured in 85 patients after using 99 different combinations of Systemic Manual Therapy protocols. When comparing scores from the beginning and end of the episode of care, 66 % of patients reported improvement in trigeminal neuralgia or facial pain complaints. The average improvement was 1.88/9 ( p < 0.001) and the overall improvement was 12.01/90 ( p < 0.001). Thirteen combinations containing eight distinct protocols were found to be better than the average. Five of the protocols effectively addressed central sensitization (UD, Barral, Barral-CVVT, LAUG, VTCP); one protocol was hypothesized to have a direct effect on the trigeminal system (SYMPN), and two protocols could have been effective because of either direct or desensitization effects (CCCV and DCS). This study demonstrated that TN can be effectively treated by focusing on central sensitization, which is preserved by the continuous input of several self-reinforcing loops into the LC-NA system. This study supports the hypothesis that central sensitization can be treated by creating intermittent disruption of these self-reinforcing loops.