PHYSICAL THERAPY INTERVENTION USING DIRECTIONAL PREFERENCE FOR A SENIOR PATIENT WITH CHRONIC IDIOPATHIC TRIGEMINAL NEURALGIA WITH 8-YEAR FOLLOW-UP. A CASE REPORT

<ns3:p>Exercises and postures based on Directional Preference (DP) have been identified as key treatment effect modifiers for prescribing pain- reducing self-management strategies in patients with spinal pain. However, no studies to date have described DP movements in senior patients with idiopathic trigeminal neuralgia (TN). This paper aims to present a case study utilizing DP in the management of TN.A 72-year-old male with left facial pain, diagnosed with chronic idio - pathic TN, consented to a physical therapy evaluation based on the DP concept. The therapeutic intervention involved cervical re- traction, initially performed without self-overpressure and later with self-overpressure, along with posture adjustments and avoidance of neck protrusion. The patient was educated on self-management techniques to control recurrent symptoms through customized pos- tures and movements. He effectively adhered to these strategies daily and as needed for eight years, with follow-up monitoring con- tinuing from 2016 to 2024.Changes in the Numeric Rating Pain Scale (NRPS) and Brief Pain Inventory – Facial (BPI-F) scores after four visits in 2016 were as follows: NRPS decreased from 2–9/10 to 0–2/10, and BPI-F im- proved from 4.4/10 to 1.1/10. Long-term follow-up assessments in 2018 and 2024 confirmed the sustained benefits of DP and the pa- tient’s ability to self-manage symptoms effectively. By 2024, the Pa- tient Global Impression of Change (PGIC) was rated at 1/7 (very much improved).DP movements, such as cervical retraction, may be a viable man- agement option for chronic, refractory idiopathic TN in select adults. The patient’s long-term commitment to regular neck directional ex- ercises and self-management significantly reduced his chronic fa- cial pain and improved his quality of life. Further research is needed to better define the role of DP interventions for patients with TN.</ns3:p>