Trigeminal neuralgia: sudden and long-term remission with transcutaneous electrical nerve stimulation.

OBJECTIVE: To discuss a case of trigeminal neuralgia that responded to an accidental high-intensity discharge of electrical current delivered by a transcutaneous electrical nerve stimulator (TENS).

CLINICAL FEATURES: A 36-yr-old man suffering from a 5-month history of worsening paroxysmal pain of the left facial and temporal regions was referred to a neurologist by his family physician. A clinical diagnosis of trigeminal neuralgia was made; before committing to pharmaceutical treatment, however, the patient sought chiropractic consultation.

INTERVENTION AND OUTCOME: A trial of self-applied TENS was recommended for pain control. Initial application to patient tolerance provided transient pain relief until an accidental, intense discharge resulted in immediate remission of symptoms, lasting now for three years.

CONCLUSION: As an initial treatment of choice, TENS can be a safe and effective therapy for trigeminal neuralgia. The unique effect of this accidental application leads us to speculate that diffuse noxious inhibitory controls may have been the pain inhibitory pathway responsible for the resolution of symptoms in this case. Although firm conclusions are difficult to draw from one incident, using TENS at an intense, noxious level may improve its therapeutic efficacy by decreasing treatment time and frequency and eliciting long-lasting effects. This case suggests the need for further investigation of TENS in the treatment of trigeminal neuralgia and related pain syndromes.