Transcutaneous electric nerve stimulation in trigeminal neuralgia: A review of literature

Abstract

Trigeminal neuralgia typically involves nerves supplying teeth, jaws and face of mostly older females around 35 years. A thorough investigation and proper diagnosis is a must prior to treatment for which investigations like computed tomography and magnetic resonance imaging should be done to rule out other systemic pathology. A proper history and multidisciplinary examination is a must for the same. The surgeon should have a thorough knowledge of both odontogenic and non odontogenic cause of pain to confirm the diagnosis and a diagnostic block has been enough in case of no other systemic pathology. Though the etiology is usually obscure, different treatment modalities have been tried for it viz. medicinal treatment, alcohol injection, peripheral neurectomy, rhizotomy and microvascular decompression etc. Transcutaneous electric nerve stimulation (TENS) is a safer, cheaper and promising option for management of neuralgic patients as an adjunct with the drugs used like baclofen or carbamazepine thereby reducing the dose of the drugs taken and minimizing the side-effects of the drugs. The analgesic mechanism of TENS involves gate control theory, physiological block and endogenous pain inhibitory systems. It is a noninvasive and safer adjunct to medical treatment in chronic neuralgic pain, economical and easy for both the doctor and the patient. The reduction of pain can be assessed by patient's verbal response as comparatively objective scale like visual analog scale or McGill's questionnaire could not be clinically applied. TENS cannot be considered as a sole remedy in chronic pain conditions, but as an adjunct whose effectiveness needs a continuous follow-up.