Health and Healing with Emmanuel Birstein

Trigeminal Neuralgia: A Pain Like No Other

Sunday, January 14, 2018
Trigeminal neuralgia (TN) is considered to be one of the most painful conditions. But one that we know very little about.

What is trigeminal neuralgia? It is a chronic pain disorder that affects the trigeminal nerve. This is a branching cranial nerve that controls sensation of the face (Branch 1 & 2) and movement of the muscles used for chewing (Branch 3). Problems with the sensory part of the trigeminal nerve can result in pain or loss of sensation in the face. The typical form of trigeminal neuralgia (Type 1) is experienced as severe, sudden, shock-like facial pain lasting for seconds to a few minutes or groups of these episodes extending over a few hours. The intensity of the pain can be physically and mentally incapacitating, leading to severe depression and panic disorder.

What causes trigeminal neuralgia? There are a number of conditions or events that can lead to TN.  Pain can occur as a result of a blood vessel pressing on the trigeminal nerve as it exits the brain stem. This compression can wear away or damage protective coating around the nerve (myelin sheath). Rarely, symptoms of TN may be caused by nerve compression from a tumor, or a tangle of arteries and veins called an arteriovenous malformation. Injury to the trigeminal nerve as a result of sinus surgery, oral surgery, stroke, or facial trauma may also produce neuropathic facial pain.

According to a 2016 article in the Oral Maxillofacial Surgical Clinics of North America Journal, painful traumatic trigeminal neuropathy (PTTN) can follow major oral trauma and even minor dental interventions. This condition has often been termed "phantom tooth pain." The onset of PTTN, following identical procedures can vary from patient to patient. Dental implants pose a significant risk. A common complication following implant insertion is damage to adjacent nerves, altered sensory perception, and possibly pain. Wisdom tooth extraction is often associated with transient numbness. Sensory changes related to root canal therapy may be due to infection, inflammation, chemical injury, or extrusion of filling materials. Local anesthetic injections also may induce nerve injury secondary to physical trauma by the needle or by chemical damage from the anesthetic solution.

What are the symptoms of trigeminal neuralgia? For those who suffer from TN or PTTN, pain can vary from sudden, severe, and stabbing to a more constant, aching, burning sensation. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, smiling or being exposed to the wind. The pain may affect a small area of the face or may spread. Bouts of pain rarely occur at night, when the affected individual is sleeping, but falling asleep as a result of pain may be difficult.

Emmanuel Birstein is a skilled and gifted practitioner and healer at PIMH. His extensive training in craniosacral therapy and his broad anatomical knowledge lends to his high success rate in relieving pain and dysfunction. Emmanuel has a particular insight into the role of the trigeminal nerve not only in neuropathic pain, but as it relates to mental health issues, especially depression and panic disorder.
How is trigeminal neuralgia treated? TN and PTTN are extremely difficult to manage. TN is typified by attacks that stop for a period of time and then return, but the condition can be progressive. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. Eventually, the pain-free intervals disappear and medication to control the pain becomes less effective. The disorder is not fatal, but can be debilitating. Due to the intensity of the pain, some individuals may avoid daily activities or social contacts because they fear an impending attack.

Pain medication is generally the first line of defense. The mainstays are antiepileptic drugs and tricyclic antidepressants. Surgical approaches may focus on release of scar tissue, decompression and neuroma excision. Overall, however, the benefit of surgery for painful trigeminal neuropathies is unclear. They may, in fact, lead to more pain. Sub-dermal nerve blocks, botox injections, fat grafting, balloon compression, and radiofrequency ablation are among other treatment interventions. Because TN, like many other chronic pains, is associated with depression and anxiety, psychosocial therapy (e.g. cognitive behavioral therapy) may be beneficial. However, to date, research has not shown a significant effect on pain intensity and quality of life measures.

Non-medical approaches and coping strategies can be helpful in managing the TN pain. Examples include: acupuncture, yoga, breathing techniques, mindfulness and meditation. Some people do find enough relief to live normal lives, but for many, TN is a hugely debilitating, disabling condition. It’s not something people can just deal with when the pain hits. It also can be hard on family and friends, as they don’t always know how to help.

Painful Scar Tissue Options for Treatment

Saturday, January 06, 2018
Pain after traumatic injury or surgery is to be expected. But pain that persists beyond the normal healing period is not expected and can often become chronic and even debilitating. The source of such pain is usually attributed to scar tissue on the surface of the skin or in subdermal skin layers and connective tissue.

Surface scar tissue pain occurs when there is damage to small skin nerves or when a nerve is squeezed by growing scar tissue. Sometimes a neuroma (growth of nerve tissue or a non-malignant nerve tumor) can form at the end of a damaged skin nerve. Internally, bands of scar tissue or adhesions can form between damaged tissue and body organs, causing them to stick together. This can cause pain and limit movement. Painful scar tissue can occur years after surgery or injury. This is often the case with scarring and adhesions from breast and abdominal surgery and traumatic injury.

Although there is a high prevalence of neuropathic pain from scarring, treatments are generally limited.

Post-mastectomy pain syndrome (PMPS) is a significant complication after breast cancer surgery, occurring in up to 60% of cases. The cause of PMPS is poorly understood but is believed to be a result of surgical injury to major nerves in the axilla (armpit) and/or the chest wall during lymph node dissection. According to a recent review of treatment options in The Breast Journal, despite the prevalence of this neuropathic pain condition, the amount of research is very limited and no consensus has yet been made. Tricyclic antidepressants and anti-epileptics have been somewhat successful and topical treatments, including ointments and dermal patches, bring some relief. Additional surgery, including fat grafting has also been found effective. Still, PMPS remains a major clinical challenge.

Emmanuel Birstein is a trained and gifted practitioner and healer at PIMH. He provides light-touch manual therapies aimed at successfully treating the syndrome of scar tissue pain that arises not just from single events (e.g. injury and surgery) but a lifetime of the buildup of scar tissue that can impact not only physical health but mental health as well.

Client Testimonial
"My great thanks to Emmanuel [Birstein]. He did not just cure me, but enabled my soul to transform my existence in this world, to look at myself from the outside in a new way. His hands, his brain and ... I do not know what else work miracles!!! Once again, thank you very much Emmanuel." [This patient was literally sewn together by a prominent surgeon 25 years ago after a trauma that shattered his body. He was in pain ever since. I worked on his scars in silence for 1.5 hours, and his pain disappeared. (Emmanuel Birstein)]
Abdominal scarring and neuropathic pain can result from surgical procedures, including c-sections, bowel resections, appendectomy etc. Another source of abdominal scarring is an abdominal wall birth defect called gastroschisis. A baby’s intestines are found outside of the body, exiting through a hole in the abdomen near the umbilicus.This is a relatively "common" congenital anomaly. In fact, its incidence seems to be increasing in recent years, having more than doubled in the United States over the past 18 years. In a 1997 study of subjects ranging in age from 12 to 23, chronic recurrent abdominal pain was reported by a quarter of participants. The article cited shorter term follow up studies with a higher prevalence of this symptom. Clinicians generally look for bowel involvement as a result of adhesions to explain the pain rather than neuropathic origins. Research seems to be sorely lacking.

Scar tissue and adhesions from other sources can limit a person's movement and cause pain. Over time, internal scar tissue or adhesions can build up in the joints, muscles, tendons, and soft tissues. It can be caused by working your body too much, injury (such as sprains, strains and trauma), surgery, disease, or just by repeated movement when the body is out of alignment. Stiffness and pain experienced as we age is often due to the build up of internal scar tissue and adhesions.

Contact us for more information or to schedule an appointment with Emmanuel.

Concussion Traumatic Brain Injury and Your Gut

Wednesday, December 27, 2017
By now you've heard about the brain-gut connection. But here is an interesting new take on this phenomenon.

Can my concussion cause intestinal problems?
Answer: The answer is yes. And now we know that the opposite is true as well. Intestinal changes and infections can cause post-traumatic brain inflammation and associated tissue loss. It is a two-way street.

The brain–gut connection has gained awareness as a major contributor to human health for some time now, but the gut-brain axis has turned out to be equally important. It's not just a top-down but also a bottom-up relationship. Recent studies in Neuroscience News  and Microorganisims  provide additional insight and implications for daily health.

Neuroscience News (November 2017) published a summary of findings from the journal Brain, Behavior, and Immunity. According to the study of traumatic brain injury (TBI) in mice, researchers found that TBI can trigger delayed, long-term changes in the colon and that subsequent bacterial infections in the gastrointestinal system can increase posttraumatic brain inflammation and associated tissue loss. This two-way focus suggests that TBI may trigger a vicious cycle, in which brain injury causes gut dysfunction, which then has the potential to worsen the original brain injury. According to the original article in Brain, Behavior, and Immunity (Volume 66, November 2017 pp. 31-44), existing pre-clinical data specific to TBI indicates that head injuries can cause structural and functional damage to the GI tract, but research directly investigating the neuronal consequences of this intestinal damage is lacking. Despite this void, the proposed mechanisms emanating from a damaged gut are closely implicated in the inflammatory processes known to promote neuropathology in the brain following TBI. This suggests that the gut-brain axis may be a therapeutic target to reduce the risk of Chronic Traumatic Encephalopathy (CTE) and other neurodegenerative diseases following TBI.

An extensive review of recent research on the bi-directional nature of the gut-brain connection appears in the October 2017 Issue of Microorganisms, The Gut Microbiome Feelings of the Brain: A Perspective for Non-Microbiologists. While many reviews have focused on the top-down, brain to gut axis, this review expands and updates from the bottom-up, namely, the gut to brain axis. This entails multiple environmental factors, gut eco-events and the two major players, nutrients and the second brain, the microbiome.

Emmanuel Birstein is a trained and gifted practitioner and healer at PIMH. He provides light-touch manual therapies aimed at treating the "axis" of problems (brain to gut" and "gut to brain") that arise from concussions and other brain injuries. Contact us for more information or to schedule an appointment.
According to the Microorganisms review article, the two opposite directions refer to a bidirectional communication that mutually affects and depends on the other (brain and gut) but it engulfs multiple intricate systems that were shaped during human evolution to maintain homeostasis and protect the body against detrimental factors, establishing symbiotic relations between bugs and us. Several pathways are suggested to deliver information from the intestinal tract to the brain: neuroanatomical, neuroendocrine, immune, macrobiotic and all gut and brain barrier pathways. Afferent vagus routes also play an essential role in bringing the lower signals up to the brain. In fact, the balanced functioning of the gut–brain axis depends on normal functional activity of the vagal nerve.

Overall, the review reflects a non-infectious, gastroenterological view, and as such, concentrates more on the enteric (intestinal) eco-events than on the very complicated central nervous system, which is a never-ending labyrinth. The implications for treatment of traumatic brain injury points directly to holistic approaches that involve not only the brain and nervous system, but novel preventive and therapeutic strategies, including nutritional approaches, microbiome manipulations, and enteric and brain barrier reinforcement that might improve physical and mental health outcomes.