Atypical facial pain is usually refractory to treatment and challenging, thus requiring a multidisciplinary approach. Here we report the successful use of new acupuncture approach.

Case Report

A 65 year old female with a five year history of right facial pain following tooth extraction. The pain is described as a constant burning sensation that begins in the right jaw and radiates to the right forehead region. She rates the pain as 8/10. Her facial pain was refractory to pharmacological therapy and she underwent unsuccessful gasserian ganglion radiofrequency ablation and glycerol rhizotomy. Subsequently she had a motor cortex stimulator without any relief.

She underwent acupuncture treatments for 3 consecutive days. After the first treatment, she reported her pain as 2/10 and she had complete pain relief following her 3rd treatment that lasted for few weeks. She managed to reduce her narcotic consumption from MorphineSR 400mg/day to only duragesic 12mcg/h.

Discussion

Our acupuncture treatment was very comprehensive targeting possible pathophysiological etiologies of atypical facial pain including autonomic sympathetic system.

We used Yang Ming-Tai Yin energy circuit with needling at LI-4, LU-7, ST-36, SP-6.

Points ST-1, ST-2, ST-3, LI-20 (infraorbital nerve V2); points ST-4, ST-5 (mental nerve V3); and BL-2 (supraorbital nerve V1)were needled.

With subsequent treatments, we added auricular acupuncture and autonomic points. Auricular acupuncture; Shen Men, point zero, thalamus point, sympathetic point, trigeminal point, master cerebral.

In an attempt to interrupt the sympathetic flow to the face and head, three needles were placed at the surface anatomy for the superior, middle, and inferior sympathetic ganglia; at C2, C4, and C6 respectively. Also we used the general sympathetic autonomic points: GV-26, GV-14, BL-23, Li-4, Li-11, ST-36, LR-3.