Effectiveness of homoeopathic remedy causticum in the treatment of trigeminal neuralgia - Two case reports

INTRODUCTION

Trigeminal neuralgia (TGN) is a complex orofacial pain syndrome characterised by the paroxysmal onset of sudden, severe stabbing, recurrent painful attacks in the trigeminal N. distribution.^[1] TGN is differentiated into classical – often caused by a microvascular compression at the trigeminal root entry zone, and symptomatic variant – due to other structural lesions apart from vascular compression.^[2] The incidence of TGN is expected to be 4–13 people per 100,000/year, with female predominance.^[3,4]

Many studies prove that the neuralgic pain of TGN is due to demyelination changes occurring at the Root entry zone, leading to imbalances in voltage gated sodium channels, causing pain recurrences. These demyelination changes are common due to nerve compression or demyelination diseases like multiple sclerosis.^[5]

Clinically, TGN is classified into primary/idiopathic and secondary/symptomatic. Also, based on symptomatology, it is divided into typical, atypical, trigeminal neuropathy, pre-TGN and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing.^[6] The diagnosis of TGN can only be clinically confirmed by the presence of symptoms like paroxysmal attacks of sudden sharp lancinating pain on one side of the face along the distribution of the trigeminal nerve, which is triggered by routine activities such as eating, chewing and talking.^[7] Investigations like magnetic resonance imaging (MRI) are recommended to exclude tumours, cysts, multiple sclerosis, or any demyelinating diseases of the nervous system. Apart from MRI, the role of biochemical investigations has the least importance in the diagnosis of TGN, but recent studies evidenced reduced levels of post-operative enolase and significant post-operative increase of C-reactive protein, ferritin and interleukin-6 values in microvascular decompression surgery.^[8] The first-line pharmacological treatments like carbamazepine oxcarbazepine to control pain in the very first instance, followed by anticonvulsants in later stages for effective relief. Studies show that the patients treated with combined surgical and medical treatment have a greater improvement than medication alone.^[9] Surgical procedures like microvascular decompression techniques provide long-term pain relief by repositioning blood vessels and compressing the trigeminal nerve. However, total relief of pain is not guaranteed, nor is it always permanent, and up to 4% of patients develop serious complications, such as cerebrospinal fluid leaks, cerebral infarcts or intracranial bleeds.^[10] In view of the temporary relief from conventional medicine or subsequent after-effects of surgical procedures, many people approach alternative treatment methods for comparatively better relief and avoid surgical procedures. In acute neuralgic pains, homoeopathic remedies reduce the pain by correcting the physiological imbalances in tissues and nerve endings. Very few significant studies on neurological diseases treated by homoeopathy were available in the literature. A case series of 15 patients of TGN by Mojaver et al. showed that the pain intensity and frequency reduced by 60% after using homoeopathic medicines alone and there were statistically significant results (P < 0/001) in a 4-month duration of treatment.^[11] The Barrow Neurological Institute pain intensity score (BNIPI) was given hereunder for assessment of the outcome, refer Table 1.

CASE SERIES

DISCUSSION

TGN is one of the most common neurovascular compression disorders. Although the causation is unknown, the common reasoning is the compression at the site of exit of nerve root from the foramen, by the aberrant vessels or the surrounding structures. TGN is often referred to as suicidal pain by physicians due to its severity. Various methods of treatment available to date do not provide satisfactory relief to the patient or fail to reduce the intensity of pain. Various surgical procedures and nerve block injections may help alleviate the pain to some extent from a few days to a few months.

Given that these patients seek alternative methods of treatment such as homoeopathy, Ayurveda, Siddha, acupuncture, or other herbal medicines. The homeopathy system of treatment is renowned for its promising and permanent curative treatment with the application of the principle of law of similarity.^[12] In the above two cases of TGN, both of them were female patients of above middle age group.

The complaints were sudden in onset as sudden toothache (as reported by patients) and later diagnosed as TGN, by dentist as well as neurologist opinion. Both cases had affections of the mandibular branch of the trigeminal nerve, which is the commonest type and both cases are right-sided affections of the face. In the first case, the patient had severe difficulty with being unable to speak even a single word (who visited the Institute by pressing the hand on the cheek very tightly). On the first visit, causticum 6c was prescribed, wherein there was immense relief in the first visit. Later on, increased potencies in causticum entirely cured her case without any recurrence of the pain even on exposure to triggering factors, though there were minor relapses on and off. After a few months, she entirely forgot her ailments of TGN and later consulted for her knee joint pains. The prescription was based on the constitutional totality selected after classical repertorisation . For the second case of TGN, initially, Aconite was given on the first visit, but as there was no relief to the patient and due to the extreme severity of the pain, causticum was prescribed, which has relieved not only her neuralgia pain but also her urinary urge incontinence. Later, due to gastric complaints, she was prescribed carbo veg (as a complementary to causticum), for which she got relief. The total outcome of the two cases was assessed by BNIPI score, which revealed that after the end of treatment, the intensity Grade was I from a Grade IV, which depicts there was good relief after homoeopathic intervention. Many clinical observations suggest that sanguinaria and spigelia are the two most common remedies prescribed for right- and left-sided trigeminal neuralgic affections for instantaneous relief followed by a constitutional prescription for a long-term cure. But in the above cases, instead of Spigelia/Sanguinaria, the constitutional remedy causticum proved its pain relieving nature in extreme painful episodes and it is suggested to be the preferable remedy to provide instantaneous relief for the TGN sufferers.

CONCLUSION

TGN is the deadliest form of neuralgia pain, often pain experienced by many patients, forcing them to use all sorts of treatments available to get relief instantaneously. Although many patients are utilising the conventional method of treatment, only less amount of satisfaction is being experienced due to the short action of medicines and intensified pain of the disease. Various surgical procedures or nerve-blocking techniques fail to produce satisfactory results. Homoeopathic remedies like causticum, with its intense action on the sentient nerves, give instantaneous and prolonged relief, as evidenced by the above cases.