A UK Traveler Navigating Chronic Pain
Recently I worked with a patient visiting from England presenting with a particularly stubborn case of trigeminal neuralgia (TN), a condition known for its excruciating pain. He had been seeking relief for over six years and kept winding up at dead ends.
This trigeminal neuralgia case study shows how DNM can help individuals strengthen their self-efficacy in managing persistent pain.
Backstory
This was a lovely English couple in their 70s.
He and his wife were visiting New York City, in part to explore whether massage therapy might offer something different from TN treatments they received in the UK, especially now that his symptoms had returned full force. With his full consent, his wife joined him in the session.
I encouraged this because I wanted them both to feel informed throughout the process. Even if manual therapy didn’t lead to a breakthrough, my goal was at least to empower them with a clearer understanding of the condition before they left, and to do my best to help him find any little window to comfort.
Intake
The intake took 15-minutes. This case was delicate. I like to be as thorough as possible when time allows because this is detective work, after all.
Onset
His symptoms began on his right side suddenly six years ago, with no known trauma or trigger. He said it just appeared one day and he’s had facial pain on the right side of his jaw ever since.
The pain was sharp, intense, and clearly movement-specific—it flared during his jaw opening (such as when brushing his teeth, talking), at a distinct angle during mouth closure, and with smiling.
He also described a persistent sense of fullness in the right ear that began alongside the TN symptoms.
History
He had no history of car accidents or head injury. While his symptoms didn’t present as the classic “shock-like” flashes of full unilateral facial pain typically seen in trigeminal neuralgia (TN), they still significantly disrupted his daily life.
His physicians in the UK suspected vascular compression of the trigeminal nerve and prescribed Lamotrigine, an anticonvulsant. It was the only medication that provided relief and worked well for about a year.
However, he had developed a tolerance to it. His symptoms had returned with severity two weeks before our appointment and he getting major bouts pain.
His doctors had not yet conducted imaging to confirm vascular compression, but had advised him to consider surgery if the medication remained ineffective.
Constraints
He was scheduled to fly back to England in two days and had already reached the maximum dosage of his medication. He hit another wall. We had a very narrow window to find relief and ideally, to offer a tool for longer-term management.
During our initial assessment, we narrowed the primary source down to the mandibular branch of the trigeminal nerve on the right side. There also appeared to be some involvement of the facial nerve.
Manual Therapy Approach
I couldn’t use any textbook “massage” protocols. Because neuralgia is unpredictable and can be triggered by seemingly minor stimuli, I proceeded with extreme caution.
If not applied with a clear understanding, massage (as is commonly thought of) can make it worse. So, a different manual therapy approach was required.
I began by placing one finger lightly on the skin over the affected area of the jaw and moving it just 2–3 millimeters at a time, pausing after each adjustment to assess his response. No pain was triggered.
I continued with this incremental approach until it was clear that the neuralgia trigger by motor involvement, and not sensory input from the skin. We continued with very gentle DNM around the lower jaw, slowly progressing toward the ganglion.
To avoid provoking dizziness, I positioned him in a slightly upright, supported posture using a pillow. After about 20 minutes of gentle work, we identified a maneuver that produced a notable change:
By mobilizing the external ear in a specific direction—posteriorly and slightly superiorly—the neuralgia symptoms resolved completely in that moment. He could open and close his jaw without pain.
Once the hold was released, the symptoms returned, though with reduced intensity. We repeated the maneuver, this time holding it longer. This led to a more sustained reduction in symptoms and I could see a shift in his expression… like a trace of hope returned.
Teaching Ongoing Relief
Since they wouldn’t be able to return for follow-ups. I showed both him and his wife how to apply the external ear maneuver safely at home.
We practiced it slowly until they felt confident doing it themselves. It was so sweet, watching them help each other. A true team effort. She did a great job!
I advised him to continue with self-treatment to see if the symptoms continued to diminished and then take it from there. At least he had a way to brush his teeth now without triggering excruciating pain.
I also suggested he get an MRI or CT angiogram once back in the UK to get clarification about the location of the vascular compression, since he hadn’t had any imaging yet and it was still just a theory. If symptoms persisted, then surgery may be a good idea to relieve vascular compression.
Results & Takeways
Before leaving, he reported the pain had decreased significantly, though not completely gone. But for the first time in weeks, he felt like he had a way to manage it. They left with:
- A self-care application for pain management
- A new understanding of the what exactly was involved
- A reminder to advocate for additional imaging
Cases like this are reminders that even chronic, confounding conditions like trigeminal neuralgia often involve mechanical interfaces that can be gently explored.
DNM supports self-efficacy by helping clients understand their own nervous system responses in plain language, and by experiencing the shifts in sensation. When people are given simple, body-based explanations they can understand, they’re better able to manage symptoms.
Helping people feel safer, clearer, and more hopeful is a technique in itself. And while that’s not always possible in every case, it most often is something we can offer in some way.
If you’re a massage professional and/or manual therapist working with pain and you’re curious about how to adapt this kind of work into your practice, join the Pinpoint Community or explore a class.
There’s always more to learn and you’re never alone in figuring it out.
Frequently Asked Questions
Trigeminal neuralgia (TN) is a condition involving the trigeminal nerve, which provides sensation to much of the face and also has a motor branch involved in jaw movement. It can cause severe facial pain that may be triggered by everyday activities such as talking, smiling, eating, or brushing your teeth. Symptoms and triggers can vary considerably from person to person.
Direct standard massage isn’t recommended, but other types of manual therapy may offer some people a way to explore symptom management, but responses can vary and the therapist should be careful and well-trained. In this case, an extremely gentle DNM approach helped the client identify a maneuver that temporarily helped manage his pain during jaw movement and reduce its intensity. It also gave him a self-care strategy he could continue using after the session.
Yes, if one is not careful or trained in methods outside of standard massage. Trigeminal neuralgia can be highly sensitive to stimulation, and seemingly minor inputs may provoke symptoms. In this case study, conventional massage techniques were avoided. Instead, contact began with very small, gentle movements while continually assessing the client’s response before progressing.
DermoNeuroModulation (DNM) is a gentle manual therapy approach that considers the nervous system and cutaneous nerves when working with pain. In this session, DNM was applied cautiously around the lower jaw while continually monitoring the client’s response. Exploring different inputs eventually identified a specific direction of external ear movement that changed his symptoms. The client and his wife were then taught how to reproduce that maneuver themselves, safely.
Trigeminal neuralgia can have different underlying causes, including vascular compression of CN-V. In this case, the client’s physicians suspected vascular compression and had discussed surgery, but imaging had not yet been performed to confirm it. He was encouraged to discuss getting imaging with his medical team after returning to the UK so they could better evaluate the suspected compression and determine appropriate next steps.
📝 Note: This post was written from my direct clinical experience. Any formatting or light editing was supported by AI tools, but the story, language, and care decisions are entirely my own.