Transcutaneous electric nerve stimulation (TENS) in the therapy of chronic facial pain. Preliminary report.

Chronic facial pain remains a therapeutic problem. We report on 29 patients (37 nerves involved), who were treated with transcutaneous electric nerve stimulation (TENS). Pain reduction was achieved in 27 patients (93%) while in 5 patients it was possible to stop the treatment because they were constantly free from pain. Two patients did not respond to TENS therapy. It was possible to reduce or discontinue the use of analgesics in 79% of the cases. There were no severe side effects. Therefore, TENS should be seen as a simple, safe and effective method of treatment for many forms of chronic facial pain, as opposed to other invasive surgical procedures.

[Diagnosis and therapy of myo-arthropathy (Costen's syndrome)]. / Diagnostik und Therapie der Myoarthropathie (Costen-Syndrom).

The temporo-mandibular joint (TMJ) syndrome was first described by Costen in 1936. It is a muscular-skeletal pain-disease. The pain is caused by hypertonia of the masticatory muscles and is projected into various regions of the head and neck. There is a primary dysfunctional etiology as well as a secondary etiology based on other diseases, particularly of the ENT region. Diagnostically, therefore, a process of exclusion is required. The symptoms can range from diffuse headache and facial pain to strictly localized or even neuralgic pain. Otogenic symptoms may be pain or various noises in the ear. For differential diagnosis, most of the painful diseases of the head area must be considered because of the multiform clinical manifestation of the TMJ syndrome. The treatment of the TMJ syndrome follows a multistep scheme that includes behavior therapy, physiotherapeutic methods, and occlusal therapy.

[Combination therapy of transcutaneous electric nerve stimulation and iontophoresis with benzydamine and diclofenac]. / Kombinationstherapie von Transkutaner Elektrischer Nerven-Stimulation und Iontophorese mit Benzydamin und Diclofenac.

Combined Therapy of Transcutaneous Electrical Nerve Stimulation and Iontophoresis with Benzydamine and Diclofenac. The combination of transcutaneous electrical nerve stimulation (TENS) and the iontophoresis of benzydamine and diclofenac in a counter-current field is a new method in the treatment of chronical pain of the head and neck region. Prior to a clinical study this method was tested in a preliminary examination in 15 healthy volunteers. Clinical and physical data were investigated from which a theoretical maximum value of the quantity of iontophorised non-steroidal antiphlogistics (NSAI) could be calculated. The actual achievable absorption is discussed. Based on these data it is concluded that a good effective tissue concentration of benzydamine and diclofenac can be achieved with iontophoresis by means of TENS.

[The treatment of neuralgiform facial pains with the combined therapy of transcutaneous electric nerve stimulation (TENS) and the iontophoresis of nonsteroidal antiphlogistics]. / Die Behandlung neuralgiformer Gesichtsschmerzen mit der Kombinationstherapie von transcutaner elektrischer Nervenstimulation (TENS) und Iontophorese nichtsteroidaler Antiphlogistika.

In a prospective study, 46 patients suffering from facial pain were treated by transcutaneous electrical nerve stimulation (TENS). In case of insufficient pain relief the combined use of TENS and iontophoresis of non-steroidal antiphlogistics was employed. Benzydamine was applied to the anode and diclofenac to the cathode instead of the contact gel, reducing average pain intensity to a marked 18%, compared to 81% to 63% by TENS only. Furthermore, the consumption of analgetics declined considerably with combined therapy. Severe side effects could not be registered. Therefore, this new combined therapy must be considered to be an alternative treatment before using systemic medication.

[Therapeutic concept of the University of Ulm for the treatment of neuralgiform facial pain]. / Das Ulmer Therapiekonzept zur Behandlung neuralgiformer Gesichtsschmerzen.

The therapy of chronic facial pain poses an interdisciplinary problem. Since 1984 the therapeutical plan of Ulm University was developed in such a way that the intensity of pain and the location as well as former treatments are accommodated. The therapeutical steps don't interfere among one another. In the first four years 204 patients were treated with this scheme. A freedom or at least a reduction of pain was achieved in 187 patients.

[Thermoprofile analysis of the face for diagnosing trigeminal nerve lesions]. / Die Thermoprofilanalyse im Gesichtsbereich bei Läsionen des Nervus trigeminus.

In the framework of differential diagnosis thermography as a non-invasive method has gained in importance. 34 patients suffering from lesions of the trigeminal nerve were examined by our method of thermoprofile analysis of the facial skin. In those lesions where perception disorders were dominant hypothermia occurred, while those lesions where pain was preponderate showed hyperthermic changes. The temperature of the facial skin, however, only shows a small difference compared to the skin of the trunk and the extremities. Therefore, our method of thermoprofile analysis should not be used as a single diagnostic test but as an objective screening procedure for nerve lesions in the facial area.