Ask a doctor on the topic of Neurology

Regular nerve pain

June 21, 2021 | 45,00 EUR | answered by Dr. med. Frauke Gehring

Dear Sir or Madam,

I have a strange pain phenomenon that I cannot classify or adjust sensibly.

It all started about 1.5 years ago:

- Pain in the neck (at the level of the larynx)
- Chest pain
- Pain in front of the ear
- Occasionally a pulling sensation between the last two upper right molars
- Occasionally a pulling sensation under the armpits

The pain was unilateral (- on the right -), not sharp but rather dull. The pain lasted for weeks.

I then had myself checked by my general practitioner (over 35 checkup), ENT dentist:

- Blood test: Slightly elevated inflammation levels
- Ultrasound of the larynx and thyroid gland normal
- Nasal endoscopy, CT head: Diagnosis "Chronic polypous sinusitis", focus "- on the left -"
- Teeth: All fine, except for a root-filled tooth on the "left" side

I was advised to extract the tooth, which I did about 10 months ago. The chronic sinusitis requires surgery (septoplasty, polypectomy), but is not responsible for the pain on the other side of the body. I was then referred by my general practitioner to an osteopath. He was the only one who shed some light on the situation.

- My body has gradually developed into a complete misalignment.
- My neck on the right side is regularly as stiff as a board
- I have a lot of tension in the head area
- The tension then also extends to the other side at the level of the back, probably to compensate for the misalignment higher up.

Since then, I have been going to osteopathy every 2-3 months to realign myself. Afterwards, the pain was usually less pronounced.

For about 2 months, the picture has changed slightly:

- Pain in the upper right jaw has appeared, which radiates into the nose
- These pains come and go
- With strong irritation, my upper lip twitches on the right side

The general practitioner says it is an idiopathic trigeminal neuralgia. From my point of view, the pain pattern does not fit this diagnosis correctly. I do not have sharp, stabbing pain attacks. Everything is rather dull. At osteopathy, they told me that the nerve is extremely irritated. But it is not known what the cause and effect would be here (do the muscles cramp because of the pain, or is the nerve irritated because of me pinching due to the tension?). If the situation does not improve within four weeks after the last treatment, I should better see a neurologist.

I am now somewhat lacking a starting point. I can only get an appointment with the neurologist in about two months. What could be the cause of my problem, and what else could I do?

Dr. med. Frauke Gehring

Good morning,

I agree with you: nothing here seems to fit with trigeminal neuralgia, which causes sharp, burning pain that is localized to a branch of the trigeminal nerve and can be excruciating.

Sinusitis may cause some discomfort and slightly elevated levels of inflammation, but it is certainly not responsible for the dull chest and throat pain.

I am surprised that an orthopedist was not consulted first, as diagnosis should come before therapy (osteopathy). It seems to me that a severe muscular imbalance is the root cause, which needs to be identified and treated holistically. This would involve less osteopathy and more of an active approach, such as physical therapy, swimming, progressive muscle relaxation according to Jacobson, and exploring psychosomatic factors.

As you have noticed, osteopathy only provides short-term relief (similar to massages) and is only marginally effective as a passive therapy here.

Whether a temporary pain-relieving medication therapy (painkillers, amitriptyline) is needed should be decided after diagnosis.

I'm not sure what the neurologist should do at this point. Please consult a good orthopedist!

I wish you all the best.

Warm regards, Dr. Gehring