Chiroblog

A study in 2015 discussed the link of trigeminal neuralgia (TN) with dysfunction of the autonomic nervous system. ¹
Method: 12 patients with classical TN and 12 healthy control patients. Patients are asked to submerge right arm for 5 into 10*C water to trigger pain. Patients rated their pain every 30 seconds on a 0-100 scale. Electrocardiograms were taken before and during experimental pain test. Heart rate was also analyzed in frequency domain, differentiating low frequency components ( HR fluctuations in the LF range reflect baroreflex-mediated sympathetic activity associated with Mayer waves of blood pressure) and high frequency components (HRV in the HF range is generated by respiratory sinus arrhythmia and
constitutes a sensitive measure of cardiac vagal parasympathetic activity).

Result: No difference in pain perception or heart rate between TN group and control group. No one in TN group experienced facial pain. All patients experienced an increase in low frequency oscillations (increased sympathetic activity) and decrease in high frequency (decrease in parasympathetic activity), but the changes were more pronounced in the TN group.

Conclusions: “Results indicate that TN patients and healthy controls have comparable
autonomic cardiac responses at rest, but that in response to a tonic experimental pain challenge, TN patients show greater sympathetic arousal and parasympathetic withdrawal than healthy controls.” “The exact reason for the negative association between sympathetic reactivity and the number of pain paroxysms experienced by TN patients remains unclear and surely merits future attention.”

The Vagus nerve has clear parasympathetic connections, but the jury is still out on the trigeminal nerve. However, one thing noticed frequently in chiropractic practices is how the temporomandibular joint (TMJ), when not functioning, will usually be associated with increased tension in that person, whether they are a child or an adult ².  Reducing the alignment issues in the TMJ often reduces that person’s stress as well.

References 

1. Léonard, G., Chalaye, P., Goffaux, P., Mathieu, D., Gaumond, I., & Marchand, S. (2015). Altered
Autonomic Nervous System Reactivity to Pain in Trigeminal Neuralgia. Canadian Journal of
Neurological Sciences / Journal Canadien Des Sciences Neurologiques, 42(2), 125-131.
doi:10.1017/cjn.2015.10

2. Santos, E. et al.  (2022). Association between temporomandibular disorders and anxiety: A systematic review. Frontiers in Psychiatry.  https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.990430/full 

Diagnosis and referral for surgical treatment of ankyloglossia, commonly referred to as a tongue-tie, has been on the rise over the past 25 years.^1-5 Breastfeeding difficulties such as poor latch, painful latch, poor infant weight gain, and long duration of feeding are most often attributed to tongue-ties. Interestingly, the highest rate of surgical intervention referrals occurs in male infants with private insurance from affluent regions of the United States.¹ However, there is a paucity of data to support that surgical interventions provide meaningful changes in breastfeeding outcomes. There is moderate data to support that mothers report decreased nipple pain but limited overall data to support immediate or long-term breastfeeding success after surgery.^1-5 Unfortunately, this has resulted in a lack of substantiated universal diagnostic and treatment criteria for tongue-ties.^1-5

The apparent lack of clinical consensus leads to confusion among parents regarding the correct course of treatment for their infant. The good news is that healthcare practitioners are starting to investigate surgical alternatives. There is some positive data to support osteopathic, myofunctional, speech language pathology and/or chiropractic therapy for improving sub-optimal infant feeding with or without a tongue-tie.^7-11 In general, the results appear to be amplified when any of the aforementioned therapies are combined with breastfeeding training with Certified Lactation Consultants.^8-10 In short, approximately 60% of patients who take a multi-modal conservative approach to a suspected tongue-tie can avoid surgical intervention.⁴ Results from these interventions can be seen in as little as two weeks.¹⁰ Some severe tongue ties may still require surgery if the degree of restriction could eventually interfere with speaking and/or swallowing solid foods.⁵ It is always recommended to speak to your pediatrician about your infant’s feeding difficulties and determine a care plan, but equally important to realize that not all tongue ties require surgical intervention and might be amenable to alternative care. 

References

1. Walsh J, Links A, Boss E, Tunkel D. Ankyloglossia and lingual frenotomy: National trends in inpatient diagnosis and management in the United States, 1997‐2012. Otolaryngology–Head and Neck Surgery. 2017;156(4):735-740. doi:10.1177/0194599817690135
2. Rosi-Schumacher M, Ma AC, Reese A, et al. Feeding issues in infants referred for frenotomy. Cureus. Published online May 2, 2024. doi:10.7759/cureus.59539
3. O’Shea JE, Foster JP, O’Donnell CP, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews. 2017;2021(6). doi:10.1002/14651858.cd011065.pub2
4. Caloway C, Hersh CJ, Baars R, Sally S, Diercks G, Hartnick CJ. Association of feeding evaluation with frenotomy rates in infants with breastfeeding difficulties. JAMA Otolaryngology–Head & Neck Surgery. 2019;145(9):817. doi:10.1001/jamaoto.2019.1696
5. Frezza A, Ezeddine F, Zuccon A, Gracco A, Bruno G, De Stefani A. Treatment of ankyloglossia: A Review. Children. 2023;10(11):1808. doi:10.3390/children10111808
6. Tomara E, Dagla M, Antoniou E, Iatrakis G. Ankyloglossia as a barrier to breastfeeding: A literature review. Children. 2023;10(12):1902. doi:10.3390/children10121902
7. Chowdhury R, Khoury S, Leroux J, Alsayegh R, Lawlor CM, Graham ME. Alternative therapies for ankyloglossia-associated breastfeeding challenges: A systematic review. Breastfeeding Medicine. 2024;19(7):497-504. doi:10.1089/bfm.2024.0072
8. Herzhaft-Le Roy J, Xhignesse M, Gaboury I. Efficacy of an osteopathic treatment coupled with lactation consultations for infants’ biomechanical sucking difficulties. Journal of Human Lactation. 2016;33(1):165-172. doi:10.1177/0890334416679620
9. Miller JE, Miller L, Sulesund A-K, Yevtushenko A. Contribution of chiropractic therapy to resolving suboptimal breastfeeding: A case series of 114 infants. Journal of Manipulative and Physiological Therapeutics. 2009;32(8):670-674. doi:10.1016/j.jmpt.2009.08.023
10. Vallone, Sharon. Evaluation and treatment of breastfeeding difficulties associated with cervicocranial dysfunction: a chiropractic perspective. Journal of Chiropractic Pediatrics. 2006; 15.
11. González Garrido M del, Garcia-Munoz C, Rodríguez-Huguet M, Martin-Vega FJ, Gonzalez-Medina G, Vinolo-Gil MJ. Effectiveness of myofunctional therapy in ANKYLOGLOSSIA: A systematic review. International Journal of Environmental Research and Public Health. 2022;19(19):12347. doi:10.3390/ijerph191912347