A Case Report : Logotherapy and the Treatment of Trigeminal Neuralgia

Abstract

Trigeminal neuralgia is a paroxysmal facial pain, characterized by an extreme, burning pain. Pain episodes are so easily triggered by daily activities that the quality of life deteriorates greatly.

The process of comprehensive medicine begins by establishing a rapport with patients. In such a relationship, one is enabled to understand patients in their bio-psycho-social and existential aspects, and assess them both pathogenically and salutogenically. By so doing, s/he tries to locate their resources as well as problems.

This is a study of a patient with trigeminal neuralgia. Based upon comprehensive medicine, we applied pharmacotherapy, nerve blocks, acupuncture, massage and medical interview to the patient. Our principal task was to bring the essence of her existence, i. e. the meaning of her life into her focus. As these complementary approaches gradually took effect and healed her physical and psychological conditions, she began to be able to control her pain. The quality of her life improved accordingly. Rather than concentrating all the effort on pain reduction, doctors and acupuncturists alike gave a top priority to the recovery of her homeostasis and quality of life.

Through logotherapy, we learned that the patient had a renowned great-grand father. It was this fact that helped her through the treatment. The awareness of her deep reverence for him stimulated the sense of incompetence she had struggled with, and motivated her to visit his grave. This became a new meaning to her. These experiences helped her to begin taking responsibility for her health.

According to “the umbrella theory”(advocated by Nagata K), an umbrella has material covering a round folding frame, and a folding stick so that it can protect one from rain. An umbrella without either material or a folding stick is useless. It is also pointed out that the structure of our medical treatment is analogous to that of an umbrella. In other words, the roles of medical treatment and patients'families are similar to material covering a round folding frame of an umbrella while patients'understanding of the meaning of life is to its folding stick. Just like an umbrella, none of them should be missing in medical treatment. The doctor-patient relationship changes as treatment progresses. Successful treatment requires not only support from doctors and therapists but also the patient's will to recover. Doctors and therapists should also engage in inspiring patients to regain their health. This case was the example of an experiential, existential approach where logotherapy was applied in combination with behavioral therapy.