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coMra FAQ on Trigeminal Neuralgia and other Types of Neuropathic Pain

1. Looking for hope

These doctors have no clue…WHY???

Give me hope please...

When we are facing excruciating neuropathic pain, the most natural response is to do whatever it takes to make it stop. And today, a nearly universal response to this urgent need is to suppress pain with pharmaceutical drugs or surgery. These methods may provide some temporary relief but eventually pain comes back thus destroying the long term quality of life. So, if a person has had trigeminal neuralgia or some other type of painful neuropathy for 5, 10, 30 years, it is fully understandable to feel despair and disillusionment when communicating with doctors. Indeed, doctors, medical science and technology are facing huge challenges when it comes to diagnosis and treatment of these conditions. But here comes a catch.

The challenge of neuropathic pain seems to be without a solution ONLY if we assume that pharmaceutical/surgical suppression of pain is the only possible solution. This may seem strange but the chronic nature of neuropathic pain arises from this assumption. In order to have hope of ever healing a disease like trigeminal neuralgia, at the very least we need to consider the possibility that there is more to the picture! We have to simply acknowledge what we already know about the nature of neuropathy and pain in general.

Simply put, it is an undeniable truth that in our perception any pain urgently calls forth a desire to be far away from that pain as soon as possible. However, in reality pain points to a need to heal the underlying injury.

And this is the most important point of our discussion because now we can see that there are two different approaches to treating neuropathic pain:

  1. The approach of managing perception of neuropathic pain is all about suppressing and controlling the pain. 
  2. The approach of healing the neuropathy is to support the natural process of regeneration of the injured nerves while encouraging the individual to resolve the cause of the nerve injury. 

Therefore, if you wish to find hope then our suggestion is to seek professionals and medical technologies who recognise these basic facts and which will help you to heal the underlying nerve injury. If you can find them, learn from them, ask for support and gradually gain confidence that you can increase your wellbeing. It is in this spirit that we are sharing with you the latest research and our clinical experience with coMra therapy.

2. Nerve injury

Why are doctors so quick to dismiss you or pass you off as a liar? I have had no relief in five years. Medicine just makes me not care that I’m hurt. Where do you go for help?

How does trigeminal neuralgia occur? How to cope with this pain?

Why do some of us suffer only periodically and others constantly?

What is the difference between neuropathic facial pain and trigeminal neuralgia? It sounds like the same thing but the doctor said I don't have trigeminal neuralgia but I have the first one.

To answer these questions, we need to look at the injury of nerves which in fact generates pain.

To state the obvious, pain signals about damage in the body. A skin cut or a burn are visible examples when the cause of pain is obvious. But sometimes pain appears "on its own", that is without an apparent damage to organs and tissues of the body. In such cases the source of pain could be within the nervous system itself. Normally, the nervous system acts only as a conduit of pain signals that travel from injured organs (for e.g. skin) to the brain. But an injured nerve may malfunction and start generating pain signals without an actual damage to other organs. 

Therefore, neuropathic pain is, by definition, pain due to injury of nerves. Neuralgia is just another term for nerve pain.

Apart from subjective pain sensation, a nerve injury could be difficult to confirm by a doctor thus a person with neuropathy often goes undiagnosed for a long time. An apparent major trauma to a nerve (for e.g. after a car accident) can be easily established. But a nerve injury can also accumulate at a microscopic level within nerve cells over many months and even years. Such microstructural damage is not readily detectable with the commonly available diagnostic tools. For example, in trigeminal neuralgia nerve fibers often have small segments where protective myelin sheath was stripped away. Without such protective cover a nerve fiber is highly susceptible to irritation and often "misfires" causing an extreme pain sensation. So the nerve may look fine on an MRI image but in fact it is suffering from internal microstructural problems that cause it to malfunction. Therefore, any nerve malfunction always points to an underlying nerve injury.

Neuropathic pain manifests differently depending on which nerve is injured and where. Consider, for example, facial pain. If one or more branches of the trigeminal nerve (cranial nerve V) are affected then facial pain presents as an electric-shock-like sensation which is typical for trigeminal neuralgia type 1. If the root of the trigeminal nerve is affected - the deeper part of the trigeminal nerve that goes to the brainstem - then pain presents as constant aching, throbbing or burning. This condition has been defined as trigeminal neuralgia type 2. In case of facial pain produced by an injured glossopharyngeal nerve (cranial nerve IX) the disease is called glossopharyngeal neuralgia. If it is unclear which cranial nerve is affected, then a doctor may diagnose the condition as persistent idiopathic facial pain.

Note that if a nerve injury progresses, then symptoms worsen over time: starting from slight changes in sensation, to more frequent and intense pain and finally to complete loss of function (numbness).

The bottom line is that any neuropathic pain is a call for help, an alarm bell signaling that a nerve is unhealthy. Consequently, neuropathic pain will persist for as long as an injury to the nerve is present. 

3. Methods of pain suppression

So, until this moment, the trigeminal neuralgia or occipital neuralgia are still mysterious for doctors to understand. And it needs a more in-depth study of how the solution does not have to rely on chemical drugs and surgery. It is necessary to study other solutions that can cure the two diseases.

Is surgery the only cure for trigeminal neuralgia?

Can trigeminal neuralgia return after ablation?

In order to discuss various treatment options for neuropathic pain, we need to be clear that the commonly used pharmaceutical and surgical methods offer only suppression of the pain.

Without going into too many details, pharmaceutical drugs aim to decrease our ability to perceive pain. In case of trigeminal neuralgia this is very difficult to do with regular painkillers because the trigeminal nerve is directly "hardwired" into the pain processing centers in the brainstem. Instead, antiepileptic medication like gabapentin is commonly used. It acts by suppressing the ability of cells of the nervous system to relay, to process electrical signals. The negative side effects such as fatigue, dizziness, dullness are direct results of the brain working sluggishly, with chemical "breaks" on. 

Various surgical methods, such as gamma knife radiosurgery, damage the nerve even further in order to make it stop working, that is sending pain signals to the brain. Microvascular decompression seeks to relieve external pressure on the trigeminal nerve that has been already weakened from the inside. But just like pharmaceutical drugs, surgery does nothing towards repairing the nerve injury.

We can clearly see that these tools help us manage our perception of pain. However, by merely switching off a ringing alarm bell we do not resolve the cause of the alarm. A nerve injury does not disappear simply because we become unaware of its presence. As soon as the effects of pain suppression wear off, injury announces itself again and pain comes back. Unfortunately, such pharmaceutical and surgical methods can never be a sound long term strategy because they are simply not designed to make the diseased nerves healthy again. This reality has to be fully acknowledged and understood if we are seeking to truly heal neuropathic pain.

So when we talk about solutions to actually resolve neuropathic pain, we need to look towards methods that repair the injured nerves. Obviously, pharmaceutical/surgical methods can still play a role but only as an emergency aid to alleviate suffering while we are restoring the nervous system.

4. Methods of healing nerve injury

What is the best natural management remedy?

Does trigeminal neuralgia ever go away? And though MVD surgery and gamma knife surgery are an option, are there any holistic methods that help?

Are there any new treatments for trigeminal neuralgia in the last decade or so besides the surgery and/or the neuro drugs like gabapentin? Has there been any headway made?

Is there any hope of healing or reducing pain from a stripped nerve? Jaw was also repaired with plates that are placed where the nerve enters the jawline. Been struggling with type 2 trigeminal neuralgia for over two years.

What are the latest non surgical treatments? I live in Hope!!!

Where do we go for help if we want to go beyond merely suppression of pain? Let us start with basic facts and common sense. We will share with you several simple guidelines that hopefully will help you make an informed choice rather than place blind trust in someone else's authority.

A Holistic Approach

Clearly, our aim is to heal an injured nerve, to make it whole again. Knowing well the destructive effects of surgery and long term medication usage, we seek for "natural” remedies, something that does not involve gross interference into the body. But what does it mean to heal naturally? The answer is simple and self-evident. Natural healing is a type of healing that occurs on its own accord when given enough time. In other words, what we are looking for are methods that somehow support, enhance and cooperate with the natural self-healing ability of the body.

The term self-healing implies that the best expert in repairing an injured nerve are the cells that compose that nerve. In fact, this is how we can define a difference between a living nerve and an electrical cable: living beings are capable of self-organization, self-maintenance and self-repair whereas faulty wiring in a car needs an electrician.

Certain ability to self-repair is inherent within each living cell because it has to continuously rebuild itself from the inside. Without this ability a cell would die within days or weeks. This is unavoidable because as the cell functions, for example when a nerve cell sends an electrical signal, it spends certain resources and accumulates “wear and tear”. Therefore, to stay healthy, a nerve cell has to continuously replenish its resources and rebuild itself. However, if the rate of replenishment slows down below the rate of wearing and tearing, then the cell starts to accumulate various deficiencies. This is a sign that a health promoting process of regeneration has now turned into degeneration, a path towards disease. In time, the temporary deficiencies may accumulate into serious structural defects (a cell injury) that manifest as various cell malfunctions such as neuropathic pain.

The process of self-repair of nerve cells is most noticeable after a sudden trauma. For example, a patient with trigeminal neuralgia may choose radiosurgery in order to have some pain relief. The procedure aims to partially destroy the nerve so that it stops transmitting signals. At this stage a patient may experience pain relief. But later on, as the nerve regenerates itself, it starts to function again and pain returns. The patient may see this as a failure of the surgery to provide prolonged pain relief but in reality it is just the nerve trying to repair/heal itself in response to trauma. The real problem is that the nerve's limited ability to self-repair often leads to incomplete healing and the nerve continues to generate neuropathic pain rather than rebuilding itself to a fully healthy state.

Therefore, holistic methods of treating neuropathy are those therapies that do not interfere with the inherent ability of the nerve cells to self-repair but rather help them to overcome various deficiencies that limit that ability. In addition, in order to repair the nerve injury, we also need to resolve the initial causes that led to nerve injury in the first place. 

Altogether, a holistic approach to neuropathy should lead to restoring wholeness to the injured nerve and the body, as well as the personality and spirit of a human being as one coherent whole.

Therapies for Nerve Regeneration

Since the early 1980s there has been a series of groundbreaking discoveries that showed how low intensity physical energies promote repair of nerve cells. We are referring to therapeutic methods that are known as Low Level Infrared Laser Therapy, Photobiomodulation, Magnetic Field Therapy, Low Level Ultrasound Therapy, Ultrasound Neuromodulation, Electrotherapy and many others:

  • Sharif, N.A. 2022. Electrical, electromagnetic, ultrasound wave therapies, and electronic implants for neuronal rejuvenation, neuroprotection, axonal regeneration, and IOP reduction. Journal of Ocular Pharmacology and Therapeutics. https://pubmed.ncbi.nlm.nih.gov/36126293/

These methods use different forms of energy that are so low in their intensity that they do not destroy cells but rather increase their capacity to self-repair. This is an opposite approach to high intensity radiation methods that blast cells with such amounts of energy that they break apart and die.

There are thousands of research articles published on the topic, so it is easy to get overwhelmed, even for a medical professional. However, if we come back to the holistic approach, we can keep it very simple. Remember that we need to help diseased nerve cells to overcome deficiencies in their basic aspects of internal housekeeping - energy, matter and information:

  1. Lack of energy in a cell inhibits self-repair and normal function;
  2. Sluggish transport of necessary nutrients and removal of waste slows down healing; 
  3. Lack of regenerative messages for engagement of stem cells.

So when you are investigating different holistic therapies you can understand for yourself what you should be looking for. Below we list for you some of the best therapies and provide links for further information.

Low Level Laser Therapy, Magnetotherapy

In the area of providing energy support for nerve repair, a low level infrared laser and magnetic field have been shown to stimulate the cellular power station, mitochondria. After application of these radiances, cells have up to 2-3 times more energy to accelerate regeneration of nerves expressed as repair of myelin sheath, improving electrophysiological function, decrease inflammation and so on. 

To get a general idea we recommend watching the following video and at least glance at these articles:

As nerve cells repair themselves, they stop generating pain signals. This most natural outcome of healing is confirmed by clinical studies on trigeminal neuralgia and other painful neuropathies. The following research articles can be considered as top level clinical evidence because they review other published clinical evidence (randomised clinical trials) and sum up their findings:

  • Camolesi, G.C.V., et al. 2022. Efficacy of photobiomodulation in reducing pain and improving the quality of life in patients with idiopathic burning mouth syndrome. A systematic review and meta-analysis. Lasers in Medical Science:1-11. https://pubmed.ncbi.nlm.nih.gov/35122543/
  • de Pedro, M., et al. 2020. Efficacy of low-level laser therapy for the therapeutic management of neuropathic orofacial pain: A systematic review. Journal of Oral & Facial Pain & Headache no. 34 (1). https://pubmed.ncbi.nlm.nih.gov/31339967/

Ultrasound Therapy

The repair of any cell injury is also a massive transport challenge. A cell needs to bring in nutrients, expel waste and reorganise cellular structures. Low level ultrasound encourages microscopic movement sufficient to accelerate molecular transport but it avoids disruption of the sensitive apparatus of cells. Therefore, application of low level ultrasound supports faster repair of nerves and thus leads to relief of chronic pain:

Light Therapy

Living cells employ specific messages in order to communicate with each other and coordinate their activities. Repair of a significant injury to a nerve involves cooperation between adult cells and young stem cells that replace those cells which were irreparably damaged. The mechanistic idea of injecting stem cells into the site of injury and inducing regeneration by chemical signals, did not produce an effective solution. Visible colour light (red, green, blue) on the other hand, has shown a remarkable property of providing specific messages that engage nerve stem cells into reparative activity:

coMra Therapy

The coMra therapy coherently combines infrared laser, magnetic field, ultrasound and colour light in one therapeutic device. Therefore, the fundamental research done on each of the low level energies also applies to coMra but with one principal difference - coMra directly supports regeneration as an holistic biological process rather than addressing only one particular cell deficiency at a time.

From the point of view of physics, regeneration of an injured cell is a process of rearrangement of disrupted flows of energy, matter and information into a coherently functioning whole. A diseased cell never experiences a deficiency only at an energy level, or only at a structure level or only at an information level. Biological self-repair is an indivisible holistic process involving all three aspects.

The word coMra stands for “coherence achieved through Modulation of different radiances”. To illustrate this, think of a professional quartet - each of the four can play solo to great effect but if we put all four together with a conductor, playing a specific piece, where each musician knows where, when and how to come in – then we have a thoroughly inspiring, stimulating and powerful experience. coMra applies this same principle. This all translates into a highly efficient and fast method of healing.

Here is a brief explanation and a more technical explanation of cellular processes involved:

5. coMra: can it help with ... ?

I have had trigeminal neuralgia for almost 30 years. I have had two operations, the first lasted 18 years, the second was in 2010. I react to the pharmaceuticals prescribed to manage trigeminal neuralgia. Would coMra be suitable, especially as now I also have cluster headache?

Could coMra be used for an injured infraorbital nerve caused by a dental injury?

Can coMra help with glossopharyngeal neuralgia?

The coMra therapy can actively support regeneration of the peripheral as well as of the central nervous systems. In other words, coMra helps practically in every situation where a nerve cell was injured: be it structural damage and/or functional exhaustion. For example, one can use coMra therapy to recover from a particularly stressful exam in school, trauma such as concussion, cluster headaches, neurodegenerative diseases and so on. The exact cause of cell injury is not so important in order to gain benefit of coMra therapy.

Regenerative effects of coMra are not limited to one specific type of cells, tissue or organ. For example, in case of neuropathy of a cranial nerve, the fundamental processes of self-repair are the same also for trigeminal, glossopharyngeal, facial nerves. And we observed positive results even with a very long history of disease:

Users of coMra devices successfully treated neuropathic pain caused by dental surgery, trauma, infection, vaccine or so-called idiopathic origin (unknown origin). As long as we can establish the location of the injured nerve, we can apply a coMra therapy device to the site of the injury in order to initiate recovery.

How coMra would work since the cause of my trigeminal neuralgia is a varicose vein attached to the right trigeminal nerve that was deemed inoperable. I was born with arteriovenous malformations in my head.

In a case of a blood vessel/nerve contact with changes in the structure of trigeminal nerve, coMra still can help even without vascular decompression surgery. Why? Consider the following facts. There are people who have neurovascular contact and do not have trigeminal neuralgia. And there are people who have trigeminal neuralgia without neurovascular contact. So a much more probable explanation is that trigeminal neuralgia is caused by internal nerve degradation (degeneration) that makes it susceptible to irritation even by a slight external pressure. It means that regardless of the presence of a neurovascular contact, we still have to heal the primary injury inside the nerve. And coMra therapy can help with that.

How many sessions of coMra treatments are required based on studies for a patient to experience improvement with trigeminal neuralgia? 

Initial improvements of acute symptoms are felt after the first 1-5 days of daily treatments. However, if there is a systemic disease present (e.g. multiple sclerosis) or other comorbid conditions, then improvements will be less pronounced and significant improvement will take more time.

We need to be clear that beneficial effects of coMra manifest differently compared to invasive methods of pain suppression. Surgery or medications block the pain signal by a sudden, disruptive action on the nerve. On the other hand, coMra works by gradually rebuilding the nerve's structure and incremental restoration of the nerve's normal function. Therefore, coMra does not "take away the problem" in a single procedure but rather needs several treatment sessions or even many courses of sessions to reduce symptoms.

Can a person achieve full, long term recovery from a disease of the nervous system? Generally speaking, yes. But individual outcomes strongly depend on the extent of nerve injury, how chronic the condition is and the presence of the factor that initially caused the nerve injury. For example, in case of a recently diagnosed trigeminal neuralgia and the absence of other chronic diseases, one week of daily coMra treatment could be sufficient. In case of a chronic trigeminal neuralgia plus other disease like diabetes mellitus, significant improvements also are noticeable during the first 1-2 weeks of treatments. However, more courses of treatments could be necessary over the next 6-12 months to support the process of healing and gradual reduction of symptoms. Further improvements vary from person to person and depend mostly on how dedicated is the person in his or her holistic approach to healing. The good news is that we've observed that even in cases of the most severe nerve injury, gradual improvements are still noticeable over 1-3 years of regular coMra treatments.

How effective do you feel coMra would be for a trigeminal neuralgia sufferer that had a failed MVD & failed rhizotomy? Also there is some numbness from the glycerol rhizotomy that was done a year ago. Is this effective for trigeminal neuralgia type 1 and 2? Thank you.

Interested if coMra will help after destruction of the nerve.

Prior surgeries, partial destruction of the trigeminal nerve decreases the already diminished ability of the nerve to self-repair. In these cases the progress of recovery is much slower and full recovery may not be possible.

Perhaps the only exception to applicability of coMra therapy is when all fibers in a nerve were completely destroyed. Permanent lack of any function (sensation, pain) suggests that the entire nerve is no longer viable. In such cases there are no living nerve cells that coMra can assist in self-repairing. However, in case it is uncertain whether there are any living nerve fibers left in the injured nerve, we recommend doing coMra treatments for at least 3 months of daily sessions without breaks and look for any changes in the condition. Even small positive changes would indicate that further coMra therapy may help in recovery of at least some function.

I had to have a tooth removed in the front of my mouth, but have refused an implant for fear that it may set off the nerves. I would like more information about that. Thank you.

You may watch the following clinical case that illustrates preventative use of coMra therapy before a dental surgery:

How can coMra help with stroke and recovery of vision? Heminopia?

Pain after stroke or some other cause is coMra applicable?

I'm interested in all your information, I have Trigeminal Neuralgia & neuropathy in both of my legs from my hips to my toes!

Will coMra work for multiple sclerosis? Any research on this?

The coMra devices have been used for preservation of existing function and partial recovery of vision in different conditions:

The coMra therapy showed positive results and significant improvement of quality of life after stroke: physical and mental function, speech, pain relief. In a case of multiple sclerosis, coMra therapy showed the most promising results in arresting degeneration and improving the condition of the nervous system:

6. coMra: How can I ... ?

What to do when there is undiagnosed trigeminal neuralgia or difficult to diagnose facial pain?

You may do coMra treatments without waiting for confirmation of a specific diagnosis. If you suspect that trigeminal nerve is involved then you may start with Neurology 4 protocol from coMra therapy User Guide:

Similarly, if there is a possibility of facial nerve injury then start with Neurology 3 protocol. If you are unsure which nerve is involved then scan the areas of the face where you have changes in sensation, pain or muscle paralysis using Neurology 3 as a guideline.

Is coMra device available for at home use and costs to the patient?

Yes, coMra devices are very easy to operate and primarily they were designed for personal use at home. You can order them at coMra online store:

Is coMra available in my region?

If you are looking for a local doctor or a clinic where you can experience coMra therapy, we recommend getting in touch with us at info@comra-therapy.com and we will recommend someone close to you.

7. coMra: Safety

Is coMra therapy dangerous, could it cause cancer?

The coMra therapy is completely safe to apply given you adhere to simple safety precautions listed in the BEFORE YOU START section of the coMra User Guide. Additionally, coMra is non-invasive and non-damaging for our body by design. How is it possible that coMra is both totally safe and effective at the same time? coMra only creates optimal biophysical conditions in which any cell can function to its fullest capacity.

Furthermore, coMra therapy does not cause cancer because it does not damage DNA or any other part of a cell. Over 50 years of worldwide clinical experience with low level laser therapy, magnetotherapy, photobiomodulation, ultrasound therapy confirmed that these therapeutic radiances do not cause cancer. Moreover, the highest degree of safety allowed application of these therapies during oncologic diseases.

What are the precautions for an 86-year-old male with pacemaker, peripheral arterial disease, high blood pressure, with big toe amputation? He is not a diabetic, but needs to be treated as one, per his podiatrist.

Do not place coMra devices within 30 cm of the heart and the pacemaker to avoid interference with electronics in the pacemaker. 

With any chronic disease at an advanced stage when the body is severely exhausted, always use the 980 nm laser (Delta Terminals or the coMra Palm) to do the first 1-2 courses of treatments in order to build up the body’s resources. Once the body has overcome the initial exhaustion and depletion, gradually introduce the 905 nm laser (Delta Pro 905 Terminals) for a more intensive healing process.

How safe (close to head) is to use coMra Delta 980 nm for earache that lingers for awhile? How many times a day is recommended?

The coMra devices should be placed directly on the skin/hair of the head as shown in the coMra User Guide. In case of acute problem, pain, local inflammation, etc. you can safely increase the treatment time per point up to 5-10 minutes if necessary. Longer treatments will also be safe but less effective. A much better strategy is to use shorter treatment times but 3-4 times per day.

Can coMra therapy be used safely with medications too? The medication is doing it’s job for me at present but I’d love to be off of it eventually and wondered how that would work?

I haven’t heard of coMra. Can you use it and drugs at the same time? Are there other comorbidities it does not work well with?

Can coMra be combined with other methods? 

The coMra therapy can be safely combined with pharmacological drugs. Moreover, because coMra enhances cellular metabolism, medications work better and require less dosages to achieve the same results. As coMra healing proceeds, patients typically significantly reduce their medication intake or completely stop pharmacotherapy. This occurs completely naturally. Once symptoms start to decrease (pain, weakness, various other dysfunctions, etc), the need in symptom management also becomes less and less.

While coMra acts differently from pharmacotherapy it does not have negative side effects or contraindications. Instead, a much more common feature of coMra therapy are the so called positive side effects. They manifest as improvements in the condition of organs and systems that were not treated directly with a coMra device. For example, when we use Universal protocols (see coMra User Guide), improvements are felt throughout the entire body - from better sleep, to better digestion and faster healing of damaged organs anywhere in the body.

Can you use it while driving and such? Is it dangerous to be left lying around the house and a toddler gets a hold of it?

You can do coMra treatments before or after driving a car. However, coMra devices cannot be used while operating any machinery since coMra Delta or coMra Palm has to be manually held in locations as shown in coMra protocols and placed directly on skin. 

The coMra device is a complex electronics apparatus and must be kept out of the reach of children and animals. Under NO circumstances should the laser light be allowed to come into contact with open eyes! See BEFORE YOUR START section in coMra User Guide for a complete list of safety precautions.

Here are the video recordings of Part 1 and Part 2 of the Live Webinar where you will find lots of information, case studies and reseach results of the holistic approach to Trigeminal neuralgia and other neuropathic diseases: