When we were figuring out how long to do the sessions for and how often to do them, all we had was Gawande’s description of a patient he had worked with who did them “a few times a day, for fifteen minutes or so at a stretch” When we started out, though, we could barely do ten minutes at a time. Partly that was the mind-numbing nature of the thing, partly it was just so surreal for David to experience sensation on that side of his face. But we did get used to it fairly quickly. And of course, the fact that we could tell it was effective relatively quickly was also a great motivation.
We did ten minutes at a time as long as we were reducing the Neurontin by 400 mgs at a time, and that seemed to work fine. Then we seemed to hit a little bit of a plateau around 1600mg and started increasing the length of the session by one minute every time we reduced the Neurontin, which we did by 200mg at a time after hitting 1200mg. This was not much of a stretch, and by the time we were done, 15 minutes did not seem long at all. In fact, doing David’s face even came to seem therapeutic—sort of like playing with playdough.
We varied the number of times we did the therapy in a day depending on how active and painful David’s face was, though we only did it as little as two times hardly ever and on account of externals in our schedule that were beyond our control. Three times a day was common, especially on easy pain days. Four was absolutely necessary in getting over a hump when the Neurontin had just been decreased.
We’d gotten good at making sure David took his meds four times a day at exact times, but we were never so exact with the timing of the sessions. We fit them in as we could and as we needed to. Usually, we’d do one within an hour of getting up and one in the evening before David got too tired. Otherwise, it varied greatly. This did not seem to make a difference in the effectiveness.