Dr. Shapira's Chicago Headache Blog

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Monday, February 15, 2010

Pain is worse after arthrocentesis.

Brenda comments : I HAVE HAD AN ANTERIOR DISC DISCPLACEMENT A YEAR AGO AND HAVE BEEN IN CONSTANT PAIN EVER SINCE. NOW BOTH SIDES HURT AND I AM VERY DISCOURAGED. HAD AN ARTHROCENTESIS THAT DID NOT WORK, I AM ACTUALLY WORSE. IS THERE ANY HOPE? I WEAR A BITE GUARD AT NIGHT AND SLEEP ON MY BACK. JUST STARTED TAKING LYRICA WHICH DOESN'T SEEM TO WORK. PLEASE PLEASE HELP ME. THIS HAS CONSUMED MY LIFE FOR THE PAST YEAR.


Dr Shapira Response:

Dear Brenda,

Yes there is hope, but there are no magic cures.

It is often thought that all the pain is from the joint but that is rarely the case. Many times we can eliminate the pain but reduced motion due to internal derangement continues. Does it only hurt when you move your jaw or is the pain continuous? You stated it was constant. Joint pain is almost always associated with jaw movement. Costant pain is usually from many different areas.

You mentioned you wore an appliance at night. If you have major instability wearing an appliance only a night is not sufficient. 24 hour wear of an neuromuscular orthotic is essential especially during the healing process. I never have patients undergo invasive procedures like arthrocentesis without a stabilizing neuromuscular orthotic. You did not say what caused the dislocation but usually patients are predisposed to dislocation due to their bite. I feel correcting the bite with a 24 hour orthotic should precede surgical intervention.

When I treat patients we work thru their pain, we initially shoot for a 50-80% pain reduction and that is usually relatively easy, We then try to relieve 50-80% of remaining pain. I like to describe my onion analogy. Treating pain is like peeling an onion, when you take away one layer you find a similar but different layer. Some layers may belong to the orthotic, some to trigger point injections etc. You work yourself thru the layers until you reach the hard white center, You without pain.

Unfortunately when you first dislocated the disk it wasn't immediately reduced. There are many techniques to reduce pain however it is impossible to determine what the best treatment is without a complete examination and history.

i would be happy to have you come for an evaluation. We have many patients who come from long distances (much farther) for treatment. You probably would have approximately a 2 1/2 hour drive to get here. Contact my office at 800-TM Joint for an appointment if you would like to have me evaluate the problem. In many cases we can give significant pain reduction at the consultation appointment. We are relatively close to the Milwaukee airport and very close to (private)Waukegan airport. We have a hotel at the country club that gives my patients discount rates.

If that is impossible I will try to find a neuromuscular dentist closer to you but many doctors do not have the experience and knowledge to treat more difficult cases. I can also work with a doctor in your area.

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posted by Dr Shapira at 10:17 AM

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