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Tuesday, December 2, 2014

TMJ (TemporoMandibular Disorders) and Ovarian Hormones

It is well known that the majority of patients complaining of TMJ Disorders are women even though the anatomy of men and women tend to be very similar.  It is also know that there are estrogen receptors in the TemporoMandibular Joints (TMJ)

A recent article in Pain  discussed the fact that in general most non-cancer pain is more frequent in women as well.  I have frequently found that in premenopausal women it is easy to get near total relief of Chronic Daily Headaches and Status Migraine for up to 25-28 days a month but that it is much harder to completely eliminate pain during ovulation and around menses.

While total pain relief is not immediately achieved the frequency and severity of headaches during those times do gradually decrease over time.  I have found that even the most severe hormonal headaches respond to a Neuromuscular Diagnostic Orthotic.

The Sphenopalatine Ganglion Block can be effective in relieving pain related to hormonal fluctuations. The SPG block has also been shown to be effective in treating anxiety both event related and general trait anxiety.

A great deal of problems may relate to the quality of sleep of women with TMJ Disorders.  The NHLBI published a report on the link between sleep disordered breathing and TMJ disorders.  There is a vast amount of literature that relates the sleep quality to hormonal regulation.

THE IMPORTANCE OF EVALUATING ALL FEMALE FIBROMYALGIA AND  TMJ FOR SLEEP DISORDERED BREATHING  CAN NOT BE UNDERESTIMATED.  IT IS VITAL CLINICIANS REMEMBER THAT MANY WOMEN HAVE UARS OR UPPER AIRWAY RESISTANCE SYNDROME THAT DISTURBS SLEEP AND WORSENS HORMONAL DISRUPTIONS AND INCREASES PAIN

The abstract of the new article in Pain is included below for your convenience.


 2014 Dec;155(12):2448-2460. doi: 10.1016/j.pain.2014.08.027. Epub 2014 Aug 27.

Ovarian hormones and chronic pain: A comprehensive review.

Abstract

Most chronic noncancer pain (CNCP) conditions are more common in women and have been reported to worsen, particularly during the peak reproductive years. This phenomenon suggests that ovarian hormones might play a role in modulating CNCP pain. To this end, we reviewed human literature aiming to assess the potential role of ovarian hormones in modulating the following CNCP conditions: musculoskeletal pain, migraineheadache, temporal mandibular disorder, and pelvic pain. We found 50 relevant clinical studies, the majority of which demonstrated a correlation between hormone changes or treatments and pain intensity, threshold, or symptoms. Taken together, the findings suggest that changes in hormonal levels may well play a role in modulating the severity of CNCP conditions. However, the lack of consistency in study design, methodology, and interpretation of menstrual cycle phases impedes comparison between the studies. Thus, while the literature is highly suggestive of the role of ovarian hormones in modulating CNCP conditions, serious confounds impede a definitive understanding for most conditions except menstrual migraine and endometriosis. It may be that these inconsistencies and the resulting lack of clarity have contributed to the failure of hormonal effects being translated into medical practice for treatment of CNCP conditions.
Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.


KEYWORDS:

Chronic pain; Chronic pelvic pain; Fibromyalgia; Irritable bowel syndrome; Menstrual cycle; Migraine headache; Ovarian hormones;Temporomandibular joint disorder

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posted by Dr Shapira at 8:23 AM

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