Melanie: I have had root canals, anti seizure meds I could not tolerate, and on 12/30/10 I had MVD brain surgery. I still have pain and shocks in my facial area, teeth, ears and the back of my head (cannot lay down). Am currently seeing a doctor that is giving me occipital nerve block injections. Just saw the doctor at Duke who did the MVD surgery and he admitted that his surgery did not fix the problem and they don't have anything else to offer me. I am seeing an oral surgeon in Vinton, VA on 3/28 for a TMJ consultation, but I went to UNC-Chapel Hill school of dentistry last year for an evaluation and was told that my TMJ is not causing the neuralgia and shocks. I am so light sensitive I cannot go outside or watch TV. I cannot talk on the phone without getting shocked so please do not call me. I cannot chew without causing an increase in shocks. Sometimes by the evening hours I cannot talk but have to write notes to communicate with my husband. I have had neck problems fo r years, treated by chiropractic. In fact the shocks started after a rather aggressive chiropractic neck adjustment (in June 2010).
Dr Shapira Response: Dear Melanie,
I am sorry you are having to bear so much pain. I know it is not easy. Are the occipital nerve blocks helping? The fact that the Microvascular decompression did not help probably means it was not the source of the problem.
Have you tried a spenopalatine ganglion block? The SPG block can be done as an injection or through the nose. It addresses the autonomic potion of the trigeminal nerve. The nasal block can be easily and painlessly self administered on a daily basis for 20 minutes (one or more times a day) and can give miraculous results for some patients.
It is unlikely that you will find an oral surgeon who understands neuromuscular (NMD) dentistry. I have seen incredible results with NMD but it can be a problem depending on where your trigger locations are. You may not have a "TMJ" problem but have problem with masticatory system and trigeminal nerves. CRPS (chronic regional pain syndrome) is also a possibility.
Do you have a specific trigger area or spots that can be identified? It is also possible that a medially displce disk can be pressing on the trigeminal nerve. This could be addressed surgically.
How long ago did this problem begin? Did the Chiropractic adjustment exacerbate or start the problem? If it really stated immediately after chiro adj you might want to consider having a stellate ganglion block.
I usually try to avoid surgical procedures initially as frequently surgery can make problems more severe. Did the severity change following surgery, for better or worse or was the pain just unchanged?
Showing posts with label neck pain. Show all posts
Showing posts with label neck pain. Show all posts
Monday, March 21, 2011
Saturday, February 5, 2011
Severe Headaches in Temples and Throbbing pain in teeth and joints after dental work.
Ruby: Headache in right temple. Throbbing in teeth and tm joint. Neck pain. Had a splint put in 10 days ago. Went for Pt, massage, chiro and today pain management dr who I didn't like much and jumped to wanting to do a nerve block. Just trying to find the right person to treat me. Chronic grinder, had crowns put on all uppers and didn't make night guard fast enough. Tmj dentist only does splints and says jaw position is 80% better. Help! Haven't been able to work in almost 2 weeks.
Dr Shapira Reponse: Dear Ruby,
I am sorry to learn of your ordeal.
Normally it is relatively easy to decrease pain rapidly but it does not sound like you were dealing with a neuromuscular dentist. Blocks can be very effective but they are rarely a first line of treatment. MASSAGE THERAPY, CHIROPRACTIC OR OSTEOPATHIC ADJUSTMENTS CAN BE HELPFUL BUT THEY DO NOT ADDRESS THE UNDERLYING CAUSES OF THE PROBLEM ABD ARE MERELY PALLIATIVE IN NATURE. Frequently, you may also have long-standing underlying postural problems that these therapies will correct.
To say your jaw position is 80% better when you are in the pain you describe is ludicrous. Quality of life is always a primary concern and it does not appear that you are doing well from the little information you have given me. I normally hold off on permanent dental work until the pain is under control but I do not know if the pain was there prior to your dental work.
The use of spray and stretch with vapocoolant and trigger point injections can speed results but the utilization of the Low Frequency TENS to reduce spasm and pain is very important.
The headache in the temple area and throbbing pain in the teeth following dental work indicates that this probably is myofascial pain or TMD that should respond well to Neuromuscular Dental Treatment. A Diagnostic neuromuscular orthotic will be made to allow your muscles to function in a physiologic zone. An orthotic is designed to correct orthopedic and physiologic funtion rather than just protect the teeth like a "splint:.
Good Luck with your treatment.
I am forwarding your information to Dr **** ******. I hope that he will be able to help you improve your quality of life quickly.. I am available in Chicago if you do not find answers but Dr **** is an excellent practitioner. If for any reason it does not work out I can help you find another doctor but I know Dr **** and he can consult with me if there are any questions.
I am willing to see long distance patients but to be effective I try to schedule you so that we can initiate treatment and control your pain and correct orthopedics as quickly as possible. This requires a significant amount of time being scheduled in advance.
Dr Ira L Shapira
Dr Shapira Reponse: Dear Ruby,
I am sorry to learn of your ordeal.
Normally it is relatively easy to decrease pain rapidly but it does not sound like you were dealing with a neuromuscular dentist. Blocks can be very effective but they are rarely a first line of treatment. MASSAGE THERAPY, CHIROPRACTIC OR OSTEOPATHIC ADJUSTMENTS CAN BE HELPFUL BUT THEY DO NOT ADDRESS THE UNDERLYING CAUSES OF THE PROBLEM ABD ARE MERELY PALLIATIVE IN NATURE. Frequently, you may also have long-standing underlying postural problems that these therapies will correct.
To say your jaw position is 80% better when you are in the pain you describe is ludicrous. Quality of life is always a primary concern and it does not appear that you are doing well from the little information you have given me. I normally hold off on permanent dental work until the pain is under control but I do not know if the pain was there prior to your dental work.
The use of spray and stretch with vapocoolant and trigger point injections can speed results but the utilization of the Low Frequency TENS to reduce spasm and pain is very important.
The headache in the temple area and throbbing pain in the teeth following dental work indicates that this probably is myofascial pain or TMD that should respond well to Neuromuscular Dental Treatment. A Diagnostic neuromuscular orthotic will be made to allow your muscles to function in a physiologic zone. An orthotic is designed to correct orthopedic and physiologic funtion rather than just protect the teeth like a "splint:.
Good Luck with your treatment.
I am forwarding your information to Dr **** ******. I hope that he will be able to help you improve your quality of life quickly.. I am available in Chicago if you do not find answers but Dr **** is an excellent practitioner. If for any reason it does not work out I can help you find another doctor but I know Dr **** and he can consult with me if there are any questions.
I am willing to see long distance patients but to be effective I try to schedule you so that we can initiate treatment and control your pain and correct orthopedics as quickly as possible. This requires a significant amount of time being scheduled in advance.
Dr Ira L Shapira
Sunday, December 5, 2010
TMJ disorders and Neck Pain are closely linked. New study shows mechanical and kinematic movement of neck is altered by neck pain.
A recent article (Arch Phys Med Rehabil. 2010 Dec;91(12):1884-90.) showed changes in neck function when pain was present. Neck pain is one of the most frequently helped conditions during neuromuscular treatment of TMD disorders. If treating the pain can return normal function this would be an incredible finding.
The article concludes "Velocity and smoothness of cervical motion were more restricted in patients with chronic neck pain than found previously. Unlike range of motion and other static measurements, these dynamic variables reflect functional cervical motion and therefore contribute to a better understanding of the impairment associated with neck pain. Because the ability to move quickly in response to external stimuli is a commonly occurring phenomenon, this deficit is highly relevant to clinical assessment and management."
The unanswered question is whether the limitation and pain have a common orgin or if the pain is the cause of the changes noted. If the pain alone causes these changes than more debilitating problems would occur over time. An interesting follow-up study would be to examine changes after treatment of pain.
The PPM, Pure Power Mouthguard has been shown to increse flexibility and balance in athletes. A Rutger's study confirmed this. I have frequently seen normalization in pain and function in patients treated with neuromuscular orthotics but these are subjective improvements. This "virtual reality assesment" may be a more objective method to measure improvement in neck function following rehabilatative medicine, physical therapy, chiropractic or osteopathic adjustments and TMD treatment.
Arch Phys Med Rehabil. 2010 Dec;91(12):1884-90.
The effect of neck pain on cervical kinematics, as assessed in a virtual environment.
Bahat HS, Weiss PL, Laufer Y.
Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.
Abstract
Sarig Bahat H, Weiss PL, Laufer Y. The effect of neck pain on cervical kinematics, as assessed in a virtual environment.
OBJECTIVE: To compare cervical kinematics during functional motion in patients with neck pain and in asymptomatic participants using a novel virtual reality assessment.
DESIGN: Clinical comparative trial.
SETTING: Participants were recruited from university staff and students, and from a local physical therapy clinic.
PARTICIPANTS: Patients with chronic neck pain (n=25) and asymptomatic participants (n=42).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Kinematic measures (response time, peak and mean velocity, number of velocity peaks, time to peak velocity percentage) were sampled while participants were engaged in the virtual game. Group and motion direction differences were assessed with a 2-way repeated-measures analysis of variance, Tukey-Kramer testing, and contrast analysis when relevant.
RESULTS: Participants with neck pain had lower peak and mean velocities than the asymptomatic participants (P<.0001). They also demonstrated a greater number of velocity peaks, indicating impaired motion smoothness (P=.0036). No significant group differences were found for response time or for time to peak velocity percentage. Cervical rotations were significantly faster and smoother than flexion and extension movements (P<.05). The overall impairment percentage in velocity and smoothness of cervical motion in patients with neck pain ranged from 22% to 44% compared with asymptomatic participants.
CONCLUSIONS: Velocity and smoothness of cervical motion were more restricted in patients with chronic neck pain than found previously. Unlike range of motion and other static measurements, these dynamic variables reflect functional cervical motion and therefore contribute to a better understanding of the impairment associated with neck pain. Because the ability to move quickly in response to external stimuli is a commonly occurring phenomenon, this deficit is highly relevant to clinical assessment and management.
Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 21112430 [PubMed - in process]
The article concludes "Velocity and smoothness of cervical motion were more restricted in patients with chronic neck pain than found previously. Unlike range of motion and other static measurements, these dynamic variables reflect functional cervical motion and therefore contribute to a better understanding of the impairment associated with neck pain. Because the ability to move quickly in response to external stimuli is a commonly occurring phenomenon, this deficit is highly relevant to clinical assessment and management."
The unanswered question is whether the limitation and pain have a common orgin or if the pain is the cause of the changes noted. If the pain alone causes these changes than more debilitating problems would occur over time. An interesting follow-up study would be to examine changes after treatment of pain.
The PPM, Pure Power Mouthguard has been shown to increse flexibility and balance in athletes. A Rutger's study confirmed this. I have frequently seen normalization in pain and function in patients treated with neuromuscular orthotics but these are subjective improvements. This "virtual reality assesment" may be a more objective method to measure improvement in neck function following rehabilatative medicine, physical therapy, chiropractic or osteopathic adjustments and TMD treatment.
Arch Phys Med Rehabil. 2010 Dec;91(12):1884-90.
The effect of neck pain on cervical kinematics, as assessed in a virtual environment.
Bahat HS, Weiss PL, Laufer Y.
Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.
Abstract
Sarig Bahat H, Weiss PL, Laufer Y. The effect of neck pain on cervical kinematics, as assessed in a virtual environment.
OBJECTIVE: To compare cervical kinematics during functional motion in patients with neck pain and in asymptomatic participants using a novel virtual reality assessment.
DESIGN: Clinical comparative trial.
SETTING: Participants were recruited from university staff and students, and from a local physical therapy clinic.
PARTICIPANTS: Patients with chronic neck pain (n=25) and asymptomatic participants (n=42).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Kinematic measures (response time, peak and mean velocity, number of velocity peaks, time to peak velocity percentage) were sampled while participants were engaged in the virtual game. Group and motion direction differences were assessed with a 2-way repeated-measures analysis of variance, Tukey-Kramer testing, and contrast analysis when relevant.
RESULTS: Participants with neck pain had lower peak and mean velocities than the asymptomatic participants (P<.0001). They also demonstrated a greater number of velocity peaks, indicating impaired motion smoothness (P=.0036). No significant group differences were found for response time or for time to peak velocity percentage. Cervical rotations were significantly faster and smoother than flexion and extension movements (P<.05). The overall impairment percentage in velocity and smoothness of cervical motion in patients with neck pain ranged from 22% to 44% compared with asymptomatic participants.
CONCLUSIONS: Velocity and smoothness of cervical motion were more restricted in patients with chronic neck pain than found previously. Unlike range of motion and other static measurements, these dynamic variables reflect functional cervical motion and therefore contribute to a better understanding of the impairment associated with neck pain. Because the ability to move quickly in response to external stimuli is a commonly occurring phenomenon, this deficit is highly relevant to clinical assessment and management.
Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 21112430 [PubMed - in process]
Monday, February 8, 2010
Sleep Apnea Appliances Can Help Resolve TMJ Clicking and Improve Headache Symptoms
Patients with morning headaches usually have either TMJ disorders or Sleep Apnea. Sleep Apnea can be treated with CPAP or an Oral Appliance. Patients who have TM Joint clicking and are undergoing treatment for headaches or TMD can benefit in several ways from having a night-time apnea appliance and a daytime neuromuscular orthotic.
A problem that is sometimes encountered with oral appliances for sleep apnea are undesired bite changes. These changes can actually be helpful when treating TMJ clicking and popping and headaches. The bite changes that occur are actuallly the healing of the TM Joint. The jaw usually postures forward unloadding the retrodiscal lamina of the TM Joint that is compressed in patients with clicking. The retrodiscal lamina rehydrates and does not let the condyle go into retrusive pathology which serves to stabilize the disk.
The Daytime appliance allows this position to stabilize and heal. In patients who are not undergoing treatment exercises are done to prevent this healing from occuring. The joints will frequently heal if placed in a healthy position. A recent paper showed no damage to the joints with sleep appliances.
The American Academy of Sleep Medicine recommends that dentists fitting patients with oral appliances for sleep apnea be well versed in treating TMJ disorders. There are many good reasons for this recomendation. Dentists who do not uderstand how bite changes affect the joints and the muscles as well as head posture can create difficult problems they do not have the expertise to treat. Please check my I HATE CPAP website (http://www.ihatecpap.com) for more information about the dangers of sleep apnea and on how oral appliances are used in treating sleep apnea.
A problem that is sometimes encountered with oral appliances for sleep apnea are undesired bite changes. These changes can actually be helpful when treating TMJ clicking and popping and headaches. The bite changes that occur are actuallly the healing of the TM Joint. The jaw usually postures forward unloadding the retrodiscal lamina of the TM Joint that is compressed in patients with clicking. The retrodiscal lamina rehydrates and does not let the condyle go into retrusive pathology which serves to stabilize the disk.
The Daytime appliance allows this position to stabilize and heal. In patients who are not undergoing treatment exercises are done to prevent this healing from occuring. The joints will frequently heal if placed in a healthy position. A recent paper showed no damage to the joints with sleep appliances.
The American Academy of Sleep Medicine recommends that dentists fitting patients with oral appliances for sleep apnea be well versed in treating TMJ disorders. There are many good reasons for this recomendation. Dentists who do not uderstand how bite changes affect the joints and the muscles as well as head posture can create difficult problems they do not have the expertise to treat. Please check my I HATE CPAP website (http://www.ihatecpap.com) for more information about the dangers of sleep apnea and on how oral appliances are used in treating sleep apnea.
Glasses and Headache Treatment: How your Optician can help relieve your Occipital and Neck Pain
An Optician can be a vital team member when it comes to treating headache pain. An Optometrist is a specialist in prescribing contanct lenses and glasses which can frequently help headaches coming from eye strain. An Opthamologist is a MD who specializes in diseases of the eyes and will do surgical interventions when necessary. Opthamologists can prescribe medications and prescribe contacts and glasses.
The Optician is offered considered someone who sells glasses but can often be the most important member of the team when treating occiptital (back of head) headaches and neck pain. Patientw will frequently cause neck pain by poor posture when working in various conditions. A sharp Optometrist can angle the lenses on glasses in order to correct postual problems. An example would be tipping the lenses on an angle so the head must be upright to read from a desk thus preventing patients tipping their necks excessively causing cervical muscle spasm and occipital pain. The same holds true when using a computer of other tasks that glasses can effect head position.
In the textbook Myofascial Pain and Dysfunction: A Trigger Point Manual by Travell and Simons there is are excellent examples of how head posture can be affected by activities and how specially fitted glasses can correct these problems. My family I have used Brian Scott of Doyle opticians in Deerfield for many years and I refer patients to him frequently.
The informed optician can frequently make a enormous difference in patients neck pain.
The Optician is offered considered someone who sells glasses but can often be the most important member of the team when treating occiptital (back of head) headaches and neck pain. Patientw will frequently cause neck pain by poor posture when working in various conditions. A sharp Optometrist can angle the lenses on glasses in order to correct postual problems. An example would be tipping the lenses on an angle so the head must be upright to read from a desk thus preventing patients tipping their necks excessively causing cervical muscle spasm and occipital pain. The same holds true when using a computer of other tasks that glasses can effect head position.
In the textbook Myofascial Pain and Dysfunction: A Trigger Point Manual by Travell and Simons there is are excellent examples of how head posture can be affected by activities and how specially fitted glasses can correct these problems. My family I have used Brian Scott of Doyle opticians in Deerfield for many years and I refer patients to him frequently.
The informed optician can frequently make a enormous difference in patients neck pain.
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