What Pain Disorders Are Confused With Tmj


Temporal tendonitis has been called "The Migraine Mimic" because so many symptoms are similar to migraine headache pain. Symptoms include: TMJ pain, ear pain and pressure, temporal headaches, cheek pain, tooth sensitivity, neck and shoulder pain. Treatment consists of injecting local anesthetics and other medications, a soft diet, using moist heat, muscle relaxants and anti-inflammatory medications, and physiotherapy. Only rarely (in approximately 4% of cases) is surgery needed.


This TMJ-like problem involves the stylomandibular ligament, at tiny structure that connects the base of the skull with the mandibular, or lower jaw. If injured, this structure can produce pain in as many as seven specific regions of the face, head and neck: the temple, the TMJ, the ear, the cheek, the eye; the throat, especially when swallowing, and the lower back teeth and jaw bone. Treatment of Ernest syndrome, which is successful about 80% of the time, consists of injections of local anesthetic and medication (cortisone or Sarapin), physiotherapy, and at times, the use of an intraoral splint.


Occipital neuralgia is generally ignored in the medical textbooks. This disorder is characterized by pain located in the cervical and posterior regions of the head (these are the occipital areas) which may or may not extend or radiate into the sides of the head and ultimately, into the facial and frontal regions. There are actually two major types of occipital neuralgia: lesser occipital and greater occipital, with the lesser type being more common.


Trigeminal neuralgia is a terrible disorder of the trigeminal, or fifth cranial nerve. This is one of the most painful problems that plagues human beings. In fact, its description first appeared in the scientific literature in 1672. Another common name for trigeminal neuralgia is tic douloureux which literally means unbearably painful twitch . Far too often, when a person is suffering with severe facial pain with no apparent cause, the diagnosis given is trigeminal neuralgia. Because of this, the patient may be subjected to medications and even very serious surgical procedures which are not necessary. The symptoms of tic douloureux are very characteristic: sharp electrical pain which lasts for seconds. This pain is triggered by touching a specific area of the skin by washing, shaving, applying makeup, brushing the teeth, kissing, or even cold air. The second division of the trigeminal nerve (the maxillary division), which supplies feeling to the mid-face, upper teeth and palate, seems to involved most. The pain is so severe that the sufferer will do virtually anything to avoid touching the trigger zone, producing the pain.


In contrast to the typical type, atypical trigeminal neuralgia seems to cause pain constantly with the intensity increasing and decreasing. There are trigger zones with this type; however, there also is an area of dull aching which is intensified by touching the trigger zones. All three divisions of the trigeminal nerve seems to be affected equally. A common cause of this disorder is trauma, especially after a surgical incision or blow to the face.


Atypical facial pain is a disorder that also affects the trigeminal nerve. However, the symptoms are not clearly defined as they are in typical and atypical trigeminal neuralgia. Atypical facial pain seems to affect people who are under a tremendous amount of stress and may even have a history of psychiatric problems. This does not mean that one suffering with atypical facial pain is mentally ill. We who treat this problem need to do much more research to understand this terrible disorder.

NICO (Neuralgia Inducing Cavitational Osteonecrosis)

As recent as 1979, a newly described pain disorder was reported. This disorder, which came to be known as osteocavitational lesions (Ratner's bone cavities,) produced pain similar to trigeminal neuralgia, both the typical and atypical types. In fact, usually these patients were diagnosed with trigeminal neuralgia. The diagnosis is complicated by the fact that the x-ray examination of the bone is usually normal. Also, NICO produces referred pain patterns which also serve to confuse both patient and doctor. However, just like trigeminal neuralgia, there are trigger areas that, when pressed, produce pain. These trigger areas develop directly over the areas of dead bone. The mandible is affected more often than the upper jaw. One important aspect of NICO is a history of tooth extraction usually years earlier. Any tooth may be involved. However, lower back teeth seem to be most common. Small areas of bone actually die, producing neuralgia-like pain symptoms. It appears that after a tooth extraction, NICO may develop due to injury of the blood vessels in the area which ultimately results in poor circulation, resulting in bone death in some cases. Pathologically, this is termed osteomyelitis. This bone infection, which can result in bone death, has been known for years. Yet, in the form of NICO, it is a newly described problem.

Dr Wilk has published an excellent research paper on treatment of these painful disorders. To request a copy of this, send a check for $7.95 to 3540 S. Poplar St., Suite #301 Denver
CO 80237 303.758.4865.

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