IncobotulinumtoxinA Injection for Temporomandibular Joint Disorder

2017 ◽  
Vol 126 (4) ◽  
pp. 328-333 ◽  
Author(s):  
Amit A. Patel ◽  
Michael Z. Lerner ◽  
Andrew Blitzer
Keyword(s):  
Temporomandibular Joint ◽  
Temporomandibular Disorder ◽  
Masticatory Muscles ◽  
Pain Scale ◽  
Pain Medication ◽  
Saline Injection ◽  
Pain Scores ◽  
Patient Reported ◽  
Joint Disorder ◽  
Muscles Of Mastication

Objectives: Temporomandibular disorder (TMD) involves dysfunction of the temporomandibular joint and associated muscles of mastication causing pain with chewing, limitation of jaw movement, and pain. While the exact pathophysiology of TMD is not completely understood, it is thought that hyperfunction of the muscles of mastication places stress on the temporomandibular joint, leading to degeneration of the joint and associated symptoms. We hypothesize that chemodenervation of the muscles of mastication with IncobotulinumtoxinA (Xeomin) will decrease the stress on the temporomandibular joint and improve pain associated with temporomandibular joint and muscle disorder (TMJD). Methods: Twenty patients were randomized to IncobotulinumtoxinA (170 units) or saline injection of the masticatory muscles. Patient-reported pain scale (0-10) was recorded at 4-week intervals following injection for 16 weeks. Patients who received saline injection initially were assessed for reduction in pain at the first 4-week interval and if still had significant pain were rolled over into the IncobotulinumtoxinA arm. Results: Preinjection pain scores were similar between patients. While there was a statistically significant reduction in pain score in the placebo group one month, there was an overall larger drop in average pain scores in those patients injected with IncobotulinumtoxinA initially. All patients initially injected with placebo crossed over into the IncobotulinumtoxinA group. Similar results were seen when examining the composite masticatory muscle tenderness scores. There was no significant change in usage of pain medication. Conclusions: We demonstrate utility of IncobotulinumtoxinA in treating patients with TMD with pain despite pain medication usage and other conventional treatments.

scholarly journals Temporomandibular Disorders and Bruxism Prevalence in a Portuguese Sample

2021 ◽  
Vol 5 (1) ◽  
pp. 37
Author(s):  
João Belo ◽  
André Almeida ◽  
Paula Moleirinho-Alves ◽  
Catarina Godinho
Keyword(s):  
Temporomandibular Joint ◽  
Temporomandibular Disorders ◽  
Temporomandibular Disorder ◽  
Masticatory Muscles ◽  
Diagnostic Aspects ◽  
Relevant Role

Temporomandibular disorder (TMD) encompasses a set of disorders involving the masticatory muscles, the temporomandibular joint and associated structures. It is a complex biopsychosocial disorder with several triggering, predisposing and perpetuating factors. In the etiology of TMD, oral parafunctions, namely bruxism, play a relevant role. The study of bruxism is complicated by some taxonomic and diagnostic aspects that have prevented achieving an acceptable standardization of diagnosis. The aim of this study was to analyze the prevalence of temporomandibular disorders and bruxism in a Portuguese sample.

Considering Depression and Anxiety as Risk Factors for Temporomandibular Joint Disorder

2020 ◽  
pp. 152-159
Author(s):  
Stefan Kindler ◽  
Marike Bredow-Zeden
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Temporomandibular Joint ◽  
Facial Pain ◽  
Masticatory Muscles ◽  
Depression And Anxiety ◽  
Temporomandibular Joint Disorder ◽  
Social Emotional ◽  
Symptoms Of Depression ◽  
Joint Disorder

Temporomandibular joint disorder (TMD) is a painful functional disorder of the temporomandibular joint, masticatory muscles, and associated musculoskeletal structures of the head and neck. TMD is a type of chronic pain and is widely used as a model for chronic pain. The etiology of TMD pain is multifactorial. Biological, behavioral, environmental, social, emotional, and cognitive factors can contribute to TMD. TMD can manifest with musculoskeletal facial pain complaints and with different forms of jaw dysfunction. Biobehavioral studies suggest an association between TMD pain and coexisting psychopathology, including depression and anxiety. This chapter presents practical clinical recommendations on how to treat patients with symptoms of depression, anxiety, and TMD pain. The authors underline the importance of considering depression and anxiety as risk factors for TMD.

scholarly journals Cervical and scapular instability in subjects with temporomandibular disorder

2020 ◽  
pp. 1-5
Author(s):  
Maryllian de Albuquerque Vieira ◽  
Maria das Graças Rodrigues de Araújo ◽  
Gabriel Barreto Antonino ◽  
Angélica da Silva Tenório ◽  
Maria das Graças Paiva ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Temporomandibular Disorder ◽  
Neck Disability Index ◽  
Shoulder Girdle ◽  
Masticatory Muscles ◽  
Control Group ◽  
Cervical Instability ◽  
Mobility Data ◽  
Significant Difference ◽  
Neck Disability

Background: Temporomandibular disorder (TMD) is a set of disorders involving the masticatory muscles, the temporomandibular joint (TMJ) and/or the associated structures. Objectives: To evaluate the occurrence of cervical and scapular instability in subjects with TMD. Methods: A total of 22 patients participated in the study, being 11 of them with TMD, selected using the RDC/TMD criteria, and 11 in the control group. The stabilization capacity of the neck muscles was evaluated through StabilizerTM and the muscles of the shoulder girdle through specific tests. Cervical mobility data from both groups were provided using the accelerometer while for cervical disability was used the Neck Disability Index (NDI) questionnaire. Results: Cervical instability was higher in the TMD group (20.36 ± 3.2) than in the control group (28.54 ± 0.8), revealing significant difference (p= 0.03). The highest percentages of scapular stabilization tests were found in subjects with TMD, (n= 9; 81.81%) when compared with control subjects (n= 5; 45.45%). The NDI results showed that the TMD group presented mild cervical incapacity (11.18 ± 2) and the control presented no disability (2.27 ± 0.4; p= 0.001). Conclusion: Cervical disability, and cervical and scapular instability were more frequent in subjects with TMD.

scholarly journals The Use of Long Acting Opioids to Prevent Rebound Pain Following Peripheral Nerve Blocks for Outpatient Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Leah Herzog ◽  
Sylvia H. Wilson ◽  
Christopher E. Gross
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Pain Medication ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Pain Scores ◽  
Ankle Surgery ◽  
Patient Reported ◽  
Long Acting

Category: Ankle; Bunion Introduction/Purpose: Peripheral nerve blocks have become an integral part of orthopedic surgery to assist with postoperative pain. However, 40% of patients who undergo a peripheral nerve block will experience rebound pain, which in turn, long-acting narcotics may be able to block. Unfortunately, this rebound pain can cancel out the potential benefits of decreased opioid medication use. Therefore, this study seeks to compare the difference in patient reported pain scores in those patients whom received long-acting opioid pain medication and those who did not. Methods: This is a retrospective review of patient-reported pain scores for 96 patients who underwent a peripheral nerve block for outpatient foot and ankle surgery. 48 patients either received three days of long-acting opioids or did not. Each patient was asked to fill out and return a pain diary as well as fill out a pain catastrophizing survey (PCS) at their postoperative appointment. The pain diary discussed their Visual Analogue Scale pain scores, amount of pain medication, and time they took the medicine. This data was then collected and compared via paired student t-tests for evaluation of significance. Results: Pain diaries were completed by 69 patients (72%). There were no significant differences between those comorbidities, types of procedures, age, or BMI between the groups. Mean postoperative pain scores did not differ between patients that did and did not receive postoperative extended release opioid medications (p = 0.226). Mean opioid consumption did not differ between groups (p = 0.945). There were no correlations between daily reported pain scores or the postoperative day with the highest pain score for those who received long acting opioid pain medication versus those who did not (r=0.336, p=0.550). Conclusion: Rebound pain is a difficult potential side effect of peripheral nerve blocks that currently does not have a preventative measure. This study was an attempted effort to help eliminate rebound pain, but there did not appear to be a significant benefit to adding long-acting opioid pain medication in addition to the peripheral nerve block and short-acting pain medication

scholarly journals Detailing postoperative pain and opioid utilization after periacetabular osteotomy with automated mobile messaging

2019 ◽  
Vol 6 (4) ◽  
pp. 370-376
Author(s):  
Christina Hajewski ◽  
Chris A Anthony ◽  
Edward O Rojas ◽  
Robert Westermann ◽  
Michael Willey
Keyword(s):  
Postoperative Pain ◽  
Response Rate ◽  
Periacetabular Osteotomy ◽  
Pain Medication ◽  
Pain Level ◽  
Pain Scores ◽  
Medication Utilization ◽  
Patient Reported ◽  
Average Pain ◽  
Daily Pain

Abstract In the setting of periacetabular osteotomy (PAO), this investigation sought to (i) describe patient-reported pain scores and opioid utilization in the first 6 weeks following surgery and (ii) evaluate the effectiveness of postoperative communication using a robotic mobile messaging platform. Subjects indicated for PAO were enrolled from a young adult hip clinic. For the first 2 weeks after surgery, subjects received daily mobile messages inquiring about pain level on a 0–10 scale and the number of opioid pain medication tablets they consumed in the previous 24 h. Messaging frequency decreased to 3 per week in Weeks 3–6. Pain scores, opioid utilization and response rates with our mobile messaging platform were quantified for the 6-week postoperative period. Twenty-nine subjects underwent PAO. Twenty-one had concurrent hip arthroscopy. Average daily pain scores decreased over the first four postoperative days. Average pain scores reported were 5.9 ± 1.9, 4.1 ± 3.3 and 3.0 ± 3.5 on Day 1, Day 14 and Week 6, respectively. Reported opioid tablet utilization was 5.0 ± 3.2, 2.2 ± 2.0 and 0.0 ± 0.0 on Days 1 and 14 and at 6 weeks. Response rate for participants completing the 6-week messaging protocol was 84.1%. Patient-reported pain scores decreased over the first two postoperative weeks following PAO before plateauing in weeks 3–6. Opioid pain medication utilization increased in the first postoperative week before gradually declining to no tabs consumed at 6 weeks after PAO. Automated mobile messaging is an effective method of perioperative communication for the collection of pain scores and opioid utilization in patients undergoing PAO.

The role of elastic bands (kinesiotapes) in complex therapy of patients with temporomandibular joint osteoarthrosis

2021 ◽  
pp. 75-85
Author(s):  
E. A. Bulycheva ◽  
M. A. Postnikov ◽  
D. S. Bulycheva
Keyword(s):  
Temporomandibular Joint ◽  
Exercise Therapy ◽  
Comparison Group ◽  
Mouth Opening ◽  
Masticatory Muscles ◽  
Pain Scale ◽  
Main Group ◽  
Treatment Methods ◽  
Elastic Bands ◽  
Opening Width

Introduction. Temporomandibular joint (TMJ) arthrosis is a chronic disease, characterized by dystrophic and degenerative changes in TMJ with aseptic inflammatory process. The prevelence of TMJ arthrosis in patients with a history of other TMJ disorders varies between 32-39 % of cases. Complex treatment of TMJ arthrosis includes pharmacotherapy, physiotherapy, exercise therapy for TMJ and massage of the masticatory muscles, manual therapy, prosthodontics, but these treatment methods are not always lead to a desired result.The aim of the study is to improve the traditional treament method of patients suffering from TMJ arthrosis by using elastic tapes (kinesiotapes).Materials and methods. 68 patients were examined at the «Galaxy» Beauty Institute Clinic (St. Petersburg) and FSBEI HE SamSMU MOH Russia (Samara). Comparison group of patients was prescribed pharmacotherapy, exercise therapy for TMJ and massage of masticatory muscles, while for the main group of patients the same therapy was enhanced by elastic bands. The effectiveness of therapy was evaluated using a visual-analog pain scale (VAS), mouth opening width and electromyography of the masticatory muscles.Results. Noticeable positive effect in the main group of patients was observed on the 21th day of treatment. By this time patients noticed significant decrease in pain intensity from 8,77±0,8 to 5,19±0,5 (Z1-4=-5,88; p1-4=0,0015) points as well as increase in mouth opening width from 21-23 to 33-35 mm. Similar changes in the comparison group of patients were achieved only by the beginning of fifth week of treatment (Z1-6=-5,58; p1-6=0,0015). The range of mouth opening width increased from 21-23 to 27-29 mm. Amplitude of masticatory muscles biopotentials in maximum intercuspation in patients of the main group almost approached to the normal results by the beginning of the fourth week. In patients of the comparison group the amplitude of masticatory muscles biopotentials remained reduced even by the end of observations (42 day of the study).Conclusion. Thus, the combination of elastic bands applications with conventional treatment methods of TMJ arthrosis greatly increases the effectiveness of therapy and allows to relief pain and normalize bioelectric activity of masticatory muscles in a relatively short time. Due to the simplicity of elastic bands application it is possible to teach patients the technique of self-applying bands and recommend to use them as a prevention of relapse of TMJ arthrosis.

scholarly journals Evaluation of occlusal factors in patients with temporomandibular joint disorder

2012 ◽  
Vol 17 (6) ◽  
pp. 61-68 ◽  
Author(s):  
Max Dória Costa ◽  
Gontran da Rocha Torres Froes Junior ◽  
Carlos Neanes Santos
Keyword(s):  
Temporomandibular Joint ◽  
Temporomandibular Disorder ◽  
Open Bite ◽  
Control Group ◽  
Temporomandibular Joint Disorder ◽  
Posterior Teeth ◽  
Posterior Crossbite ◽  
Asymptomatic Volunteers ◽  
Anterior Guidance ◽  
Joint Disorder

OBJECTIVE: The aim of this study was to determine the prevalence and the relation between the main occlusal factors and the temporomandibular disorder (TMD). METHODS: We analyzed 100 patients (50 diagnosed with TMD and 50 asymptomatic volunteers, control group) through a questionnaire that classified TMD as absent, mild, moderate and severe. Then, an evaluation was made of intraoral occlusal factors: Absence of posterior teeth, wear facets, overjet, overbite, open bite, posterior crossbite, sagittal relationship (Class I, II and III), centric relation discrepancy for maximum intercuspation, anterior guidance and balancing occlusal interference. The c² examined the association between TMD and considered occlusal variables. RESULTS: The prevalence of studied occlusal factors was higher in patients with moderate and severe TMD. Statistically significant results were found on: Absence of five or more posterior teeth, overbite and overjet greater than 5 mm, edge-to-edge bite, posterior crossbite, Class II and III, the absence of effective anterior guide and balancing side interferences. CONCLUSIONS: Indeed, it is concluded that there is a relationship between TMD and occlusal factors, however it can not be told to what extent these factors are predisposing, precipitating or perpetuating the disease. Therefore, despite its multifactorial etiology, one can not neglect the occlusal analysis of these patients.

scholarly journals Standardized mastication increases the coordination in masticatory activity in women with chronic temporomandibular joint disorders: a case control study.

2020 ◽  
pp. 1-7
Author(s):  
Carlos Eduardo Fassicollo ◽  
Maylli Daiani Graciosa ◽  
Daiane Lazzeri de Medeiros ◽  
Licerry Palma Soares ◽  
Luis Mochizuki ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Motor Pattern ◽  
Movement Pattern ◽  
Masticatory Muscles ◽  
Temporomandibular Joint Disorders ◽  
Electromyographic Activity ◽  
Emg Signal ◽  
Joint Disorder ◽  
Agonist And Antagonist ◽  
And Control

Background: The effects of jaw movement pattern on masticatory activity during chewing remains unclear in chronic temporomandibular joint disorders individuals. Objective: to assess the effect of habitual and non-habitual mastication patterns based upon the activation of the masseter and temporalis muscles in individuals with or without temporomandibular joint disorder (TMJD). Methods: Fifty-four participants (age: 18–44 years) were divided into two groups: the TMJD (n=27) and control (n=27) groups. TMJD was identified using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Electromyographic activity of the masticatory muscles was measured during 2 tasks: habitual mastication with parafilm (HM) and non-habitual mastication with parafilm (NHM). MATLAB software was used to process electromyography (EMG) signals. The root mean square, symmetry index (SI%), anteroposterior coefficient (APC%) and torque coefficient (TC%) were determined from the processed EMG signal. Results: Reduced right masseter activation was observed for the TMJD group (p<0.05) during jaw agonist phase. During the jaw agonist phase, all muscles presented with more activation during NHM. Symmetry of temporalis (ST%) and APC% were the lowest for HM. TC% was increased for HM. Conclusion: Habitual and non-habitual mastication differ in masticatory activity during jaw agonist and antagonist phase and TMJD individuals presented a different way to recruit muscles under these circumstances. Non-habitual mastication has a more coordinating and stable motor pattern in masticatory activity and has less variability than habitual mastication to assess masticatory activity.

scholarly journals Pain scores among ED patients: correlation with desire for pain medication

2014 ◽  
Vol 1 ◽  
pp. 1-4
Author(s):  
Catherine A. Marco ◽  
Megan McGervey ◽  
Joan Gekonde ◽  
Caitlin Martin
Keyword(s):  
Emergency Department ◽  
Pain Scale ◽  
Pain Medication ◽  
Survey Study ◽  
Insurance Status ◽  
Pain Scores ◽  
Pain Medications ◽  
Lower Pain ◽  
Ed Visits ◽  
Emergency Department Patients

Introduction: Pain has been identified as the most common reason for Emergency Department (ED) visits. The verbal numeric rating pain scale (VNRS) is commonly used to assess pain in the ED. This study was undertaken to determine whether VNRS pain scores correlate with desire for pain medication among ED patients. Methods: In this prospective survey study, eligible patients included Emergency Department patients over 18 with painful conditions.  The primary outcome measures included self-reported VNRS, ED diagnosis, number of ED visits and number of ED admissions within the past year, and the self-reported desire for pain medication. Results: Among 482 participants in 2012, the median triage pain score was 8 (IQR 6-10); the most frequently occurring score was 10. Overall, there were significant differences in pain scores with patient desire for analgesics. 67% reported desire for pain medications. Patients who did not want pain medications had significantly lower pain scores (median 6; IQR 4-8) compared to those who wanted medication (median 8; IQR 7-10) (p<0.001) and compared to those who were ambivalent about medication (median 7; IQR 6-10) (p=0.01). There was no association between desire for pain medication and demographics including age, gender, race, or insurance status. Conclusions: ED patients who did not desire pain medication had significantly lower pain scores than patients who desired pain medication. Pain scores usually effectively predicted which patients desired pain medications.  Desire for pain medication was not associated with age, gender, race, or insurance status. 

Improved acute pain management in oncology patients using early scheduled contact with a pain coach.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 293-293
Author(s):  
Johanna M. LaSala ◽  
Anne C. Chiang ◽  
Kimberly M Severino
Keyword(s):  
Pain Control ◽  
Short Interval ◽  
Pain Scale ◽  
Record Keeping ◽  
Pain Diary ◽  
Pain Scores ◽  
Ambulatory Oncology ◽  
Patient Reported ◽  
Oncology Practice ◽  
Control Pain

293 Background: Pain control is a challenging balance in the ambulatory oncology practice. Standard methods of pain reassessment resulted in poor pain control in the majority of patients given prescriptions for narcotics. We developed a proactive reassessment of pain using patient reported outcomes and a coach to assist in medication usage. The aim was to decrease the time to reassessment of pain to fewer than 5 days and achieve acceptable pain control in greater than 50% of patients receiving new narcotic prescriptions in an ambulatory oncology setting. Methods: Patients receiving a new narcotic prescription or a new dose were provided with a pain diary and an appointment with their pain coach at 48 hours. Using a standard pain scale 1-10, patients’ pain scores were recorded by the patient in their pain diary and communicated via nurse/patient phone contact at 48 hour intervals. Dosing intervention by the patient’s oncologist was made for unacceptable pain and reassessed at 48 hours. Uncontrolled pain at 96 hours was followed by in person appointment with the oncologist. Pain scores and days to reassessment were recorded using an Excel data collection tool for patients receiving new or dose adjusted narcotic prescriptions between August and December31, 2017. Results: There were 17 patients encounters where the patient received a new prescription or a dose change from August 1- Dec 31, 2017. Reassessment of pain was achieved in 100% of patients in fewer than 5 days. The average time was 2.6 days (range 2-4). Acceptable pain control (pain scores 0-3) at the time of reassessment was achieved in 53% of patients. Conclusions: Cancer related pain is an ongoing challenge in oncology practices. Barriers include lack of planned follow-up and patient education. The institution of a pain coach, pain diary and scheduled contact decreased the time to reassessment of pain and decreased pain scores during short interval reassessment periods achieving better pain control in 50% of patients during the evaluated period. Quality interventions in ambulatory settings are achievable though multiple patient interactions and record keeping require additional staffing resources to sustain this change.

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