05 Jul The Diagnostic Evaluation of Referred Jaw, Temporal, and Facial Pain in Sarasota, Florida.
by Scott Greenburg, M.D.
Patients who present with sinus pain and pressure or who describe constant pain in the jaw, temple or temporomandibular joint should be evaluated for referred pain. Referred pain or the sensation of pain in an area distant from its origin is commonly seen in patients whose leg pain originates from the back or in an amputee who suffers from phantom limb pain. While sciatica is diagnosed more frequently than referred jaw and facial pain, its occurrence is quite common.
While a lot of the time a TMJ specialist will be needed for most cases of jaw pain, many cases of jaw and facial pain and headaches unresponsive to traditional measures such as analgesics, night guards, bite plates, or antibiotics for sinusitis can be traced to the occiput, cervical facet joints, cervical interspinous ligaments, and the trapezium.
Patients should be fully evaluated by physical examination including but not limited to the strength of the arm and hands, integrity of the cranial nerves, sensory nerves and deep tendon reflexes, and range of motion of the neck. Furthermore, careful evaluation of the cervical facets, occiput, interspinous ligaments, and trapezium should be performed by a physician skilled in diagnosis and treatment of such injuries. Injury in the latter regions, caused either by trauma, overuse, or degeneration is often responsible for causing headaches, jaw aches, and facial pain.
Cervicocranial syndrome (Barre-Lieou syndrome) can also occur from injury to the cervical facet joints. This syndrome is often manifest by a variety of findings such as vertigo, tinnitus, visual blurring, nasal stuffiness, and facial numbness.
Radiological studies such as plain radiographs and MRI may be useful in some cases of referred head, face, and jaw pain but often diagnose incidental findings that do not contribute to a patient’s pain syndrome. Findings such as degenerative disc disease, herniated cervical discs, or spinal arthritis may be incidental, as a significant percentage of the population (over 60% in some studies) demonstrate similar findings and remain asymptomatic. The author strongly believes that a careful physical examination with clinical correlation is paramount to diagnosis and treatment of referred pain problems and can help to spare the patient from the cost and inconvenience of further diagnostic studies, treatments, and unnecessary medications.
Treatment of referred pain should be directed to correcting the source of the problem. While analgesics, antidepressants, and anti-inflammatory drugs can help to temporarily eliminate chronic pain, they do not cure the underlying pain problem. In those with injury into the cervical facet joints, interspinous ligaments, trapezium, or occiput will likely benefit or be cured by Prolotherapy injections. Prolotherapy injections, placed directly into the fibro-osseus junction trigger the immune system to permanently rebuild and reorganize collagen tissue, thus regrowing damaged tendons and ligaments. Once this process is completed, the integrity of the joint is restored, and the patient’s chronic pain should be alleviated. Prolotherapy injections are the only documented treatment to restore joint, ligament, and tendon damage without surgery and can permanently cure the origin of referred facial, temporal, and jaw pain.
I agree that the These patients need repair of damaged ligaments and tendons. In addition to prolotherapy we find class 4 laser therapy (K-laser) to assist in post prolotherapy or even as a first line therapy.
What almost all doctors treating TMJ and facial pain don’t recognize is the shifting of the facial bones. This is often related and can be dramatic when corrected. When it boils down to it if a cranial adjustment fixes these problems, everything else is just a fancy patch job. The underlying problem with almost all TMJ patients is that the skull moves and the mandible can’t. It’s a fixed bone but the temporal bones that float outside of the sphenoid bone do move. When that happens they usually go from one side of the jaw and it shift off it’s tract. This puts stress on the ligaments, tendons and muscles. When that is Fixed, the rest will take care of itself. Even though we do prolotherapy at our office we often don’t need to perform them on most TMJ patients. NeuroCranial Restructuring is often the answer. Dr. Ross Hauser is also trained with NCR and performs it occasionally.
In our office I focus on NCR and Functional Neurology. Using treatments to balance the brain hemispheres can often help with these cases as well as the motor function and position sense can be effected and the Jaw is a common area it shows up often. If you have chronic pain and are having trouble finding help we may be your answer. Watch any one of the dozens of testimonials on FunctionalCranialRelease.com.