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Title: Management Of Chronic Pain Of Temporomandibular Joint (TMJ) With Neural (Steroid Injections) And Muscular Interventions [Ultrasonography Guided Dry Needling (USG DN)]- A Case Report
e-poster Number: INSIM106
Category: Pain
Author Name: Dr Jain Roma
Institute: Topiwala National Medical College And Bai Yamunabai Laxman Nair Charitable Hospital
Co-Author Name: Dr Varsha S Suryavanshi, Dr Harshwardhan Tikle, Dr Sarita Fernandis, Dr Trupti Kamble, Dr Snehal Ingole, Dr Pallavi Randive
Abstract :
Aim: To present a novel perspective of treatment of TMJ pain with existing neuromodulation techniques.
Introduction: 21 years, male with bilateral TMJ pain, continuous, aching (VRS 8/10) with clicking sounds for 6 years, unable to eat solid food (chapatti), pain on talking, maximum mouth opening was 2 finger breadths due to pain; received pain killers with four TMJ steroid injections from dental surgeons with which transient pain relief achieved but clicking sounds persisted.
Methods: Started with oral pregabalin 75 mg OD, myospas (paracetamol and chlorzoxazone) BD. After 7 days, 40% pain relief achieved but clicking sounds persisted. USG DN started with 32G solid needles once a week, which addressed the muscles of mastication and neck.
Results: Resting twitches, which increased on USG DN of masseter, lateral pterygoid and temporalis, were found. After 1 session, 60% relief in both pain and clicking sounds achieved.
Complete relief from pain and clicking sounds achieved after 3 sessions. After 3 months of 6 USG DN sessions and tapering of pregabalin, patient could eat solid food and talk comfortably.
Discussion: Cause of pain and clicking sounds was probably due to generation of myofascial trigger points in neck and masticatory muscles.
USG DN produces local twitch reflexes in muscles which leads to relaxation with reduction in pain and disability. Whereas use of pain killers, steroid, opioids and neural interventions reduces only pain.
Conclusion: Considering TMJ pain as neuromyopathy, combined approach of neuromodulation and USGDN gives uniform lasting pain relief and also improves disabilities.
