All posts by Dr. Glenn Clark

About Dr. Glenn Clark

Glenn Clark, DDS, MS is an expert on sleep apnea, orofacial pain and oral medicine, and Temporomandibular Joint Disorder (TMJ). Dr. Clark serves as the Director for the Advanced Program in Orofacial Pain and Oral Medicine at the Herman Ostrow School of Dentistry of USC.

Man grabbing his head in pain

Physical Medicine and Primary Headache Pain Disorders

Man grabbing his head in pain

A headache can be a small effect of a bigger primary headache disorder. These disorders include migraines, tension type headaches, cluster headaches, or medication-overuse headaches.

There are treatments both with and without the use of physical medicine. Treatment methods without the use of physical medicine vary in levels of success and pain relief.

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Women grabbing her back from pain in the spine

Causes of Multiple Sclerosis

Women grabbing her back from pain in the spine

Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system, specifically the brain and spinal cord. This disease affects women twice the amount as men. Onset commonly occurs between ages 20 and 50 years.

There are many negative consequences of multiple sclerosis. It is known to cause chronic neuroinflammation and demyelination. The cause of this disease remains unknown.

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Person grabbing wrist in pain from sympathetic pains

Three Types of Sympathetic Maintained Pain

Person grabbing wrist in pain from sympathetic pains

The idea that sympathetic pain exists is based on clinical findings seen in a small subset of patients suffering from neuropathic pain. Sympathetic pains occurs when the pain is clearly dependent on activity in the sympathetic nervous system. This is often referred to the ‘sympathetically maintained pains.’

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Silas Weir Mitchell, who lived from 1830 to 1914, was the first to describe sympathetically maintained pains. During the Civil War, he studied nerve injuries. He described these pathological states and causalgia.

 

Sympathetic pains are classified into three groups:

  1. Various Autonomic Dysfunctions
  2. NPP with sympathetic activation
  3. Complex Regional Pain Syndrome

 

Autonomic Dysfunctions

Autonomic dysfunctions develop when certain Autonomic Nervous System (ANS) nerves are damaged. There are multiple types of the dysfunctions. Once common type is Raynaud’s Disease.

Raynaud’s Disease is characterized by constriction of the blood vessels. It can be caused or provoked by exposure to cold or extreme emotional stress.

Related Reading: Does Emotional Approach Coping Ease Chronic Pain?

 

Complex Neuropathic Pain

Complex Neuropathic Pain (NPP with sympathetic activation) occurs when the pain is clearly aggravated by the sympathetic nervous system. For example, stress makes the pain more severe, and there is an enhanced vasoconstriction reaction associated with the
pain. Complex NPP is sometimes described as sympathetic maintained pain and is distinguished from CRPS in that SMP is not as severe and does not meet all of the criteria for CRPS-I or CRPS-II.

Related Reading: RGS4 Protein May Help Play a Role in Chronic Pain Maintenance

 

Complex Regional Pain Syndrome

There are two types of Complex Regional Pain Syndrome. The first is called Reflex Sympathetic Dystrophy (CRPS – I), commonly caused by an innocuous injury. The symptoms vary in duration and can develop over weeks or months. Sometimes, no symptoms can be identified. In CRPS – I, genetic predisposition is likely.

The second type is Causalgia (CRPS – II). This is caused by a clearcut nerve trunk injury. The onset of symptoms is immediate and obvious after the injury. The symptoms in CRPS – II are more severe than the symptoms of CRPS – I. Genetic predisposition is likely.

Related Reading: Understanding Complex Regional Pain Syndrome (CRPS)

 

Clinical Features of Sympathetic Pains

  • Allodynia (vibrational or thermal)
  • Disproportionate pain to injury
  • Periphery pain that spreads centrally
  • Contralateral side involvement
  • Color changes in affected limbs
  • Sweating in affected limbs
  • Cold periphery with vasoconstriction in affected limbs
  • Piloerection

Related Reading: Does Self-Compassion Help with Chronic Pain Management?

 

Earn a Master’s Degree in Orofacial Pain and Oral Medicine Online

Like what you’re learning?  Enroll in the Herman Ostrow School of Dentistry of USC’s online medicine and certificate program or 3-year Master’s program in Orofacial Pain and Oral Medicine.

 

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Woman sitting outside grabbing her jaw in pain

Alternative Medications to Uncommon TMJ Disorders

Woman sitting outside grabbing her jaw in pain

Motor Neurectomy

Motor neurectomy involves identifying the select branches of the motor nerve and perform radiofrequency lysis of the motor nerve itself. This will denervate a portion of the motor nerve and cause a resulting atrophy of the muscle. The area of the muscle that atrophies produce is irregular, and the resulting shape of the muscle is non-cosmetically acceptable.

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Man holding jaw in pain due to jaw disorder

Ankylosis and Facial Asymmetry Disorders

Man holding jaw in pain due to jaw disorder

High Condylectomy & Temporal Fascia Graft

In cases where the jaw opening ability is severely compromised due to ankylosis, it is necessary to perform surgical treatment of the TM joint. This involves a high condylectomy (removing approximately 4 mm on top of condyle) and grafting tissue between the bone components. In most cases, the oral surgeon will place an interposition autologous graft between the fossa and remaining portion of the condyle to prevent adhesion or re-ankylosis. One successful graft is a piece of temporal muscle fascia, although other autologous grafts have been used.

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Man grabs his face in pain from his jaw

7 Imaging-Based Diagnostic Tests for TMJ Disorders

1. Jaw Bone Scan with Radionucleotide

Bone scans are utilized to assess bone tissue growth. It is an older technology and less specific technology (2D) than SPECT (3D), but it still has a role in diagnosis of bone scan. After the injection of the nucleotide, a gamma camera is used to capture the radiation emitted by the radiotracer (nucleotide) and generates a representative two-dimensional image of the uptake. This method is used to determine if a TMJ lesion, such as osteochondroma, is still actively growing.

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