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 The
Diagnostic Evaluation of Referred Jaw, Temporal, and Facial Pain
Scott R. Greenberg, 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.
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. |
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