Research
- Oral appliances (night guards, etc.) for TMJ Disorders
Oral appliances which reduce clenching and bruxing (at least temporarily) can be helpful in controlling TMJ pain but the research shows that appliances by themselves are only marginally effective (possibly no more than placebo). Combined with other treatment methods such as physical therapy, acupuncture or medication success rates can be up to 90%. Therefore, it is important that other treatment modalities (to be determined by you and your doctor) be employed at the same time that an appliance is made so that they can work together.
Partial coverage appliances that are so popular now can cause major irreversible changes in the patients bite and TM joint if used long term. Once these changes occur they are difficult to treat. The same is true for the over-the-counter type appliances sold online and at pharmacies. To prevent problems these prefabricated appliances should be avoided but, if used, should only be used short term (1 or 2 months max) and as the research shows, are not very effective without other forms of therapy.
- New Technology for TMJ Diagnosis
Jaw Tracking, Elecromyography, Sonography and Vibratography are some of the latest tools for diagnosing TMJ disorders. Although the instrumentation for these methods have been classified by the FDA and the
- Migraine headaches (NTI oral appliance)
The NTI oral appliance has been approved by the FDA for the treatment of migraine headaches.
- Botox Therapy for Migraine headaches and Facial Pain
Although Botox has been FDA approved for cosmetic purposes and certain movement disorders, its use for pain due to bruxism (tooth grinding), migraine headache and other pain disorders has not yet been fully researched. However, there have been positive reports regarding these uses and many physicians are treating these disorders now with Botox.
Our office has had success in treating severe bruxism, the resulting pain and migraine headaches with Botox. The effects last for 4 to 6 months and can be repeated if the pain returns. Patients must realize that although, there have been many reports of success, there are risks and the procedure is still considered experimental.
- Sleep Disorders
Sleep is very important to our survival and lack of good quality sleep can have severe consequences. Obstructive Sleep Apnea (OSA), a serious medical condition, where people may stop breathing for 10 seconds or more, 5 or more times an hour, has been linked to:
- Heart attack and stroke
- High blood pressure
- Type II diabetes
- Weight gain
- Depression
- Sexual dysfunction
- Cognitive dysfunction
In addition to the above disturbed sleep can cause a variety of other problems including aggravation of pain due to TMJ disorders. In order for painful muscles to recover the body needs a good restful sleep. Studies have shown that inadequate or disturbed sleep may also cause increased clenching or bruxing thus adding to the problem. For patients with disturbed sleep we recommend an overnight sleep study at a sleep center to determine whether or not poor quality sleep is contributing to their pain.
Several studies regarding Slow Wave Sleep (SWS) were discussed recently at the Sleep 2008 conference in Baltimore. SWS occurs in the deepest stages of non-rapid eye movement (NREM) sleep and is often referred to as the rejuvenating part of sleep during which time the pituitary gland secretes growth hormone to enhance tissue repair. Eplivanserin is a promising new medication for improving SWS, as well as treating the type of fragmented sleep found in people with fibromyalgia. It is anticipated to be available sometime in 2009 in the United States. This drug represents a new approach to treating insomnia (rather than sedation being the mechanism).
- Depression
Research over the past 30 years clearly demonstrates that depression and pain are closely linked. Depression can cause pain and pain conditions lasting for 3 months or longer do cause depression. Because of the close link between these two seemingly dissimilar disorders treatment for one can have positive effects on the other. Drugs used to treat depression are also effective in treating chronic pain. One of the newer drugs for depression, Cymbalta, has been shown to be very effective in treating a variety of pain disorders also.
- New Drugs
The following are some of the latest drugs in the treatment of pain disorders. Some of them are available currently but others have not yet been approved by the FDA.
- Xyrem
Drug Class – Sleep agent. Currently approved for the treatment of excessive daytime sleepiness associated with narcolepsy. Estimated to be approved for Fibromyalgia by 2010.
- Reboxetine
Drug Class – Selective NRI antideppresant. Not available for use in the
- Lacosamide
Drug Class – Anti-Epileptic. Expected to be approved in the
- Rotigotine (Neupro)
Drug Class – Transdermal dopamine agonist once daily patch. Approved for treating parkinson’s disease. Approval for treating restless leg syndrome is pending and it should be approved for fibromyalgia around 2012.
- Cymbalta
Drug Class – SNRI antidepressant. Has been available for several years now. Currently approved for the treatment of depression, diabetic neuropathic pain, anxiety, and fibromyalgia. Has also been used successfully in other forms of chronic pain. This is a good drug for those who suffer with TMJ pain due to bruxism and need to take an antidepressant. Unlike some of the other antidepressants (SSRI’s), Cymbalta does not cause an increase in nighttime clenching and bruxing.
- Lyrica
Drug Class – Anticonvulsant. Has been approved for seizures, diabetic neuropathic pain, post herpetic neuralgia and fibromyalgia. Has also been effective in other types of nerve pain.
- Milnacipran
Drug Class – SNRI antidepressant. Expected to be approved for Fibromyalgia in October 2008. Although it has been used for the treatment of depression since 1997 in Europe and
- L-naltrexone and Ibudilast
are two potential agents currently under study for the control of chronic pain. These agents are not associated with the problems of tolerance, dependence, and withdrawal-induced pain enhancement that narcotics produce. They act by blocking the activation of glial cells which release cytokines. These agents in turn can trigger the release of noxious substances that promote more pain and lead to further activation of the glial cells. Glia activation may also alter the concentration of neurotransmitters in the synapses which affect the way neurons function. The glia are also thought to be responsible for the development of analgesic tolerance and withdrawal-induced pain enhancement (caused by narcotics and antidepressants).
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Two other agents Minocycline (a tetracycline antibiotic) and Thalidomide (taken off the market years ago because of birth defects) also quiet glia activity but testing on these drugs is currently not being done.
Drug Class - seratonin antagonist. A promising new drug for the treatment of insomnia expected to be available in 2009 in the US.
please check back soon for more research items
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