mm disorders and tx pt 2 Flashcards
potential home care options for mm disorders
- soft diets
- moist heat
- ice
- no gum
- massage
- good posture
- exercises
stretching exercises
- done gently or smoothy no jerking
- side bend with axial extension
- rotation with axial extension
- mid trap stretch
- masseter and temporalis stretch
what can be used with stretch exercises to facilitate them
ethyl chloride spray
paraspinalis stretch
mid trap stretch
upper trap stretch
SCM stretch
masseter and temp stretch
MANAGEMENT MASTICATORY MUSCLE PAIN: potential options
- PHYSICAL THERAPY
- SPLINT THERAPY
- TRIGGER POINT INJECTION
- MUSCLE RELAXANTS
- NSAID’s
- REST (soft/liquid diet x 2 wks)
- HEAT/ICE THERAPY (10 min. 2x/day)
- ELIMINATE PARAFUNCTIONAL HABITS
PT with massetter mm pain may involve:
- stretching exercises,
- ultrasound,
- topical steroids with iontophoresis,
- deep tissue release,
- vapocoolant
splint used for mm pain
Stabilization splint
Rx options for mm pain
- NSAIDs,
- Medrol dose pack (severe pain)
- muscle relaxants,
- sleep medications,
- TCAs,
- local anesthetic injections
Behavioral modification of mm pain
- stress management,
- cognitive therapy,
- elimination of parafunctional habits
Ethyl chloride directions
Spray and Stretch
Apply 5 sprays to face 2x per day
Masseter/temporalis muscle stretch
Hold tongue on roof of mouth (N-
position) and open for 6 seconds,
repeat 6 times. Repeat 6 sets per
day.
ethyl chloride rx
Trigger point injection
Trigger point injection using 1% Lidocaine
without vasoconstrictor - may require repeat
injections 2-3 x to inactivate trigger points
finger placed to locate TP, may spray to numb before shot
Non-opioid Analgesics
Acetaminophen (Tylenol)
Ibuprofen (Motrin)
ASA
Acetaminophen (Tylenol) dosages
325-650mg q4-6h
500mg (ES) 4-6hr
650mg (ER) 8hr
Acetaminophen (Tylenol) max dosages
3g/day Chronic Pain, 4 for healthy ot
* Hepatic Failure/toxicity
IBU dosages
400-800mg tid- qid
max IBU per day
3,2g
ASA dosages
325-650mg q4h
max ASA per day
4g
Anti-inflammatories/NSAIDs used for mm pain
naproxen sodium/naproxen doses
sodium: 275-550
normal: 250-500
naproxen sodium/naproxen daily doses
BID
indomethacin
p.o. dose
25-50mg
indomethacin
p.o. daily dose
BID-TID
indomethacin
SR dose
75mg
indomethacin
SR daily dose
QD-BID
IBU dose
600-800 mg
IBU daily dose
BID-TID
ketorolac po dose
10mg
ketorolac po daily dose
QID
ketorolac IM dose
30mg
ketorolac IM daily dose
qd-bid
H2 blocker use with NSAIDs?
examples
Prescribe an H2 blocker with the NSAIDs if use will exceed 2 weeks or if GI symptoms develop. This will inhibit gastric secretion and serve to protect from GI side effects.
Examples:
Prilosec (20mg) 1 tab q d- OTC
Nexium (40 mg) 1 tab qd
anti-inflammatory/ Cox-2 Inhibitors
celecoxib
(Celebrex)
celecoxib (Celebrex) dosage
100mg
200mg
celecoxib (Celebrex) daily dosage
qd-bid
Muscle Relaxants intro to mm tx
start with 1 tab
at bedtime
mm relaxants used
- Lioresal (Baclofen)
- Cyclobenzaprine (Flexeril)
- Carisprodal (Soma)
- Metaxalone (Skelaxin)
- Tizanidine hydrochloride (Zanaflex)
- Methocarbamol (Robaxin)
- Lioresal (Baclofen)
mm relaxant
- Cyclobenzaprine (Flexeril)
mm relaxant
- Carisprodal (Soma)
mm relaxant
- Metaxalone (Skelaxin)
mm relaxant
- Tizanidine hydrochloride (Zanaflex)
mm relaxant
- Methocarbamol (Robaxin)
mm relaxant
Muscle Relaxant Adverse Effects
Dizziness
Drowsiness
Lightheadedness
Paradoxical stimulation
Abdominal pain
Nausea
Vomiting
Headaches
Nervousness
Uticaria
Hypotension
Blurred vision
Fatigue
Dry mouth
Constipation
start with lowest dose at bedtime
Steroids used with mm pain
Medrol dose pack (4mg)- as directed, 6 tabs day one then one less each day
Methyl prednisone 30-40mg qd for 3-4 days then taper by 10mg q 3-4 days
until discontinued
Prescribe for patients with **moderate to severe pain **and no resolution of pain occurred with NSAIDs
Topical Analgesics advantages with tx
Topical Analgesics: less likely than systemic analgesics to
produce side effects & can treat a variety of painful disorders
topical anesthetics used for mm/TMJ pain
NSAIDS: Compounded
10% or 20% Indomethacin
10% or 20% Ibuprofen
10%, 15% or 20% Ketoprofen
3%, 5%, or 10% Diclofenac
topical anesthetics used for musculoskeletal pain
NSAID with muscle relaxants
1% flexeril with10% ketoprofen/10% ibuprofen
1% diclofenac sodium gel(Voltaren) Rx or OTC
PT modalities used
Ultrasound
Electrical stimulation
Stretching exercises
Stabilization exercises
Alternative Treatments of Musculoskeletal Pain
Physical therapy or Massage (Trigger point release)
Biofeedback/relaxation training or psychotherapy
Acupuncture
Stabilization Appliances for Myalgia or Myofascial Pain functions
5 total
- Provide joint stabilization
- Relax the elevator (closing) muscles
- Provide stable occlusion
- Increases awareness of jaw habits
- Alters rest position of jaw to a more relaxed, open position
Onabotulinum toxin type A (Botox)
moa
Potent neurotoxin that inhibits acetylcholine (ACh) on both afferent & efferent motor nerves
Weakens painful muscles & inhibits muscle contractions
Interrupts pain cycle & may block peripheral neurotransmitters (i.e. Substance P, glutamate, & calcitonin gene-related peptide (CGRP)
Onabotulinum toxin type A (Botox) duration
Therapeutic injections have an average duration of
12 weeks before re-injection is necessary
Oromandibular Motor Disorders & Facial spasms
treated by onabotulinum A Injections:
Severe bruxism
Hypertrophy of masseter/temporalis
Secondary muscle spasm (i.e.radiation, multiple sclerosis,amyotrophic sclerosis, scleroderma)
Hemimasticatory spasm
Dystonia
Tongue hyperactivity
Motor tics
Palatal myoclonus which may cause tinnitus
Sialorrhea (i.e. ALS)
Hemifacial spasm- CN VII (synkinesis
Psychotherapies used for mm tx
Biofeedback (EMG, thermal)
Relaxation techniques (imagery, muscle contraction/relaxation, deep breathing)
Cognitive therapy (decrease life stressors, caffeine, alcohol; & coping techniques)
- Lioresal (Baclofen)
- Cyclobenzaprine (Flexeril)
- Carisprodal (Soma)
- Metaxalone (Skelaxin)
- Tizanidine hydrochloride (Zanaflex)
- Methocarbamol (Robaxin)
mm relaxants used
mm relaxers
