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face pain > mm disorders and tx pt 2 > Flashcards

mm disorders and tx pt 2 Flashcards

1
Q

potential home care options for mm disorders

A
  • soft diets
  • moist heat
  • ice
  • no gum
  • massage
  • good posture
  • exercises
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2
Q

stretching exercises

A
  • done gently or smoothy no jerking
  • side bend with axial extension
  • rotation with axial extension
  • mid trap stretch
  • masseter and temporalis stretch
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3
Q

what can be used with stretch exercises to facilitate them

A

ethyl chloride spray

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4
Q

paraspinalis stretch

A
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5
Q

mid trap stretch

A
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6
Q

upper trap stretch

A
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7
Q

SCM stretch

A
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8
Q

masseter and temp stretch

A
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9
Q

MANAGEMENT MASTICATORY MUSCLE PAIN: potential options

A
  • 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
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10
Q

PT with massetter mm pain may involve:

A
  • stretching exercises,
  • ultrasound,
  • topical steroids with iontophoresis,
  • deep tissue release,
  • vapocoolant
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11
Q

splint used for mm pain

A

Stabilization splint

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12
Q

Rx options for mm pain

A
  • NSAIDs,
  • Medrol dose pack (severe pain)
  • muscle relaxants,
  • sleep medications,
  • TCAs,
  • local anesthetic injections
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13
Q

Behavioral modification of mm pain

A
  • stress management,
  • cognitive therapy,
  • elimination of parafunctional habits
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14
Q

Ethyl chloride directions

A

Spray and Stretch
Apply 5 sprays to face 2x per day

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15
Q

Masseter/temporalis muscle stretch

A

Hold tongue on roof of mouth (N-
position) and open for 6 seconds,
repeat 6 times. Repeat 6 sets per
day.

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16
Q

ethyl chloride rx

A
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17
Q

Trigger point injection

A

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

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18
Q

Non-opioid Analgesics

A

Acetaminophen (Tylenol)
Ibuprofen (Motrin)
ASA

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19
Q

Acetaminophen (Tylenol) dosages

A

325-650mg q4-6h
500mg (ES) 4-6hr
650mg (ER) 8hr

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20
Q

Acetaminophen (Tylenol) max dosages

A

3g/day Chronic Pain, 4 for healthy ot
* Hepatic Failure/toxicity

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21
Q

IBU dosages

A

400-800mg tid- qid

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22
Q

max IBU per day

A

3,2g

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23
Q

ASA dosages

A

325-650mg q4h

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24
Q

max ASA per day

A

4g

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25
Q

Anti-inflammatories/NSAIDs used for mm pain

A
26
Q

naproxen sodium/naproxen doses

A

sodium: 275-550
normal: 250-500

27
Q

naproxen sodium/naproxen daily doses

A

BID

28
Q

indomethacin
p.o. dose

A

25-50mg

29
Q

indomethacin
p.o. daily dose

A

BID-TID

30
Q

indomethacin
SR dose

A

75mg

31
Q

indomethacin
SR daily dose

A

QD-BID

32
Q

IBU dose

A

600-800 mg

33
Q

IBU daily dose

A

BID-TID

34
Q

ketorolac po dose

A

10mg

35
Q

ketorolac po daily dose

A

QID

36
Q

ketorolac IM dose

A

30mg

37
Q

ketorolac IM daily dose

A

qd-bid

38
Q

H2 blocker use with NSAIDs?

examples

A

 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

39
Q

anti-inflammatory/ Cox-2 Inhibitors

A

celecoxib
(Celebrex)

40
Q

celecoxib (Celebrex) dosage

A

100mg
200mg

41
Q

celecoxib (Celebrex) daily dosage

A

qd-bid

42
Q

Muscle Relaxants intro to mm tx

A

start with 1 tab
at bedtime

43
Q

mm relaxants used

A
  • Lioresal (Baclofen)
  • Cyclobenzaprine (Flexeril)
  • Carisprodal (Soma)
  • Metaxalone (Skelaxin)
  • Tizanidine hydrochloride (Zanaflex)
  • Methocarbamol (Robaxin)
44
Q
  • Lioresal (Baclofen)
A

mm relaxant

45
Q
  • Cyclobenzaprine (Flexeril)
A

mm relaxant

46
Q
  • Carisprodal (Soma)
A

mm relaxant

47
Q
  • Metaxalone (Skelaxin)
A

mm relaxant

48
Q
  • Tizanidine hydrochloride (Zanaflex)
A

mm relaxant

49
Q
  • Methocarbamol (Robaxin)
A

mm relaxant

50
Q

Muscle Relaxant Adverse Effects

A

 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

51
Q

Steroids used with mm pain

A

 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

52
Q

Topical Analgesics advantages with tx

A

Topical Analgesics: less likely than systemic analgesics to
produce side effects & can treat a variety of painful disorders

53
Q

topical anesthetics used for mm/TMJ pain

A

 NSAIDS: Compounded
 10% or 20% Indomethacin
 10% or 20% Ibuprofen
 10%, 15% or 20% Ketoprofen
 3%, 5%, or 10% Diclofenac

54
Q

topical anesthetics used for musculoskeletal pain

A

 NSAID with muscle relaxants
 1% flexeril with10% ketoprofen/10% ibuprofen
 1% diclofenac sodium gel(Voltaren) Rx or OTC

55
Q

PT modalities used

A

 Ultrasound
 Electrical stimulation
 Stretching exercises
 Stabilization exercises

56
Q

Alternative Treatments of Musculoskeletal Pain

A

 Physical therapy or Massage (Trigger point release)
 Biofeedback/relaxation training or psychotherapy
 Acupuncture

57
Q

Stabilization Appliances for Myalgia or Myofascial Pain functions

5 total

A
  1. Provide joint stabilization
  2. Relax the elevator (closing) muscles
  3. Provide stable occlusion
  4. Increases awareness of jaw habits
  5. Alters rest position of jaw to a more relaxed, open position
58
Q

Onabotulinum toxin type A (Botox)

moa

A

 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)

59
Q

Onabotulinum toxin type A (Botox) duration

A

Therapeutic injections have an average duration of
12 weeks before re-injection is necessary

60
Q

Oromandibular Motor Disorders & Facial spasms
treated by onabotulinum A Injections:

A

 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

61
Q

Psychotherapies used for mm tx

A

 Biofeedback (EMG, thermal)
 Relaxation techniques (imagery, muscle contraction/relaxation, deep breathing)
 Cognitive therapy (decrease life stressors, caffeine, alcohol; & coping techniques)

62
Q
  • Lioresal (Baclofen)
  • Cyclobenzaprine (Flexeril)
  • Carisprodal (Soma)
  • Metaxalone (Skelaxin)
  • Tizanidine hydrochloride (Zanaflex)
  • Methocarbamol (Robaxin)
A

mm relaxants used

mm relaxers

face pain (12 decks)

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