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
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
3
Q
what can be used with stretch exercises to facilitate them
A
ethyl chloride spray
4
Q
paraspinalis stretch
A
5
Q
mid trap stretch
A
6
Q
upper trap stretch
A
7
Q
SCM stretch
A
8
Q
masseter and temp stretch
A
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
10
Q
PT with massetter mm pain may involve:
A
- stretching exercises,
- ultrasound,
- topical steroids with iontophoresis,
- deep tissue release,
- vapocoolant
11
Q
splint used for mm pain
A
Stabilization splint
12
Q
Rx options for mm pain
A
- NSAIDs,
- Medrol dose pack (severe pain)
- muscle relaxants,
- sleep medications,
- TCAs,
- local anesthetic injections
13
Q
Behavioral modification of mm pain
A
- stress management,
- cognitive therapy,
- elimination of parafunctional habits
14
Q
Ethyl chloride directions
A
Spray and Stretch
Apply 5 sprays to face 2x per day
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.
16
Q
ethyl chloride rx
A
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
18
Q
Non-opioid Analgesics
A
Acetaminophen (Tylenol)
Ibuprofen (Motrin)
ASA
19
Q
Acetaminophen (Tylenol) dosages
A
325-650mg q4-6h
500mg (ES) 4-6hr
650mg (ER) 8hr
20
Q
Acetaminophen (Tylenol) max dosages
A
3g/day Chronic Pain, 4 for healthy ot
* Hepatic Failure/toxicity
21
Q
IBU dosages
A
400-800mg tid- qid
22
Q
max IBU per day
A
3,2g
23
Q
ASA dosages
A
325-650mg q4h
24
Q
max ASA per day
A
4g
25
Anti-inflammatories/NSAIDs used for mm pain
26
naproxen sodium/naproxen doses
sodium: 275-550
normal: 250-500
27
naproxen sodium/naproxen daily doses
BID
28
indomethacin
p.o. dose
25-50mg
29
indomethacin
p.o. daily dose
BID-TID
30
indomethacin
SR dose
75mg
31
indomethacin
SR daily dose
QD-BID
32
IBU dose
600-800 mg
33
IBU daily dose
BID-TID
34
ketorolac po dose
10mg
35
ketorolac po daily dose
QID
36
# ketorolac IM dose
30mg
37
ketorolac IM daily dose
qd-bid
38
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
39
anti-inflammatory/ Cox-2 Inhibitors
celecoxib
(Celebrex)
40
celecoxib (Celebrex) dosage
100mg
200mg
41
celecoxib (Celebrex) daily dosage
qd-bid
42
Muscle Relaxants intro to mm tx
start with 1 tab
at bedtime
43
# mm relaxants used
* Lioresal (Baclofen)
* Cyclobenzaprine (Flexeril)
* Carisprodal (Soma)
* Metaxalone (Skelaxin)
* Tizanidine hydrochloride (Zanaflex)
* Methocarbamol (Robaxin)
44
* Lioresal (Baclofen)
mm relaxant
45
* Cyclobenzaprine (Flexeril)
mm relaxant
46
* Carisprodal (Soma)
mm relaxant
47
* Metaxalone (Skelaxin)
mm relaxant
48
* Tizanidine hydrochloride (Zanaflex)
mm relaxant
49
* Methocarbamol (Robaxin)
mm relaxant
50
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
51
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**
52
Topical Analgesics advantages with tx
Topical Analgesics: less likely than systemic analgesics to
produce side effects & can treat a variety of painful disorders
53
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
54
topical anesthetics used for musculoskeletal pain
NSAID with muscle relaxants
1% flexeril with10% ketoprofen/10% ibuprofen
1% diclofenac sodium gel(Voltaren) Rx or OTC
55
PT modalities used
Ultrasound
Electrical stimulation
Stretching exercises
Stabilization exercises
56
Alternative Treatments of Musculoskeletal Pain
Physical therapy or Massage (Trigger point release)
Biofeedback/relaxation training or psychotherapy
Acupuncture
57
Stabilization Appliances for Myalgia or Myofascial Pain functions
| 5 total
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
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)
59
Onabotulinum toxin type A (Botox) duration
Therapeutic injections have an average duration of
12 weeks before re-injection is necessary
60
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
61
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)
62
* Lioresal (Baclofen)
* Cyclobenzaprine (Flexeril)
* Carisprodal (Soma)
* Metaxalone (Skelaxin)
* Tizanidine hydrochloride (Zanaflex)
* Methocarbamol (Robaxin)
# mm relaxants used
mm relaxers
