TMJ NEWS

Chronic Pain Evaluation and Management Tool for Clinicians

noreply@blogger.com (Dr. Steve Levitt) — Wed, 01 Oct 2008 23:16:00 +0000

The Chronic Pain Battery™

What is it? A computer scored, paper and pencil, multi-dimensional assessment and management tool for use by clinicians who evaluate and treat patients with chronic or recurrent non-malignant pain.

Who uses it? The CPB was developed for physicians, dentists, psychologists, and specialists in chronic pain evaluation and treatment. Since 1984 it has been employed in university and private pain centers and clinics, hospitals, schools of medicine and dentistry, mental health and rehabilitation centers, industry and private practices. Clinicians frequently use it for consultative, worker’s compensation and disability evaluations.

What does it do? The CPB takes a comprehensive pain history and performs a medical, psychological, behavioral and social assessment, including a psychological screening. It examines the many subtle issues necessary for successful treatment and management. It saves valuable clinical time by collecting, analyzing and integrating the vast amount of relevant information necessary for a thorough evaluation of the chronic pain patient.

Date Collection Methods. Highly diverse data collection and measurement techniques are combined with a logic system built into the scoring program that mimics how a highly trained pain specialist would behave in a similar situation. The information collected, the manner in which it is analyzed, integrated and used, and the diagnostic impressions, formulations and recommendations to act are all designed to exemplify the actions of a well trained clinician. Data collection methods and analysis are designed to detect and minimize inaccuracies through frequent cross-checking for internal consistency, random, confused or non-responding.

When to use it? For evaluation of outpatients and inpatients having chronic or recurrent non-malignant pain problems including headache syndromes, facial and TMJ disorder pain, back or extremity pain whether or not a physical cause has been identified. Often used as part of the initial evaluation of a patient with chronic pain. Useful when a comprehensive assessment is needed and when a guide to evaluation and management is desirable, especially in complex cases. Ideal for disability, worker’s compensation and consultative evaluations involving chronic pain.

Testimonial: “I began using the Chronic Pain Battery over 20 years ago. This instrument is an invaluable tool for both diagnostic impressions and treatment plan development. My clients are looking for ways to assist in their recovery and the CPB gives them concrete steps in the recommendation section.” --Dr. S.A. Edwards Recovery Counselling, Inc Fort Mojave, AZ

Special Features:
An extremely comprehensive, multi-dimensional, bio-psycho-social-behavioral assessment and analysis of the chronic pain patient

Provides both an overview of a patient’s clinical status in all relevant areas in addition to a highly detailed analysis of their symptoms and level of function

Produces key recommendations for further assessment and management

Helps the clinician collect and organize the extensive amount of information necessary to properly evaluate complex pain problems and facilitates treatment and management decisions with specific recommendations.

Combines extensive patient history, relevant immediate information about perception, belief and function with psychological screening data to produce a clear, well rounded and clinically meaningful analysis.

Produces a fully interpreted and clearly written narrative report ready to read and apply.

Clinicians can obtain more information and evaluate the CPB by emailing Pain Resource Center, Inc. at painres@tmjscale.com or going to www.tmjscale.com and selecting Log On and then Register.

Re-testing helps patient and dentist

noreply@blogger.com (Dr. Steve Levitt) — Thu, 25 Sep 2008 02:13:00 +0000

Case Example: Re-testing helps patient and dentist

A 19-year-old female was suffering from TMJ pain and severe bilateral (both sides) headaches of more than three years duration. The pain started after an auto accident, and she did not have any pain before the accident. A neurologist ordered a CT scan after the accident, but it was negative. She had been treated with several medications with no success and was involved in long-term litigation with her insurance companies.

The patient was extremely anxious and nervous during the clinical examination. She was going to be married in three or four months and was concerned whether she could afford treatment.
The physical exam found extreme tenderness over the left TM joint, and in several facial muscles. Jaw opening was restricted, and a click occurs in the left TM joint at 23mm. Severe crepitus was heard in the right TM joint upon movement. The patient had recently completed orthodontic treatment and was wearing an upper removable retainer and a lower bonded retainer. All teeth were present and in good condition. X-rays were normal, showing no bony abnormalities. A diagnosis of trauma-induced bilateral disc location without reduction (the disk is misplaced and does not move upon opening(see Glossary)

The TMJ Scale was given by the dentist to corroborate these findings and to measure the severity of symptoms before treatment. All areas were elevated, except for the bite feeling off and Non-TMJ.

Repositioning splints were placed on the upper and lower teeth and the patient was instructed to wear the upper appliance only at night and the lower one during the day. She was then treated for three months with another type of splint. The patient was checked monthly, and after three months of treatment she said she felt 95-100% better. Another TMJ Scale was administered by the dentist. Some improvement was found, but many of the areas were still elevated. He immediately noted that her answers to the TMJ scale did not agree with her statement that she was much improved. When confronted with this discrepancy, she said that she was to be married in a few weeks, and had not reported some pain and teeth clenching.

Treatment continued and five weeks later she again reported a 95% improvement. She had been married, and the apartment complex she and her husband managed had been burned by an arsonist. A third TMJ Scale was given, and again the results were at odds with her verbal report. She then admitted that she needed a release from treatment to complete a settlement with her insurance carrier.

The patient was advised that it was in her best interest to finish treatment. She consented and within two months she again reported complete relief from pain. At this point she had a 55mm opening (considered normal) and no joint sounds. A final TMJ Scale report which showed most areas below significance confirmed her verbal report and she was considered completed.
Comment: This case demonstrates how the TMJ Scale can be used to monitor treatment progress, and to help the dentist and the patient to determine when treatment should be concluded.

(Published in the Journal of Clinical Orthodontics, 1991)

To see an example of the TMJ Scale Report-Patient Version go to http://www.tmjscale.com/examplereport.html

To read more about the TMJ Scale and how to take the patient version of this test click http://www.tmjscale.com/tmj-scale-description.html

noreply@blogger.com (Dr. Steve Levitt) — Tue, 16 Sep 2008 01:42:00 +0000

Chronic TMJ Pain and Stress

A 21-year-old white female was experiencing chronic facial pain and clicking in the left TM joint that made chewing difficult. Her doctor thought that orthodontic treatment was necessary, even thought the patient had no specific concerns about the appearance or functioning of her teeth. The problem had been present for 8 years. During this time she had multiple adjustments to her bite. An orthodontist constructed an occlusal splint designed to adjust her bite. When that did not bring any relief, she was referred to a pain clinic for evaluation and treatment. During the initial interview, it was discovered that stress made the problem worse. The patient was under considerable stress in work and family environment. She also said that she was sometimes aware that she clenched her teeth.

Her TMJ Scale Report noted significant overall TMJ symptoms and pain, joint noises and functioning problems, limitation in jaw opening and the impression that the teeth did not fit together properly. Emotional factors were not elevated, but a significantly high stress level was found. The report also indicated that clenching and sore teeth in the morning (a sign of jaw clenching and/or grinding during sleep) were found.

The physical examination found facial muscle tenderness, but not the joint clicking she had reported, even when the jaw was forced open to 45mm past the 32 mm that was comfortable to the patient. A diagnosis of MPD brought on by stress and clenching was made, with a minor click due to an anterior (to the back of the joint) disk displacement. The treatments prescribed were physical therapy, biofeedback to reduce stress, and Flexeril, to control pain.

Comment: The TMJ Scale (and the patient) reported joint noises, but the physical examination did not. This is because TMJ symptoms can be intermittent, present one day, but not the next. Because the TMJ Scale asks about recent symptoms, not just symptoms present now, it augments the physical exam and provides data that might otherwise be missed. This case also points out the importance of determining whether stress is an issue, and not just looking for a physical problem, as the patient's doctors first did.

(published in the TMJ Scale Manual 1987)

To see an example of the TMJ Scale Report-Patient Version go to

http://www.tmjscale.com/examplereport.html

To read more about the TMJ Scale and how to take the patient version of this test click

http://www.tmjscale.com/tmj-scale-description.html

Case Study: Sports Injury

noreply@blogger.com (Dr. Steve Levitt) — Sun, 17 Aug 2008 16:42:00 +0000

Example of the role the TMJ Scale can play in evaluation and treatment.

An 18 year old male suffered a facial injury during a basketball game. Shortly after the injury he could not open his left jaw joint and had pain on both sides of his jaw, pain in his ear, and headaches. He completed a TMJ Scale which showed he probably had a TMJ problem, with overall symptom intensity worse than 65% of TMJ patients. The report also indicated he had elevated pain, internal joint problems, and limited jaw opening ability. The Non-TM scale which screens for other non-TMJ disorder problems, was not above average. Also, his score on the Stress Scale was not elevated. He saw a local dentist who specializes in treatment of TMJ disorders and who prepared a soft splint. He wore this splint over his bottom teeth for five months. After that time he only wore the splint during sporting events, as directed by the dentist.

After five months the patient was asked to take another TMJ Scale by his dentist. The second report, according to the dentist, "displays the dramatic improvement reported by the patient." His percentile rank on the Global Scale, which measures the overall symptom intensity of a TMJ disorder, fell from 65% before treament to 8%, and all of the other scale scores were no longer elevated. The dentist also reported that the TMJ Scale demonstrated that treatment had been successful and "provided data to both the patient and insurers that Maximum Medical Improvement had been attained."

(This Case Study was published by: Steed, P.A., Clinical Application of Psychometric Analysis for Temporomandibular Dysfunction. The Functional Orthodontist, 13:32-39, Fall 1996.

To read more about the TMJ Scale and how to take the patient version of this test click http://www.tmjscale.com/tmj-scale-description.html

Case Report: Facial pain is not always "TMJ"

noreply@blogger.com (Dr. Steve Levitt) — Wed, 30 Jul 2008 20:51:00 +0000

Example of the role the TMJ Scale can play in evaluation and treatment.

A 48-year-old married white male was experiencing headaches and facial pain. He had a history of arthritis in his cervical spine (upper spine near the neck). He had been treated with medications, including Sansert and Cortisone. He had seen many doctors, dentists, and chiropractors for his problems, but found little relief. His headaches awakened him from sleep and were accompanied by redness and tearing of the eye and a stuffy, running nose. Drinking alcohol brought on the headaches. He was experiencing a great deal of stress from these problems, and was having difficulty sleeping.

He was given a TMJ Scale to help diagnose his problems.

He was classified as 'borderline' for overall TMJ symptoms, indicating the possible presence of a TMJ disorder. He reported significant pain and pain on pressing the facial muscles and the TM joint. The TMJ Scale Report indicated he did not have significant jaw joint noise or pain, and did not have problems with opening and closing his mouth and the teeth fitting together. This patient did indicate a high level of emotional problems, and his answers indicated he was predisposed to develop a chronic problem. The Non-TMJ problem area was elevated, suggesting that a non-TMJ illness was present.

The TMJ Scale results and a physical examination suggested that the primary problem was not TMJ, but cluster headaches with secondary myofascial pain. A sphenopalatinate block (a local anesthetic administered directly through the nose with a thin rod to a nerve near the sinuses) during a headache completely relieved the pain, confirming that the pain was vascular(related to blood vessels) in origin.

The patient was treated with physical therapy and TENS, transcutaneous electrical nerve stimulation. Two months later he was headache free. There was some 'mild' facial pain and 'moderate' muscle tenderness, but the patient was not concerned and felt he could treat these symptoms with aspirin. A follow-up TMJ Scale showed that lower levels of pain were still present, and non-TMJ disorders were no longer significant.

This case illustrates that facial pain is not always TMJ, and that other non-TMJ factors need to be considered during examinations and diagnosis. The TMJ Scale in this case helped to point out that the patient did not have TMJ.

To read more about the TMJ Scale and how to take the patient version of this test click http://www.tmjscale.com/tmj-scale-description.html

New On-Line Test

noreply@blogger.com (Dr. Steve Levitt) — Sun, 06 Jul 2008 14:19:00 +0000

This is a brief announcement that the Chronic Pain Battery assessment tool is now available for scoring on-line by registered clinicians. http://www.tmjscale.com/

Do you try to cope with chronic pain?

noreply@blogger.com (Dr. Steve Levitt) — Sun, 06 Jul 2008 00:49:00 +0000

Cope With Pain-Parts 1 & 2
by Stephen R. Levitt, MD, PhD
A three hour audio educational program (MP3 format compatible with both PC and MAC) written and narrated by an expert in the field and created for patients with chronic or recurrent pain. A number of years ago, Pain Resource Center produced an audiotape course to teach the essentials for understanding chronic pain and what decisions and actions could be taken by patients with chronic pain to help them better manage this complex problem. Over the years, the information in this course has been used by thousands of chronic pain patients. While the field of chronic pain treatment has progressed in many ways over the years since this program was originally written, the core essentials of this program remain highly relevant today. With this in mind, a decision was made to digitize the original program and make it available as a download for those with chronic pain who now have internet access. This course can help reduce confusion and frustration, improve self-reliance and doctor-patient communication, and lead to a higher quality of life while living with chronic pain. Please visit the website for more information.