Pain Management for TMJ? - TMJ Disorder -TemporoMandibular Joint Message Board

Amazon1 · 04-08-2004, 11:10 AM

Hi, I was wondering if anyone else here was currently in Pain Management (PM) for their TMJ? I have been taking Vicopropfen (7.5/200mg) for about 8-months now which was prescribed by my GP and allowed up to 8-a day which I most always need as my TMJ pain is quite severe! I have seen several dentists and one TMJ Specialist who said he could not treat me until I got my pain under control and recently, at the request of my Insurance company, my GP refered me into PM. (Also, I feel he might no longer feel comfortable prescribing my medication)

Today was my first PM apt and after filling out all the forms and talking to the doctors aide (I never even got to see the doctor!), she said that the amount of Vicopropfen I had been taking was too high and was equal to what a cancer patient might be taking and that she didn't think I could continue...then she said they would not even take me a patient until I had an MRI to "prove" that my TMJ pain was valid! Even though I had all my documentation and xrays from a previous apt with a TMJ dentist! The doctor even refused to refill my empty bottle of Vicopropfen after my GP had said to take it with me and that they would take care care of me! When I became distressed about this and asked what I was to do (I didn't want to be in pain NOR go through WDs!!)...she said I could go to the detox center at the hospital for more advice! ( how uncaring and insensitive!!!)

Needless to say, I was very surprised at such treatment but agreed to have the MRI done, took a urine test and told them that I would just call my GP for my usual refill, which I did when I got home and they said that was fine and they would continue until I had the MRI and we would take it from there.

What I am wondering is for those who are in PM due to their TMJ pain, is this standard treatment for a first apt? What kind of pain meds do they usually prescribe for this sort of pain and should I seek out another PM facility if they are not willing to give me something equal to the pain relief I am accustomed to? Any info or advice would be appreciated!
Thanks!
Amazon1

delilah1963 · 04-08-2004, 11:55 AM

Hi, I have gone into PM. My med intake was rather minimal tho...Vioxx, Soma at night and Darvocet for breakthrough pain. I also have some bulging discs in my cervical spine and have had neck pain off and on for years.

I have a wonderful PM doc. He suggested some blocks and epidurals, of which I had two (ESI, facet joint injections, and Occipital Nerve Block)...the first didn't do much, but the 2nd helped me a lot and I was 90+% pain free, but only for about a month. But what a month!!! I feel it creeping back in and now am taking Vioxx, Valium and Darvocet. Going into massage therapy soon. Still can't find a good TMJ spec.

My guess, and you can clarify this on the PM board, is that you need to find another PM doc. Mine, though admittedly not TMJ edcuated, has assured me he will keep me out of debilitating pain using as many modalities, not just meds, but PT, MT, injections, infusions. I love him for that.

You need to jump over to the PM board and ask Shoreline about his wife and what has worked for her. She has TMJ and has had a few things that have worked, including the occipital nerve blocks and robaxin (sp.?) infusions...

Shoreline is going in tomorrow for a procedure, but I'm sure he would be willing to offer up some advice. If you do a search on that board with the words "Shoreline" and "TMJ" I think you'll be able to find his past posts.

Regards and best,
Del.

TiffanyAnn · 04-08-2004, 07:09 PM

Hi Amazon:
I'm so sorry to hear how badly they treated you. I refused to go into pain mamagement for the very reasons you mentioned in your post. It seems they always treat people as if they are drug addicts using them as a pharmacy. It seems so many have become hardened to people's pain and see us all as drug addicts. You might be wise to begin slowly cutting down your pain meds so that you don't find yourself in detox. If you wean yourself down and supplement the ones you do take with something else (I use Excedrin PM to supplement when my meds aren't enough). Of course they don't work nearly as well as the pain meds do but I do what I have to do to get by. I don't want to end up at the mercy of some jerk like the one who treated you so badly today. I realize you are in alot of pain so don't take me wrong. I'm just trying to give you ideas to stretch your pain meds until you get this whole situation figured out. I feel so badly for you that they said you have to get an MRI to prove you have TMJ. Good lord, why would you say you did and why would ANYONE in their right mind put up with being treated they way they treated you if they weren't truly in great pain. Your GP sounds like a really nice person. My internist perscribes my pain meds too. I've been seeing him for a long time now and we have developed some trust between us. As long as I don't abuse the pain meds he continues to give them to me. I appreciate it so very much. I wish you the best of luck and keep us updated on what happens ok.
Hugs,
Tiffany

Kaylbe · 04-08-2004, 10:23 PM

Sadly, this seems to be the mode of operation for certain PM specialists. Most patients are forced to endure several months of "everything else", ie. injections, blocks, PT, etc., before any real efforts are put into treatment with medications. I can only think this may be their way of weeding out drug seekers. How cruel for the majority, I'm sure, who are truly in a desperate amount of pain. --Kaylbe

Amazon1 · 04-09-2004, 01:55 AM

Thanks everyone for your replies!

Delilah, I wish I could get by on the minimal amout of pain meds you take! I did start out taking Vicoden (1 every 4-6 hours as needed), but after several months I asked my TMJ dentist to switch me over to Vicopropfen as I had researched and read that it was easier on the liver and contained Ibupropfen, which I needed anyway for inflamation. Eventually I built up a tolerance and have needed to take 2 instead of 1 and they wear off after 4-hours although I try to hold off for the full 6 in order to stay within the boundaries of what is safe for my liver...I am not allowed to exceed more than 8 within a 24 hour period.

I have tried the Vioxx and unfortunately it never did a thing for me...I have also tried Flexeril, Toridol, Topamax, Neurontin, Ultram...the list goes on...nothing seemed to work as good as the Vicopropfen and a few of those I had bad reactions to and refuse to ever take them again! (The Neurontin especially!)

I was having regular and Trigger point massage once a week which seemed to help some, but have had to stop for awhile as money is tight right now and I was paying for it out of pocket. I am willing to try just about anything (except surgery) to treat my TMJ, but I have to have my pain treated as well or it just won't work! As I read in someone elses post here, maybe it will take several good, caring doctors working together to help me get this TMJ pain under control. I will give this new PM doctor a chance (if I ever even get to see him and NOT his aide!!), but if I don't receive any better treatment than I did today after they get the MRI results back confirming my problem, I will be seeking out another PM clinic! TC!

TiffanyAnn, I had heard alot of good things about PM and how it had helped several "cyber friends" I have, despite some of the things I have read about it on the internet...so I thought it was really the way to go...until today, that is!

It is my Insurance company however, that is pushing me into it, and they told my GP that eventually they will refuse to pay for my pain meds unless I give it a try! My GP is a very caring and kind doctor though and I was assured when I went in upset today that he would still continue to treat my pain and not to worry so much and to just try to take it one step at a time...the ordered MRI being step one. The same thought had occured to me as what you posted...to try to wean myself down to a more "acceptable" dosage before I find myself being "forced" into it! As unpleasant as this sounds to me, you have made a good point and I will have to give it a try...I have never had much luck nor willpower at doing this so please keep me in your thoughts! Thanks and TC!

Kaylbe, I am hoping that after I have the MRI and my pain is proven to be real enough, that the PM specialist will decide to continue my current pain treatment while offering me other options to try along with it to decrease my pain levels...and amount of pain meds needed! But it would be comforting to know that if I cannot succeed, that they will continue to at least treat the pain! My TMJ was "dormant" for almost 20 years before resurfacing after a severe dental proceedure...maybe, in time, it will go "dormant" again? One can only wish!

Thanks again and sorry for the novel!

I'll keep you all posted and I wish you all lots of luck as well with your TMJ!

Amazon1