Creating a referral network for the treatment of craniofacial pain

Patients can feel discomfort without knowing that the underlying cause might have a dental origin. This can include anything from headaches to jaw pain. And with an estimated 45 million Americans complaining about headaches each year–that’s almost 1 out of every 6 people–it is time to take a stand and complete continuing education as a dentist. By better understanding craniofacial pain, how to treat these condition and how to create a referral network, you can be that solution they need for pain relief.  Let’s take a look at the treatment of craniofacial pain and how building a relationship with an appropriate medical professional is important.

Craniofacial pain treatment

There is a large portion of the  U.S. population that is not getting treatment they need to overcome their often debilitating disorders. This has created an incredible need for dentists who understand the neuroanatomical relationship within the cranio-cervical area and how to diagnose common pain complaints in the head and neck. But remember, the treatment of craniofacial pain is a team effort.

This team-based care often includes you, the dentist, an ENT, neurologist, physiatrist, physical therapist and psychiatrist. Each specialist plays a role in the diagnosis and treatment of craniofacial pain. However, it is important for the dentist to understand what physicians do in a diagnostic workup and treatment, as well as when it is necessary to refer out. This helps dentists to better understand their role and to fulfill their duties in patient care, as well as establishing referral relationships across various medical specialties.

Establish a Working Relationship with a Medical Professional

Patients will often find themselves in a neurological, primary care, chiropractic, pain management or an ENT’s office when experiencing craniofacial pain. However, these offices are not always be the best place. For example, undiagnosed TMD may be mistaken for different ailments because this condition can often stump many medical practitioners with the wide variety of a crossover of symptoms patients experience.

A patient might complain of TMJ pain, but in reality they are suffering from a disease or infection of the ear, nose or throat. It is also common for a patient to complain of ear pain, but have the pain really be related to an affected TMJ. When this occurs, patients might be in the wrong medical office seeking treatment, or the clinician is frustrated that their prescribed therapy based on symptoms has not helped in resolving a patient’s complaints.

Whether it is neurological or sinus related, you want your patients to get the best care available, and that means joining forces with other medical professionals. From neurologists and otolaryngologists to family practitioners, it is important to create a working relationship with each medical practitioner in order to discuss or refer for diagnosis and management of your patients when further assistance is needed.

By learning how to diagnose and treat craniofacial pain, dentists gain a great power to change their patients’ lives. With great power comes great responsibility for the proper diagnosis and management of pain in and around the mouth, face and neck.

Comparing chronic migraines with TMD pain, a study

Another study I recently read took at look at chronic migraines and temporomandibular disorder (TMD) pain. The researchers wanted to compare patients with chronic migraines and chronic TMD on disability, pain and fear avoidance factors. While the study didn’t utilize dental offices, they did take a look at a neurology department and a TMD consult in a tertiary care center. There were a total of 50 patients with chronic migraines and 51 with chronic TMD.

Results from this study showed that there were significant differences between those with migraines and those with TMD. However, there were no differences between the chronic migraine group and the neck disability, visual analog scale and kinesiophobia groups. For chronic TMD, the combination of neck disability and kinesiophobia was a significant covariate model of craniofacial pain and disability. For chronic migraine patients, the regression model showed that neck disability was a significant predictive factor for headache impact.

The differences between the chronic migraine group and chronic TMD group were found in craniofacial pain and disability, pain catastrophizing and headache impact. But these groups were found to be similar for pain intensity, neck disability and kinesiophobia.

We can take this study to further help us in treating our patients who are suffering from chronic pain, whether it is due to migraines or TMD. By understanding these relationships, we might be able to take preventive measures or catch conditions earlier in the process.

What other studies are out there that could better guide us in understanding our patients’ pain and discomfort?

The mechanisms of craniofacial pain

A recent journal looked at the mechanisms of craniofacial pain. The researchers worked to highlight peripheral and central adaptations that might promote chronification of pain in craniofacial pain states, including migraines and temporomandibular disorders (TMD). Pain is a common symptom that is associated with disorders of the craniofacial tissues, such as the teeth and their supporting structure, the temporomandibular joint (TMJ) and the muscles of the head.

Most acute craniofacial pain conditions are easily recognized and well managed. However, others, especially those that are chronic such as migraines and TMD, present clinical challenges for dentists and physicians. While the mechanisms of chronic craniofacial pain in patients remains limited, both clinical and preclinical investigations suggest changes in afferent inputs to the brain occur in chronic pain. This results in amplification of nociception, which promotes and sustains chronic craniofacial pain states.

Through an increased understanding of the physiological and pathological processing of nociception in the trigeminal system, we can learn about new perspectives for the mechanistic understanding of acute craniofacial pain conditions. This also helps with the peripheral and central adaptations that are related to chronic pain. We can offer improvements in treatment for chronic and acute craniofacial pain conditions.

What are your thoughts on this? Does this information help improve treatment options for your patients?

Chronic Migraines Worsen Jaw Pain

Headaches and migraines are bad enough, but add jaw pain on top of that and our patients are bound to be miserable. To make matters worse, frequent migraines can actually increase a patient’s risk for developing temporomandibular disorder (TMD), according to a recent study published in the Journal of Manipulative and Physiological Therapeutics. As a result, patients will not only experience migraines, but jaw pain, clicking and even difficulty with chewing.

The connection between migraines and jaw pain

In the study, researchers found that people who experience migraines on 15 or more days of the month were three times more likely to exhibit severe symptoms of TMD. Previous studies suggested there was a link between migraines and TMD, but this current study is actually the first of its kind to study migraine frequency and jaw pain severity.

Of the 84 women in their early mid-thirties that were observed, 32 had episodic migraines and 32 had no history of migraines. TMD symptoms were observed in 54 percent of the women with no history of migraines, 80 of those with episodic migraines and all of the women with chronic migraines.

This is an interesting study because we might not place enough emphasis on this link between migraines and TMD. As dentists, we need to look at all aspects of conditions. If your patients suffer from migraines, it is important to also determine if they have TMD for the best treatment options.