Chronic Pain: Multiprofessional Case Report – New Vision

Case Report

J Dent & Oral Disord. 2018; 4(1): 1083.

Chronic Pain: Multiprofessional Case Report – New Vision

Prada SG¹ and Chilvarquer I²*

¹Private clinic, São Paulo, Brazil

²Radiology Department, Faculty of Dentistry, University of São Paulo, Brazil

*Corresponding author: Chilvarquer I, Radiology Department, Faculty of Dentistry, University of São Paulo São Paulo, Brazil

Received: December 12, 2017; Accepted: January 30, 2018; Published: February 06, 2018


Objective: We present a case of chronic pain with multiprofessional treatment (new vision).

A female patient presented with chronic migraine, myofascial pain with referred pain, muscular and articular TMD, facial asymmetry, joint hypermobility and rebound head, neck and right shoulder blade pain, which have persisted for three years since an accident (whiplash syndrome).The patient is under hormonal control with an intrauterine device. The teeth, Temporomandibular Joint (TMJ) and neuromuscular system were harmonized with occlusal splint therapy (24 hours). A stable mandibular head position was obtained (disc recapture). Orthopedic misalignment (tilted occlusion and pelvis) was treated with rehabilitation and therapeutic insoles, respectively, which controlled body pain. Conclusion: Some cases of myofascial pain and temporomandibular disorder respond favorably to occlusal splint therapy. The patient experienced a better quality of life, almost without pain, for two years and nine months after treatment, although during the last four months, the patient experienced symptoms of depression and anxiety. The Diagnostic Criteria for Temporomandibular Disorders Research (DC/TMD) Axis I, Patient Health Questionnaire-4 (PHQ-4), Graded Chronic Pain Scale (GCPS), and temporomandibular joint resonance were assessed before and after treatment.

Keywords: Chronic pain; Orofacial pain; Quality of life; Neck pain; Temporomandibular joint


TMD: Temporomandibular Dysfunction; TMJ: Temporomandibular Joint; PHQ-4: Patient Questionnaire-4; DC/ TMD axis 1: Temporomandibular Dysfunction Research Diagnostic Criteria; GCPS: Graded Chronic Pain Scale; CR: Centric Relation; MIC: Habitual Maximum Intercuspation; HPI: Mandibular Head Axis Position Indicator; IUD: Intrauterine Device; VAS: Visual Analog Scale; DDC: Disc Displacement with Reduction; DDSR: Disc Displacement without Reduction.

Case Presentation

Clinical record (Figure 1)

DC/TMD axis I [1] pressure upon muscular palpation of 1kg for 5 seconds, [2-4] with a VAS [5] scale from 0 (no pain) to 10 (maximum pain) (Figure 2). DC/TMD (Figure 3).