A 36-year-old white female was referred to a university pain clinic for evaluation of pain in her jaw and face. Her problem had started eight months earlier as a result of an automobile accident during which she sustained a “whiplash” injury and subsequent neck pain and stiffness. She also suffered from tension headaches. She had been evaluated by doctors with several different specialties, and had undergone neck traction, which produced pain in the teeth, jaws, and TM joints. She was evaluated by a neurologist who ordered CT scans of the head and neck, as well as an EEG. Occlusal splint treatment was started. She had not found any relief for her pain and was considering litigation at this point. As part of her evaluation at the university pain clinic, the patient was given a TMJ Scale, along with a physical examination. The TMJ Scale’s overall score confirmed she had a significant TMJ disorder. Pain and pain on pressing were elevated, as were limited jaw movement and the bite feeling off. No clicking and popping were found during the clinical exam, suggesting that jaw functioning was not impaired, and this was confirmed by the TMJ Scale. The Non-TMJ scale was also elevated, reflecting the tension headaches. X-rays found no evidence of bony abnormalities. The patient reported significant emotional problems, and borderline stress, probably reflecting the result of eight months of searching for a solution for her pain problems. A tendency for chronic problems was revealed, alerting the doctor to the possibility of chronic pain syndrome. It was noted that litigation issues can present problems in managing pain because they may reinforce “illness behaviors,” which may be quite unconscious on the part of the patient. The elevated stress scale suggested that stress may have been contributing to the tension headaches. The overall diagnosis was Myofacial Pain Dysfunction and tension headaches. Comment: This case describes the use of the TMJ Scale in a complex clinical setting, where many different specialists may be called upon to help a pain patient. The test helped to confirm the diagnosis, and suggest that other factors, such as stress and a tendency to chronic illness, may need to be considered.
Published in the Journal of Craniomandibular Practice, Vol. 6, No. 4, pages 339-344, 1988