Temporomandibular Disorders by Daniel M. Laskin Charles S. Greene & William L. Hylander

Author:Daniel M. Laskin, Charles S. Greene & William L. Hylander
Language: eng
Format: epub
ISBN: 0867154470
Publisher: Quintessence Publishing Co, Inc

Fig 17-1 (a and b) Pain localization by the patient.

There are many descriptors that patients may use to describe the quality of their pain, such as sharp, dull, burning, electrical, aching, etc. Although these descriptors may help the clinician to differentiate muscular pain from, for example, pain of neuropathic origin, they are not diagnostic per se.

Visual analog scales are very useful instruments that serve to gauge the intensity of the pain or the level of suffering that patients are or have been experiencing. These scales are the best method available to try to quantify an admittedly subjective and very personal sensory experience. Furthermore, when used sequentially, visual analog scales enable the clinician to measure changes in patients’ perceived pain intensity (eg, the increase or decrease in pain during the course of intervention). Thus, the use of these instruments is highly recommended.

With regard to onset, pattern, and duration, patients should be asked how long the pain or other symptoms have been present, when and under what conditions their complaints first appeared, and the relative course of the pain since its onset. The initial symptoms may have begun in a gradual or spontaneous way, for no apparent reason, or they may have occurred following some specific event such as a long dental appointment. Questions about the pain pattern provide important information about diurnal, constant, episodic and other pain characteristics over time.

Patients should be asked about so-called modifiers, ie, conditions or situations that exacerbate or diminish the pain. A very effective way to obtain this information is by asking patients what makes their pain better and what makes their pain worse. For example, answers such as, “drinking ice water makes the pain go away,” or, “chewing makes the pain worse,” are revealing statements that greatly enhance the process of differential diagnosis. Thus, it is important that the clinician obtain as much information as possible about any factors that may modify the course of the pain condition, including self-help methods and past professional interventions.

Box 17-2 Pain characteristics

Quality

Patient’s description of quality of the pain.

Pain descriptors can include the terms sharp, dull, aching, electrical, burning, etc.

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