Are physios/osteopaths available to med card patients?GP refused me muscle relaxants.

marti8

I was diagnosed 12 months ago with TMJD by a dentist who has since become my regular dentist. Using an occlusal splint at night for the last 6 months but at the weekend I woke up in pain all around that area of the right side of my face. It's now painful when I open my jaw too much, chewing, if the lefthand side of my face is pressed, if my chin/lower jaw is pressed, yawning and there's a constant dull pain. And a constant pressure by my right ear. My dentist has told me to stop using the splint at night.

Been asking around and some people are telling me it might be good for me to see an osteopath or a physiotherapist. I'm a mature student and have a medical card. Was at my soon to be ex-doctor yesterday and explained the TMJD diagnosis, the pain I now have etc etc, I asked if it was possible that I had osteoarthritis in that joint now and he said I could have. I asked how would a diagnosis be made as to whether I had osteoarthritis and he said an MRI or xray or something, I asked shouldn't I be referred for one, eh, nah, no point was his response. Suffice to say I am moving doctor.

I was given painkillers yesterday called Ixprim (a variant of Tramadol) which made me very ill, that doctor is changing me to 500mg Ponstan from today. Despite needing a muscle relaxant as is commonly prescribed to patients with TMJD pain and possibly even to patients with osteoarthritis he refused to prescribe any as I have a history of depression and according to him muscle relaxants can affect the brain and there's the potential for a negative reaction. While that might be all very true, I feel that a definite takes precedence over a potential - and I am definetly in pain and I definetly need muscle relaxants for my jaw and tm joint. Moving doctor anyway. Anyway just wondering, are there physiotherapsits and osteopaths to which a GP can refer a medical card patient?

I also have other conditions: asthma, allergic rhinitis, GERD, depression, possible ADHD (being assessed in November), possible "personality disorder", short term memory issues, non-stop tinnitus most likely caused by the TMJD and slightly reduced hearing according to an audiologist. I take Nexium, Amitriptyline, Ventolin, Seretide, Singulair, Flixonase and from today Ponstan in place of Ixprim (Tramadol) Thanks.

Oral Surgeon

Maybe you should ask on Dental Issues??

marti8

Oral Surgeon wrote: »

Maybe you should ask on Dental Issues??

Funny Banned from that section for being too critical and expressive :rolleyes: Anyway, TMJD spans a number of areas not only dental or maxilofacial. Especially as I may have osteoarthritis of that tm joint. As far as I can tell med card patients can be referred to physios but of course with waiting lists you'd never konow how long you'd be waiting. So, will have to depend on painkillers to deal with it for now, possibly for always. Oh well.

davo10

are you certain you have osteoarthritis?, what are the symptoms and how do they differ from TMJ disorder?, what is the differential diagnosis and what other pathological conditions could it be?, how is this your "soon to be exDoctor's" fault?, it definately sounds like a dental problem to me.

marti8

davo10 wrote: »

are you certain you have osteoarthritis?, what are the symptoms and how do they differ from TMJ disorder?, what is the differential diagnosis and what other pathological conditions could it be?, how is this your "soon to be exDoctor's" fault?, it definately sounds like a dental problem to me.

Nope, not sure that I have osteoarthritis at all. The only way that can be diagnosed is by having an xray and if that is inconclusive by having an MRI. My former doctor said I may have it. The difference between OA and TMJD pain? Not sure as I never had TMJD pain. I was diagnosed with TMJD 12 months ago but have never had an xray or MRI of the tm joint. The pain only started a week ago.

As for my now former doctor? Well, he refused to refer me for an xray or MRI to establish whether I have osteoarthritis even though he said I may have it. "Arthritis Ireland" state that the first step to diagnose arthritis is an xray.

From what I can see the only way to accurately confirm whether I have osteoarthritis of the tm joint or not is to have an xray or MRI of the tm joint. And all the literature I've read backs this up. While to you it may sound like a dental issue, one way to establish that it isn't OA is to have an xray and if required an MRI done.

This is the same former doctor who in his wisdom decided that I didn't need a chest xray either despite the fact that I have asthma, had a bronchial infection last summer and another bronchial infection 2 weeks ago from which I am still recovering. This is the same doctor who didn't suggest I needed further antibiotics as augmentin and steroids didn't fully shift my bronchial infection. My new doctor said I need both, more antibiotics and a chest xray. I am now on Ciprofloxacin - a rather heavy duty antibiotic compard to Augmentin from what I can establish and I am getting a chest xray in a few days time.

An article on Osteoarthritis of the Temporomandibular Joint

sam34

davo10 wrote: »

it definately sounds like a dental problem to me.

please avoid suggesting potential diagnoses/causes

Susie564

I was put on a muscle relaxant for a while and they were of no help whatsoever. I wouldn't be looking to be put on themif I were you. They're extremely addictive & not suitable for long term use anyway.

marti8

Susie564 wrote: »

I was put on a muscle relaxant for a while and they were of no help whatsoever. I wouldn't be looking to be put on themif I were you. They're extremely addictive & not suitable for long term use anyway.

Thanks for that. I know different people can react differently to different medications. For example I nearly collapsed, quite literally, after taking just 2 Ixprim pills (a variant of Tramadol) whereas for others they could just the thing. While muscle relaxants didn't help you, that doesn't mean they won't help me. But I see what you are saying alright. I know many meds are addictive to varying degrees but pain is pain and can't be simply ignored especially when it starts impacting on your quality of life. So I guess it's about weighing up the pros can cons of giving or not giving any particular drug.

Even the ever popular Ponstan that I'm on now has side effects even including potential renal failure if taken over the longer term as far as I know. But if you need painkillers you simply need painkillers. Although if the pain doesn't abate (fingers crossed it will, fingers crossed I don't have osteoarthrits at all) I'll probably need to be moved onto a different type of painkiller. Seems my system can't handle opioid like/opioid based painkillers so will have to see what else could be prescribed. But who knows maybe things will improve.

Did the condition for which you required muscle relaxants improve?

Susie564

Unfortunately not, but I am taking different meds now which are working mostly and are appropriate for long term use. I wouldn't suggest that anyone should put up with any pain condition. Just that muscle relaxants didn't work for me and I've been told that they're not really suitable for TMJ related pain since then. There are lots of options for pain relief and I had to try a few before I found one that works for me. I’m sure you’ll be the same.

marti8

Susie564 wrote: »

Unfortunately not, but I am taking different meds now which are working mostly and are appropriate for long term use. I wouldn't suggest that anyone should put up with any pain condition. Just that muscle relaxants didn't work for me and I've been told that they're not really suitable for TMJ related pain since then. There are lots of options for pain relief and I had to try a few before I found one that works for me. I’m sure you’ll be the same.

So the meds you are on now don't have any serious negative effects? That's good. From other forums I know that a lot of people with TMJD are on muscle relaxants. Would be great if I really don't need them, the last thing I want to do is have to start taking another bloody pill. I know some people with TMJD get botox injections into that area. Sounds a bit extreme to me but I guess it really depends on how bad the pain is. I've heard of one painkiller called Mobic - or something like that and another called Kappake or something? Well, will see how it goes - was kinda odd that the pain only started when I was sick with bronchitis and flu, maybe just bad timing or maybe the bacterial or viral infection triggered something. I'm no doctor so hard to know! Do you use an occlusal splint for TMJD? Ever try or hear of a mandibular repositioning splint?

Will be seeing an oral surgeon in a couple of weeks so will ask about one of them. Was using an occlusal splint but my dentist said stop using it when I told him about the pain. If the pain continues, and if it's osteoarthritis it probably will, hopefully the doctor will be able to prescribe me a longer term painkiller that won't screw with mysystem too much.

Hal Emmerich

To long, didn't read all this Thread, Answer to your Medical Card question is Yes. Physios are available.

GERD is probably connected to diet, something doesn't agree with you that your eating. Try sticking to this Food list (Limited Diet) for awhile and see if it bothers you.

Take up running if you are able for the other stuff, you'd be surprised how it can help to clear the head if you can stick at it.

Oral Surgeon

Hal Emmerich wrote: »

Take up running if you are able.

Good advice, para-gliding is also very good

Hal Emmerich

Oral Surgeon wrote: »

Good advice, para-gliding is also very good

Where do you do that?

marti8

Hal Emmerich wrote: »

To long, didn't read all this Thread, Answer to your Medical Card question is Yes. Physios are available.

GERD is probably connected to diet, something doesn't agree with you that your eating. Try sticking to this Food list (Limited Diet) for awhile and see if it bothers you.

Take up running if you are able for the other stuff, you'd be surprised how it can help to clear the head if you can stick at it.

ENT have said I have GERD, I'm just accepting what they said - never had what's informally called a "scope test" (camera down into the gut although I did have a camera up my nose!) Was supposed to yeasr ago but chickened out. Might look into getting one done. I guess ENT are pretty much going on what I tell them, bad indigestion (before taking Nexium), that's cleared now, vomitting, again cleared since taking Nexium. A former doctor at the surgery I've just moved from referred me to ENT to try and diagnose what was making me so bunged up all the time - blocked nose, sniffling, clearing my throat all the time etc - ENT believe its due to GERD, acid reflux. So, to deal with that they put me on Nexium. What actually caused the GERD, I'm not to sure. Could be diet I guess although my diet has been pretty consistent over the years yet GERD only started a few years back.

Running? I use to cycle before but not very much. Bought a nice bike with the best of intentions but after a few weeks kinda dropped off. Sitting in the shed these days. Joined a bloody expensive gym too but let that slide also. Bought a home gym but ended up selling it. My exercise basically consists of taking the doggie for a walk but with even that it's my better half who usually does it. Thanks anyway.

And don't mind the para-gliding remark from yer (wo)man, I'm sure that individual would like me to go parachuting without a parachute

Btw, took a quick look at the food list, I do take probiotics daily - L.acidophilus capsules. Also take some other vitamins and supplements: spirulina (an algae), fish oil, magnesium, kelp (source of iodine), vitamin b6, vitamin c, vitamin a & d3 and a vitamin e complex. Also take Pau D'arco (Tabebuia), White Tea, Cascara Sagrada and caffeine pills sometimes though not so often.

Susie564

marti8 wrote: »

So the meds you are on now don't have any serious negative effects?

That's what I'm told anyway - on them since March and no problems so far.

marti8 wrote: »

From other forums I know that a lot of people with TMJD are on muscle relaxants.

I read that too but they did little for me. And I've since been advised otherwise by other medics. Like you say it may work for you, but just be careful. You're already taking a lot.

marti8 wrote: »

I know some people with TMJD get botox injections into that area.

I've read that there is little evidence to support it's efficacy in the treatment of TM problems, other than that I know nothing.

marti8 wrote: »

I've heard of one painkiller called Mobic - or something like that and another called Kappake or something?

Been on both Kappake is goooood for pain relief but not good for long term use. The dizziness was quite unreal. Mobic was also good but after 3-4 months they started to affect my stomach quite badly.

marti8 wrote: »

Do you use an occlusal splint for TMJD?

Yes, like you I was wearing at night time but the maxfax told me to only wear it for 1-2 hrs in the evening as my jaw isn't opening wide enough or smth to that effect.

marti8 wrote: »

Will be seeing an oral surgeon in a couple of weeks

I think this is defo a good idea.

You say you've only had pain for a week? I'd relax and try not to worry too much about osteoarthritis and such like. You said you hadn't been well - maybe it will settle of it's own accord. I do think a trip to a specialist is a good idea though.

Hal Emmerich wrote: »

Take up running if you are able for the other stuff, you'd be surprised how it can help to clear the head if you can stick at it.

Funnily enough I think it was starting jogging which triggered off my pain in the first place. Not that I'm suggesting that it caused my problems or anything, but maybe the impact aggravated it????

marti8 wrote: »

referred me to ENT to try and diagnose what was making me so bunged up all the time - blocked nose, sniffling, clearing my throat all the time etc

BTW had all this crap too, ENT diagnosed rhinitis which is total BS in my opinion. Been on every nasal spray/drops, antihistamines, decongestants etc that's on the market.

marti8

Susie564 wrote: »

That's what I'm told anyway - on them since March and no problems so far.

I read that too but they did little for me. And I've since been advised otherwise by other medics. Like you say it may work for you, but just be careful. You're already taking a lot.

I've read that there is little evidence to support it's efficacy in the treatment of TM problems, other than that I know nothing.

Been on both Kappake is goooood for pain relief but not good for long term use. The dizziness was quite unreal. Mobic was also good but after 3-4 months they started to affect my stomach quite badly.

Yes, like you I was wearing at night time but the maxfax told me to only wear it for 1-2 hrs in the evening as my jaw isn't opening wide enough or smth to that effect.

I think this is defo a good idea.

You say you've only had pain for a week? I'd relax and try not to worry too much about osteoarthritis and such like. You said you hadn't been well - maybe it will settle of it's own accord. I do think a trip to a specialist is a good idea though.


Funnily enough I think it was starting jogging which triggered off my pain in the first place. Not that I'm suggesting that it caused my problems or anything, but maybe the impact aggravated it????

BTW had all this crap too, ENT diagnosed rhinitis which is total BS in my opinion. Been on every nasal spray/drops, antihistamines, decongestants etc that's on the market.

For pain all I'm taking is Ponstan. Also on a strong antibiotic called Profloxin (Ciprofloxacin) to try and get rid of an ongoing cough and bronchial infection etc. Then of course there's all the other stuff for GERD, athma, tinnitus etc.

Yeah, seeing an oral surgeon soon, saw her twice already but tha was simply to get an occlusal splint made up. May need to referred to a maxfax specialist but the waiting list is very long from what I know, possible upto 18 months.

I'm only worried about osteoarthritis because my former doctor said that I may have it. Pain isn't as bad today however the right side of my face feels numb with a kind of dull pain and a pressure on my right ear. Anyway, thanks again for your reply and hope things work out for you!