Case Study #4

• 38-year-old female, employed as computer systems analyst for large South Florida data company.
• Onset of pain at age 21. Facial pain in left side of head and face but mainly in jaw. Concurrently involved in abusive marriage.
• Treated initially by family doctor with pain medications. No relief.
• Evaluated by orthodontist for possible TMJ syndrome or other dental problem. Four teeth felt to be causing problems. All were extracted. no relief.
• Ends abusive marriage. Pain subsides. Patient remarries.
• Pain gradually returns after 7 years of the original injury. Treated with nonsteroidal medications. Pain subsides.
• Two years later, pain gradually returns to high levels, centering in left jaw, often extending to whole head. Patient under considerable stress at home. Family, financial difficulties lead to loss of home and moving into parent’s house with husband and child.
• Patient continues to work as she is primary source of family income.
• Patient tries applications of heat, ice, plus pain medications with limited and temporary relief.
• MRI indicates vein pressing against fifth cranial nerve. Thought to be possible cause of pain.
• Pain is also suspected to have a behavioral/emotional component. Patient begins treatment with psychologist.
• Pain becomes so severe that patient is hospitalized for three days for intravenous narcotic pain medications.
• ·Admitted to RCPC for evaluation and treatment.
• Diagnosed with unresolved myofascial syndromes of the head and neck muscles plus depression.
• Treated at RCPC for two weeks inpatient and two weeks outpatient.
• Treatment included aggressive physical and occupational therapies, use of modalities, strength and endurance training for activities of daily living and work, instruction in proper body mechanics and energy-saving techniques, psychological counseling both with patient and family, biofeedback and relaxation training for stress reduction.