I am sorry for your prolonged and persistent treatment.
Following would be the treatment protocol for TMJ;
1) Tylenol; acetaminophen
2) Anxiety reducing medicines; called as anxiolytics, will need prescription for it.
3) Non-steroidal anti-inflammatory drugs
5) Muscle relaxants
B. Psychological interventions
1) Cognitive behavior therapy (CBT)
2) Relaxation techniques
3) Stress management
C. Alternative therapies
D. Physical therapy modalities
1) Transcutaneous electrical stimulation
5) Superficial and deep heat
6) Therapeutic exercise; like Lateral jaw movement, Protrusive jaw movement, Tongue-up exercise, Resisted opening, Resisted closing.
Eustachian tube dysfunctions can be helped by Valsalva maneuver (positive pressure against a closed nasal airway); usually equilibrates pressure in the middle ear to the outside and can be helpful if done 5-7 times in a day.
The treatment of fibromyalgia is comprehensive and a single guideline for an individual is difficult to make. The treatment has to be individually tailored among these;
1) Aerobic exercise; low-impact aerobics, walking, water aerobics, stationary bicycle.
2) Heat, massage, and other treatments like sauna, hot baths and showers, hot mud, and massage.
3) Trigger-point injections,
5) Chiropractic manipulation,
6) Myofascial release
7) Neural pulse stimulation (CNP) device
8) Cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT)
9) Relaxation training and biofeedback
10) Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen
11) Opioid analgesics (hydrocodone, oxycodone, fentanyl, morphine),
13) Estrogen receptor modulator raloxifene
14) St. John's wort, ginseng, valerian, botanical oil, melatonin, magnesium, dehydroepiandrosterone
A combination of above is tried for an individual to relieve the symptoms.
The goal of fibromyalgia treatment is to improve the physical and mental health and quality of life. This goal implies helping manage distressing symptoms, but with decreased dependence on the medical care system. The common recommendations of education, exercise, and pharmacotherapy are often appropriate. Comorbid conditions, such as arthritis and obesity, should be treated because they can contribute to increasing physical and mental symptoms. In fibromyalgia; you are best person to guide your physician, as there are no set rules or standard of protocol which can be effective. The treatment which have been best and efficacious for you in past can be repeated. Because medical therapy is unsatisfactory, patients find their way to alternative therapies. Some of these therapies may be helpful to individual patients, such as massage, water therapy, spa treatment, and acupuncture. So, your decision to choose them supersede the physician's recommendations. The research, in addition to the clinical experience, indicates that the addition of education and a behavioral or cognitive-behavioral component to fibromyalgia treatment protocols is warranted. A combination of the Patient Education, Cognitive-Behavioral Therapy, Relaxation Techniques, and Complementary and Alternative Medicine is suppose to bring the best outcome in quality of life.
For the management of the fibromyalgia using the principles of comprehensive nonpharmacologic pain management represented by the acronym ExPRESS; has been suggested.
1) Ex is for exercise.
2) P is for psychiatric comorbidity, because depression and anxiety disorders are common in chronic pain conditions and contribute significantly to pain and disability.
3) R is for regaining function; this often involves helping patients with activity pacing so that they do not do too much on days when they feel good and do too little on days when they feel bad.
4) E is for education; Web sites hosted by the Arthritis Foundation and the National Fibromyalgia Association are the best education sites.
5) S is for sleep hygiene, which is necessary for many who have developed counterproductive habits.
6) Finally, S is for stress management, which includes any number of elements, such as CBT, relaxation techniques, hydrotherapy, and gentle exercise to name just a few.
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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