Orofacial Pain, SI Joint Pain and TENS

Orofacial Pain, SI Joint Pain and TENS

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Musikamole
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Joined: 02/13/2012 - 2:47pm
Orofacial Pain, SI Joint Pain and TENS

I’ve been living with continuous pain for 22 years, from age 30 to 52.

Orofacial Pain

It started with orofacial pain from a routine dental procedure. I went to the Cedar-Sinai pain clinic, and after many tests, was diagnosed with atypical odontalgia. There is no cure, and most people with this problem respond to tricyclic anti-depressants. That didn’t work, so the pain doctor very reluctantly prescribed Klonopin, for which I have been taking for 22 years. The big problem with Klonopin is that the body develops a tolerance to the drug, so it stops working as good as when I first started taking it. A few years ago, when I couldn’t stand the pain anymore, my neurologist added Cymbalta, which made the pain tolerable again, however, my orofacial pain averages around a 5, which is still too high. I take Klonopin .5 mg t.i.d. and Cymbalta 60 mg q.d.

SI Joint Pain

In my mid-30’s I developed right SI joint pain. The pain travels down the right leg and into the foot. When it gets real bad, I can’t sit or walk, and the pain spreads to my trochanter. I’ve been on temporary disability for the first time, starting in mid – November. X-rays and MRI’s of both my lower spine and hip reveal nothing. Physical exams show point tenderness to the SI joint. Range of motion tests reveal pain in the right trochantor and right hip. Injection of the SI joint did nothing. Physical therapy, including TENS and deep tissue message offers a temporary reduction in pain, sometimes a significant reduction after a physical adjustment, but it never lasts. I am working on stretching and strengthening my core muscles, and just started Yoga.

I am taking Norco (hydrocodone) 10/325, q.i.d. My GP now believes the problem is probably permanent, and prescribed Butrans 20mg for continuous pain, with Norco for breakthrough pain. I am still waiting on my health insurance to approve Butrans.

Question – I’ve been reading about some of the success stories here and elsewhere of people who have benefited from a home TENS unit. During PT, my TENS sessions last for 20 minutes, and the frequency is three times a week, at best. I am very interested in seeing what a more frequent use of a TENS unit can do for my SI joint pain, since I find it relaxing at PT. I am also wondering if it could help with my orofacial pain, which is felt in the jaw, and palate. Is it safe to attach electrodes to the face? Has anyone tried a TENS unit for TMJ? My orofacial pain is pretty much the same as that of someone who suffers from TMJ. For some reason, hydrocodone has never worked for my orofacial pain, even taking 40 mg a day!

Last, my insurance will not pay for the TENS unit that my therapists use, the EMPI Select, which I understand costs $500.00! Will something I find at Amazon for $50.00 even come close to doing the job? If so, any suggestions on brands would be greatly appreciated. Thank You!

This brand, Authentic Ultima 20 Digital TENS Unit! 20 Preset Modes, has gotten 5 star reviews, as an example, and costs $38.00. With what I have shared so far, would a TENS + Muscle Stimulator be even better for my problems?

I am so glad that I found this site. It’s been great, reading the stories of other people, and what they have found that works. It’s encouraging!

Donnabe
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Joined: 05/09/2011 - 7:09pm
I was prescribed a tens unit

I was prescribed a tens unit by my physiatrist. I was sent to a medical supply company and given the "Intensity twin stim III". They charged my insurance company 450 dollars and the insurance company paid them 350. Looking online I can buy that unit for about 75 dollars. Although it is not as good as the unit from PT, it still works well and I love it!! A lot depends on the leads you buy as well. The ones that come with most tens units are not great. I bought some that were a little more expensive (about 5 dollars for 4) and they also work very well.

ACDF C4-5 June 23rd, 2011

Another surgery in the near future. I am 26 years old.

Current Meds- Norco 7.5/325, Cymbalta 60mg, Gabapentin, Adderall 20mg

Musikamole
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Any difference between TENS and EMS?

Donnabe wrote:
I was prescribed a tens unit by my physiatrist. I was sent to a medical supply company and given the "Intensity twin stim III". They charged my insurance company 450 dollars and the insurance company paid them 350. Looking online I can buy that unit for about 75 dollars. Although it is not as good as the unit from PT, it still works well and I love it!! A lot depends on the leads you buy as well. The ones that come with most tens units are not great. I bought some that were a little more expensive (about 5 dollars for 4) and they also work very well.

I’ve heard people talk about getting better electrodes, but not leads. What did you notice with the new leads?

I am pretty sure that I am getting only TENS at PT, but I could be getting EMS as well. The therapists call it STIMS sometimes. Do you feel any difference between the two settings, TENS and EMS? I feel a tingling sensation below the skin. The therapist will set it to either steady or pulse.

Neck of Steel Cindy
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Joined: 06/23/2008 - 10:28pm
I see you're a band teacher

You're a guy I admire very much! I have had children excel in band and in fact, one daughter was her high school band's president. Kudos to you for teaching the young people.

I have 2 tens units. One is an empi brand that I absolutely love. My ultima 5 can't even begin to work as well as the empi. Of course, the Empi was about $700 when new, and the Ultima 5 is about $50, so in this case you certainly get what you pay for. I have used the empi daily for several years, and it is still running strong. The major difference in the two that I feel is that the Utlima seems to bite my skin, no matter which setting I choose. The empi has more settings and also works as a stimulator. It seems to be more effective at relieving my pain, and seems to relax the muscles more. I do keep the Ultima 5 in my car and have used it when I don't have the empi with me. But like I said, the empi wins hands down.

Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!

Musikamole
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Empi Select and Ultima 5

Neck of Steel Cindy wrote:
You're a guy I admire very much! I have had children excel in band and in fact, one daughter was her high school band's president. Kudos to you for teaching the young people.

I have 2 tens units. One is an empi brand that I absolutely love. My ultima 5 can't even begin to work as well as the empi. Of course, the Empi was about $700 when new, and the Ultima 5 is about $50, so in this case you certainly get what you pay for. I have used the empi daily for several years, and it is still running strong. The major difference in the two that I feel is that the Utlima seems to bite my skin, no matter which setting I choose. The empi has more settings and also works as a stimulator. It seems to be more effective at relieving my pain, and seems to relax the muscles more. I do keep the Ultima 5 in my car and have used it when I don't have the empi with me. But like I said, the empi wins hands down.

Thank you for the kind words. I started teaching band and orchestra in 1985 at the high school level, and from 1989 to the present have been teaching 4th - 6th grade students band and orchestra. I've had the good fortune to start thousands of students as beginners in the 4th grade, and have been in the same town long enough to see several go on to start families, even to the point of teaching the children of my former students!

It's too bad that the Ultima 5 causes a "bite to the skin" feel. I have felt that unpleasant sensation in other units many years ago. I've read a few positive reviews regarding one of the Ultima units. I can't afford the Empi Select at $500.00, so I will need to order something less expensive and hope for the best.

Donnabe likes the Intensity twin stim III, so that will be one to take a closer look at.

Thanks again for the post. smiley

JulieA
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Joined: 06/26/2008 - 1:02am
Musikamole

My empi was billed to my insurance for $2500.00 smiley I use it alot.

I wanted to ask have you had flexion extension x-rays yet? definately something to think about if you have not had them. My lumbar mri's only showed small bulges and complete loss of disk height, but the flexion extenion xrays showed severe retrololothesis (backward slippage of the vertabrae) at L5/S1 otherwise known as instability. Every time i moved or bent over I made it worse. It was near normal when I layed flat or stood straight. I had sciatic pain and very bad (like 8-10) low back pain daily for about 17 months before my lumbar fusion.

Good luck & Feel better smiley

Julie

Musikamole
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Flexion Extension X-rays

JulieA wrote:
My empi was billed to my insurance for $2500.00 smiley I use it alot.

I wanted to ask have you had flexion extension x-rays yet? definately something to think about if you have not had them. My lumbar mri's only showed small bulges and complete loss of disk height, but the flexion extenion xrays showed severe retrololothesis (backward slippage of the vertabrae) at L5/S1 otherwise known as instability. Every time i moved or bent over I made it worse. It was near normal when I layed flat or stood straight. I had sciatic pain and very bad (like 8-10) low back pain daily for about 17 months before my lumbar fusion.

Good luck & Feel better smiley

Julie

Wow! $2500.00 for an EMPI. You must have some super duper model that not even PT places have. lol

To answer your question, I have never had flexion extension x-rays. Never heard of such a thing. I have lived with right sciatica for many years, as well as point tenderness to the right SI Joint, and pain in the right buttocks when I sit. I always need to sit on my left side. For all of these years living with pain, I have never had any problems with my left side. Never. How can this be?

I can feel this pain right now as I type, and I am on 10 mg of Norco 4 times a day. I've been on increasing strengths of hydrocodone, from 5mg, to 7.5mg, to 10mg, since November. I think that I have developed a pretty strong tolerance to this drug already, perhaps because I have been on and off it for 22 years.

I am still waiting on approval for Butrans, but I am not real excited about trying the patch, since I have heard complaints about the patch only working for 5 days, not 7. Plus, it sounds like many people get skin irritations from using the patch.

I would think that a steady dose of some narcotic, like one tablet every 4 hours, might work similar to a patch? I don't know. Right now I am taking the Norco once every six hours, with the idea of always having the drug working in my body.

Maybe I would do better to cut the tablets in half, and take them more frequently, like every 3 hours? I don't know how fast drugs metabolize and go from maximum therapeutic effectiveness to zero, but it's something I would like to learn more about. I want to use Norco, and any future pain drug, as effectively as possible, and especially in a way that will minimize developing a tolerance.

Musikamole
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Update on Chronic Pain Med Butrans

I am posting this update to share what I learn about the drug Butrans.

I just got my first month supply of Butrans 20 mcg. It's a patch, worn once a week. With the discount card, I paid $15.00, and if it works, I pay $15.00 per month for the first year. After the first year, my co-pay will be $45.00, which is higher than my highest co-pay of $30.00. My co-pay for generic drugs is $10.00.

Side Effects - I read on the insert that 23% of those who take Butrans experience nausea, 16% dizziness, 16% headache, 15% application site pruritus, 14% constipation, 14% somnolence (drowsiness), and 11% vomiting. Those are all of the side effects that are higher than 10%.

I am not excited about those percentages, so it will be a wait and see.

My doctor said that Butrans and Hydrocodone are similar in strength, whereas Oxcycodone is a stonger pain killer.

Reading the insert, Butrans is indicated for moderate to severe pain, which sounds pretty strong, more like Oxcycodone.

---

I have two major pain problems, and have been on temporary disability since November 2011, because the low back pain gets severe when I am more active. The hope is that taking Butrans will get me working again.

1. Chronic Orofacial Pain - It feels like a deep muscular ache in my palate and jaw. The pain is continuous and consistent in intensity, about a 3, and has been managed for 22 years with Klonopin with the recent addition of Cymbalta. When I get a head cold, my orofacial pain shoots up to a 5.

2. Chronic SI Joint Pain and Sciatic Pain - The pain is continuous, but can go from mild to severe.

TracyLynne
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Joined: 06/20/2008 - 2:12am
I can SO relate to your story....

I started with low back pain at the age of 23 when I was pregnant with my first son, and was rear-ended a year later, causing more complicated low back pain. My right SI joint has a lot of inflammation in it, and there is arthritis all through L4 to S1, which causes me a LOT of grief; I am on two medications that should ease the inflammation, but often it is only a course of prednisone that will actually knock it down. I have also had prolotherapy, four rhizotomies and cortisone injections into the SI joints, all of which have helped temporarily.

I also suffer from orofacial pain, most of which is related to TMJ (I have arthritis in the joint and the disc is dislocated). I have never tried a TENS machine on my jaw; I don't like the idea of having it on my head - it would be wise to do some research before you tried that. I started on Cymbalta at the beginning of December, and I think I am just now seeing some benefit from that, as the facial pain seems to have eased off a little bit. I just looked up your condition, and interestingly enough, I have one molar that gives me a lot of pain, though it has had two root canals and has been crowned. X-rays show nothing out of the ordinary, but it is painful to even tap.

I have a very inexpensive muscle stim machine (very similar to TENS) that I have used for about 8 years, and it is great for temporarily settling down my low back/SI pain sometimes....not always, but sometimes....

I wish you luck in finding some relief. There will be a lot of support for you here on this forum, so keep posting!

Tracy