Abstract
Patient: A 67-year-old woman presented with a 5-month history of pain in the right maxillary molar; the patient also reported having right occipital pain after boarding an airplane one month prior to the first visit to our hospital. Moreover, she had been experiencing headaches and discomfort since a traffic accident that had occurred 2 years ago. After visiting her family dentist, she received occlusal treatment, splint therapy, and instructions on avoiding tooth contact, but her pain did not improve. At the first visit, pressure pain in the right masseter muscle was induced with referred pain to the right occipital region and the right maxillary molar region. After receiving an explanation of her clinical condition, initial treatment by means of self-care, and information on lifestyle changes, the patient’s pain in the maxillary molar region disappeared, and the occipital pain improved. Goreisan and Zomig （a triptan） were prescribed for the patient’s edema and migraine, resulting in an even greater decrease in her pain level. However, the neuropathic pain was still present; therefore, low-dose pregabalin was prescribed, and her neuropathic pain improved subsequently.
Discussion: This patient presented with concurrent myofascial pain of the masticatory muscle, referred pain in the jaw and the occipital region, neurovascular pain, and neuropathic pain. Self-care, information on lifestyle changes, Goreisan, and low-dose pregabalin were effective in relieving pain in this complicated case.
Conclusion: In this case of complicated chronic pain, suitable treatments for each possible factor resulted in adequate pain control.
