Medication Options for Refractory Pain

In this episode, Dr. Linda Bluestein is joined by Professor Tara Renton, a globally recognized expert in orofacial pain, to explore the nuanced world of facial pain, temporomandibular joint (TMJ) dysfunction, and migraine disorders. Together, they unpack why so many patients suffer from persistent facial, jaw, or head pain despite “normal” scans and what magnetic resonance neurography (MRN) can reveal that traditional imaging might miss. They also dig into local anesthetic reactions, the limitations of pain scales, and how to distinguish between healthy vs. unhealthy pain. .

Takeaways

Professor Renton explains how magnetic resonance neurography (MRN) can detect nerve irritation that typical MRIs may miss, especially in TMJ and facial pain cases.

You’ll hear how migraine-related nerve dysfunction can present as jaw pain, facial burning, or unexplained dental sensitivity without classic migraine symptoms.

They explore how patients with conditions like mast cell activation may react to preservatives or delivery mechanisms in numbing agents, even if allergy tests are negative.

The conversation questions whether traditional 1-to-10 pain rating tools capture the lived experience of chronic nerve or facial pain and what alternatives might help.

Dr. Bluestein and Professor Renton discuss how to recognize pain that signals normal healing versus pain that points to long-term nerve dysfunction or central sensitization.

Find the episode transcript here.

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